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Children, Adolescents,
and the Media: Five Crucial Issues
Victor
C. Strasburger, M.D.
Chief, Division of Adolescent Medicine
Associate Professor of Pediatrics
University of New Mexico School of Medicine
Albuquerque, New Mexico
University of Minnesota Children, Youth and Family Consortium. Permission
is granted to create and distribute copies of this document for noncommercial
purposes provided that the author and CYFC receive acknowledgment and
this notice is included.
Reprint requests to:
Victor C. Strasburger, M.D.
Division of Adolescent Medicine
University of New Mexico
School of Medicine
Albuquerque, NM 87131
ADOLESCENT MEDICINE: State of the Art Reviews--Vol. 4, No. 3, October
1993 Philadelphia, Hanley & Belfus, Inc.
This
instrument can teach, it can illuminate; yes, and it can inspire. But
it can do so only to the extent that humans are determined to use ft
to those ends. Otherwise it is merely wires and lights in a box.
Edward R. Murrow, 1958 (49)
Those
who tell stories hold the power in society. Today television tells most
of the stories to most of the people, most of the time.
George Gerbner, 1992 (16)
Television and other media represent the single most important modifiable-and
neglected-influence on children and adolescents in the 1990s. Although
pediatricians and child psychologists would agree that, overall, parents
constitute the single most important influence in young people's lives,
modifying parental attitudes or improving their standard of living is
no easy task. For teenagers, peers can play a powerful role; but they,
too, are often influenced by the media. Unhealthy attitudes learned
from the media during childhood may be put into action during adolescence,
with adverse consequences. Although there remains considerable controversy
about the media and their effects on human behavior, much information
is already known, either directly through research or intuitively. Physicians
who treat children or adolescents need to acquaint themselves with recent
advances in this crucial area.
ISSUE
NO. 1: HOW MUCH INFLUENCE DO THE MEDIA HAVE?
This
is an issue that many parents would rather not consider. After all,
no parents in their right minds would invite a stranger into their household
to teach their children for 3-5 hours a day, yet television does precisely
that (49). The real questions are (1) what, exactly, is it teaching
children? and (2) are all children equally susceptible?
Television is by far the most significant medium by time criteria alone.
American children and adolescents spend 22-28 hours per week viewing
television--more time than any other activity except sleeping (Table
1) (1). Although adolescents may spend an equal amount of time listening
to the radio (31,35), music is usually used as an accompaniment to homework,
conversations, or even watching television (54).
Given the sheer volume of time that American young people spend with
this medium--15,000 hours by the time they graduate from high school
versus 12,000 hours in formal classroom instruction--one might think
that its influence would be forgone conclusion. Yet, to date, television
remains dismissed by many observers as "mere entertainment" or "fantasy."
Unfortunately, children and adolescents do not view it as either. Perhaps
many adults are quick to dismiss the influence of television because
they do not want to admit that they, too, have been influenced by it.
For children, television represents the real world and gives secret
glimpses of teenage and adult behavior, as enacted by attractive role
models.
The role-modeling aspect of television, although frequently overlooked,
is crucial to understanding its influence (2). Children, in particular,
learn to behave by imitating attractive role models--their parents,
most notably--but those present on all small screen in their living
room as well. Contrary to popular belief, people rarely imitate what
they see in the media immediately and directly. When they do--as when
an Iowa teenager was killed after running in front of a train (imitating
a scene from the popular movie, Stand by Me)--it invariably makes headlines.
Rather, television exerts a far more subtle and insidious effect by
shaping viewers' attitudes and perception of social norms (2, 6). One
group of researchers refers to this as "stalagmite effects--cognitive
deposits built up almost imperceptibly from the drip-drip-drip of television's
electronic limewater" (6). For example, television may offer older children
and younger adolescents scripts about gender roles, conflict resolution,
and patterns of courtship and sexual gratification that they may be
unable to observe anywhere else (47). Heavy consumers of television
may begin to believe that the world is a more violent place than it
really is (15), that violence is an acceptable solution to any problem,
(15, 54) or that all conflicts can be easily resolved within a short
period of time. Similarly, if they watch a lot of soap operas, they
may overestimate the number of sexually active teenagers and the incidence
of extramarital affairs or underestimate the risk of sexually transmitted
disease (55).
Specific areas of influence include:
1.Television violence and aggressive behavior. Over 1,000 studies
and reviews attest to the fact that exposure to heavy doses of television
violence increases the likelihood of aggressive behavior, particularly
in males (Fig. 1) (9, 10, 14, 27). Two official U.S. government reports
have confirmed this: the Surgeon General's Report in 1972 and the National
Institute of Mental Health report in 1982 (40, 57). America's apparent
love affair with guns is frequently played out on prime-time television;
yet the United States leads the Western world in both handgun availability
and handgun death (Table 2) (61). American children are more likely
to be shot than children in any other country, and guns kept at home
are far more likely to kill or injure a family member than an intruding
criminal (43, 61) Homicide and suicide are now the second and third
leading causes of death among teenagers, and guns contribute significantly
to both. Several good studies now link television or newspaper publicity
about suicide with an increase in teenage suicide (17-19, 45). Although
the mechanism of this effect is unknown, role modeling probably plays
a significant role.
2.Commercialization and consumerism. American television is the
most commercially exploitative of any broadcasting medium in the Western
world. Toy manufacturers make an estimated $40 million a year pitching
their products to children who are psychologically incapable of understanding
the intent of commercials and believe that the claims are real (10,
33). Teenagers, on the other hand, are capable of understanding the
sometimes deceptive nature of commercial advertising; they represent
a potential market for manufacturers and producers worth $71 billion
a year (37). In 2250 B.C., the Code of Hammurabi made it a crime punishable
by death to sell anything to a child. In the 1980s, the Reagan/Bush
administration and the al Communications Commission (FCC) made such
practices "business as usual." At the same time, the United States is
the only Western nation that does not insist that its commercial networks
produce at least one hour per day of educational programming for young
people.
3.School performance. Early studies, which failed to control
for IQ and socioeconomic status, showed variable effects of heavy viewing
on school performance. However, more recent, better controlled studies
have consistently documented a significant deleterious effect of more
than 1-2 hours/day of television viewing on academic performance, especially
reading scores (Fig. 2) (52). Such effects probably derive from displacement
of schoolwork and reading for pleasure (Fig. 3).
4.Stereotyping. Children's television is dominated by white male
figures, who represent 75-90% of all characters (3). In addition, cartoons
are rich in stereotypes, with villains usually possessing non-Caucasian
features and speaking in foreign accents (39). For adolescents who are
trying to figure out their place in the adult world, the world of television
is overpopulated with doctors, lawyers, and policemen, giving the mistaken
impression that only professionals have value in adult society (54).
By contrast, old people are underrepresented on American television
and are frequently shown as "feeble grandparents bearing cookies" (15).
A 1988 report also found that teenage girls are stereotypically portrayed
as obsessed with shopping and boys and incapable of having serious conversations
about academic interests or career goals; their looks are important
than their brains (51).
5.Prosocial television. Television can be a powerful prosocial
teacher of children and adolescents. As Sesame Street and Mister Rogers'
Neighborhood have demonstrated, toddlers can learn many valuable ideas
about racial harmony, cooperation, and kindness, as well as simple arithmetic
and the alphabet (44). For older children and teenagers, shows like
DeGrassi Junior High, DeGrassi High, Beverly Hills 90210, Roseanne,
and various afternoon specials have dealt sensitively with such issues
as divorce, teenage pregnancy, drug use, alcoholism, AIDS, and suicide
(Fig. 4).
6.Obesity. Recent evidence implicates heavy television viewing
as one cause of obesity in children and adolescents (10). This may be
because watching television is such a passive activity; because many
unhealthy products are advertised, such as coated sugarcereals; or because
many people tend to snack while viewing television. In addition, the
unhealthy depiction of certain body types (e.g., fat people are represented
and often subjected to ridicule) and the frequent depiction of food
as a bribe may also contribute to the prevalence of eating disorders
(10, 29).
7.Sex and sexuality. In the absence of effective sex education
at home and school, television has become the leading sex educator in
America today. Sex is used to sell everything from shampoo to cars,
yet birth control advertising remains taboo on national network television--despite
the fact that Americans would like to see more responsible sexuality
in programming and approve of airing ads for contraceptives (Tables
3 and 4) (24). American television is extremely sexually suggestive:
the average American teenager views over 14,000 sexual references annually,
of which less than 175 deal responsibly with human sexuality (25). Of
course, the worst offenders are soap operas. Since 1980, the sexual
content of soap operas has increased over 100% (20). Sex between unmarried
partners is 24 times more common than between spouses, and the mention
of birth control or sexually transmitted disease (STD) is still extremely
rare (21, 34). Not surprisingly, American society pays a high price
for its refusal to allow teenagers ready access to birth control: the
highest teenage pregnancy rate in the Western world, despite the fact
that American teenagers are not having sexual intercourse at higher
rates than other teenagers (28).
8.Cigarettes and alcohol. Ironically, American networks refuse
to allow advertising for contraceptives, which would prevent untold
numbers of pregnancies and STDs, yet gladly accept advertising for a
product involved in 25-50% of all adolescent deaths--alcohol. American
youth view between 1,000 and 2,000 beer and wine commercials per year,
and many of the implicit messages are meant to appeal specifically to
them: beer is fun, people who drink beer have more fun and are sexier,
and "real" men drink beer (41, 53). Beer and wine manufacturers spend
$900 million a year advertising, and per capita consumption has increased
50% in the United since 1960 (53). Given these facts, manufacturers'
claims that they are merely trying to "influence brand selection" ring
false. Clearly, advertising increases consumption (56). Sweden, which
banned alcohol ads in the mid-1970s, experienced a 20% decrease in per
capita consumption (42). Although manufacturers are now devising "know
when to say when" campaigns, this has been primarily in response to
the threat of a complete television ban on all beer and wine ads. In
addition, for every such public service announcement teenagers see,
they see 25-50 regular advertisements (53). Sadly, although the Partnership
for a Drug Free America has concocted clever antidrugs ads ("This is
your brain. This is your brain on drugs. Any questions?"), it has never
dealt with either alcohol or tobacco.
Despite the fact that tobacco products were banned on television by
the Public Health Cigarette Smoking Act of 1969 (a later 1986 act banned
ads for chewing tobacco), much inadvertent or passive advertising exists
on television (4, 56). In addition, tobacco manufacturers spend $3.2
billion a year on advertising in print media and promotional campaigns
for their products (8), which kill over 400,000 Americans each year
(38).
ISSUE
NO. 2: ARE ALL CHILDREN EQUALLY SUSCEPTIBLE?
This
is a deceptively difficult question, but the answer appears to be no.
Early studies of effects of televised violence indicated that boys were
far more susceptible than girls (33). But those studies have not been
replicated recently, and there is increasing concern that girls are
now equally vulnerable. Most studies of major television influences,
from sex-role stereotyping to impact of advertisements on drinking or
smoking behavior, have found that heavier consumers of television are
more at risk than infrequent viewers. And recently, several intriguing,
small-scale laboratory and field studies about adolescent sexuality
and the media have shown that:
Teenagers may not be a homogeneous group of viewers. White and black
teenagers interpret Madonna's "Papa Don't Preach" video very differently,
for example. White teenagers were nearly twice as likely to think the
video was about teenage pregnancy, whereas black teenagers considered
it to be a story about father-daughter relationships (5).
"Massive
exposure" to prime-time programming that deals with pre-, extra-, or
nonmarital sex may desensitize young viewers to such "improprieties."
However, several factors can mitigate against this effect, including
a clearly defined value system within the family, an ability to discuss
freely important issues within the family, and active, critical viewing
skills (6).
In a small study of adolescents' interpretations of soap operas, one
researcher found that teenagers' own sexual "schemas" influenced their
perceptions of the characters' relationships (51).
Such studies seem to indicate that parents play a preeminent role in
their children's social learning, but only if the parents' views are
discussed explicitly. Otherwise, the media may "fill in the blanks."
In addition, these studies and most communication experts suggest that
media literacy exerts a protective effect against harmful influences.
Several different types of curricula have been developed for school
use. At Yale, the Singers developed an eight-lesson critical viewing
curriculum for third through fifth graders, designed to teach them how
television programs are produced, how special effects are accomplished,
how television differs from reality, how stereotypes are portrayed on
television, and the unreality of television violence (48). Dorr at UCLA
has developed a similar curriculum (11). Both have been extensively
and successfully filed-tested. In 1983, Huesmann and Eron--two leading
researchers--developed a curriculum to counter some of the adverse effects
of televised violence and implemented successful pilot tests. First
and third graders who completed the program experienced changes in attitudes
about television violence and in their own level of aggressive behavior
as rated by peers (26). More recently, the Center for Media and Values
in Los Angeles has developed a four-session curriculum for parents,
entitled TV Alert: Parenting in a TV Age, and an eight-lesson program
for children, entitled TV Alert: A Wakeup Guide to Television Literacy
(7). Moreover, Home Box Office and Consumer Reports have pioneered a
series of shows, including Buy Me That! and Buy Me That TOO, which teach
children about television commercials and consumerism. Finally, the
Singers have also developed an effective adolescent health education
minicurriculum using five episodes of DeGrassi Junior High with teenagers
and preteens in grades 5-8 (50).
Currently, this is an area of intensive research among communication
specialists and may yield exciting new approaches in the 1990s for mediating
the harmful effects of the media on children and adolescents.
ISSUE
NO. 3: HOW VALID IS THE RESEARCH?
Media
research is not easy to understand, nor is it readily accessible to
the busy average practitioner or academician. In addition, communication
research differs significantly from medical research, especially when
considering the concept of significance. An r value (correlations coefficient)
of 0.3 is moderately significant in social science research, whereas
it would be dismissed as insignificant in most medical research, where
values of 0.8 and above are needed.
The field of media research is a fascinating one because it represents
the attempt to delineate effects of a medium that is ubiquitous--television.
How does one study such a phenomenon when a control group does not exist
anywhere in the Western world (More American households have television,
for example, than indoor plumbing!) Researchers have employed a variety
of creative techniques. The earliest laboratory experiments documented
that children would often imitate what they saw on the television screen,
but these studies were deemed artificial (33). Naturalistic studies
which compared children with television to children without access to
television, were possible until the late 1970s. The last study, which
examined a Canadian town before and after the introduction of television
(with two nearby towns, both with television, serving as controls),
found that children were more aggressive and less creative in their
play, had lower reading skills, and exercised less during the first
two years after television was introduced (60).
Much recent work has taken the form of content analysis--simply counting
up the number of behaviors depicted in television programming over a
unit of time. Such analyses show, for example, that American television
is extremely violent (27), sexually suggestive (22, 25), and rife with
alcohol advertisements (56), alcohol use (58), and sexually violent
videos (46). But these studies document only what is shown, not its
effect on the viewer. To obtain cause-and-effect data, a longitudinal
correlational study is needed: study of a large population over a period
of time to determine if frequent viewers of television are more likely
to be affected than infrequent viewers. This is the "smoking gun" type
of study that the networks demand before being willing to make changes,
but only a few such studies exist in the area of violence and its effect
on aggressive behavior. In a unique, 29-year study, Eron and Huesmann
found that the amount of violent programming viewed in the third grade
was directly related to aggressive behavior at age 19 and age 30 years.
This relationship holds true across national and cultural borders as
well (26).
Of course, practitioners should realize that objections to various programming
and advertising practices can exist on common sense, philosophical,
aesthetic, humanistic, or public health grounds as well as on scientific
grounds (13). Researchers will never be able to deluge 8-year-old girls
with sexy soap operas and ascertain what attitudinal changes have taken
place.
Much research is still needed, but adequate funding continues to be
a major obstacle. Although this is a crucial area of inquiry, not a
single foundation or government agency has taken on television research
as a major funding goal. Possibilities for future research include:
- Funding
of Udry's national study of adolescent sexual behavior, rejected by
the Bush administration because it was considered too "controversial"
(36). This study would have included several questions on adolescents'
use of the media.
- A
large-scale longitudinal correlational study that would help to elucidate
television's effects on consumerism, sex-role stereotyping, racial
attitudes, sexual attitudes and behavior, sexual violence, drug use,
and attitudes about eating and body habitus.
- Updating
of the 1982 National Institute of Mental Health report with a 1996
follow-up report that coordinates all existing data on television's
effects on young people and sets priorities for new research.
ISSUE
NO. 4: WHAT CAN BE DONE TO IMPROVE THE QUALITY OF TELEVISION?
The
quality of television programming for children and adolescents in the
United States is a national disgrace (15). American television is the
most violent, the most sexually suggestive and irresponsible, and the
most commercially exploitative in the world. Other countries-most notably
Great Britain and Japan-have given far higher priority to daily educational
programming for children and adolescents by adequately funding their
public television stations. By contrast, in the United States there
is not a single hour of daily educational programming for children on
any of the four commercial networks (the last such show was Captain
Kangaroo!). The Corporation for Public Broadcasting, which controls
the Public Broadcasting System, is woefully underfunded and, of course,
has to program for adults as well as children. The industry claims that
(1) it is simply giving the American public what it wants and (2) parents
have the responsibility to guide their children's viewing. Although
the latter is certainly true, it is also the industry's responsibility
to produce high-quality, entertaining, socially conscious programming
for young people. Gratuitous sex and violence are unnecessary to ensure
Nielsen or box-office success-witness the popularity of The Cosby Show
or Grated movies like The Little Mermaid, Beauty and the Beast, or Aladdin.
A number of suggestions have been made that would significantly improve
American television:
- An
annual tax on each television set in the United States to help to
endow public television. This is how Great Britain can afford BBC-1
and BBC-2. The tax is approximately $75/set/year.
- Creation
of a separate, commercial-free, educational channel for children-a
Children's Television Network. (Current estimates are that within
the next decade, television programming will be carried into households
via fiberoptic phone lines. Potentially, this could mean hundreds
of available channels. If this is true, at least 10 or 20 such channels
should be reserved for commercial-free, age-specific, educational
channels for children and adolescents.)
- Resurrection
of an activist Federal Communications Commission (FCC). In 1934, Congress
empowered the FCC to regulate the television industry. Under the Reagan
and Bush administrations, the FCC has rolled over and played dead.
An activist FCC would ensure that Americans get the high-quality television
they deserve (and that many Hollywood writers and producers are capable
of creating--Steven Bochco, for example).
- Adoption
of a uniform television industry code that insists on responsible
portrayals of sexuality (Table 5), advertising of birth control products,
avoidance of gratuitous violence, and a willingness to deal with controversial
subjects, particularly health-related ones. Vigorous counterprogramming
campaigns may also be useful (Fig. 5).
- Voluntary
avoidance by the Hollywood community of such unnecessary ploys as
racist, sexist, or violent song lyrics, camera shots that linger on
bullet holes or spurting blood, and graphic depictions of women being
beaten or raped.
- A
ban on beer and wine commercials in broadcast media and a ban on tobacco
advertising in all media (Fig. 6). In addition, other advertising
that targets younger children (e.g., toy or food ads) should be more
strictly regulated by the FCC and the Federal Trade Commission.
Many
of these items are contained in current bills pending in the U.S. Congress,
have been endorsed by the American Academy of Pediatrics.
ISSUE
NO. 5: WHAT IS THE ROLE OF THE PRIMARY-CARE PHYSICIAN?
Parents
and health professionals need to familiarize themselves with what is
on television, to watch television with their children, to exercise
control over how many hours per day are watched, and to understand that
they have the power to effect changes in the media through federal regulations
and legislation.
Practitioners who treat babies can have the most powerful effect, because
the recommendations listed below need to be implemented early, before
1 year of age if possible. Practitioners who treat older children and
teenagers need to take a detailed television history if they see patients
with any of the following problems:
- obesity
- learning
disorders
- aggressive
behavior
- suicidal
ideation
- depression
In
addition, adolescent medicine physicians should be aware of the fact
that a strong preference for heavy metal music has been shown to correlate
with many acting-out or depressive behaviors in adolescence (30, 31).
Specific counseling recommendations for families with children and teenagers
include:
1. Parents should be counseled to limit their children's television
viewing to no more than 1 hour per day. Obviously, alternative activities
must be provided and should be strongly encouraged.
2. Parents need to monitor what shows their children and teenagers are
watching. Ideally, television should not be used as an electronic babysitter.
Nevertheless, if parents want free time of their own, at least they
can use a videocassette recorder with prerecorded or rented tapes of
their own choosing rather then let their young children play "channel
roulette."
3. Parents of teenagers need to realize that they can counteract the
overly sexual or violent nature of much television programming, including
MTV, but only if they watch such shows with their teenagers and explain
their own views (Table 6). Clear explanations of parents' values and
expectations-even if they are conservative ones-are useful and protective
of teenagers against adverse media effects.
Practitioners who are interested in public health or political action
can have a major impact in their own communities by supporting such
legislation and also by serving as a resource for local school programs.
Specific curricula can teach young people how unreal media violence
is, how television is actually made, or how commercials are meant to
sell products without necessarily telling the whole truth; but such
programs need to be "sold" to school administrators. Finally, according
to the Children's Television Act of 1990, passed by Congress, each local
television station has an obligation to produce programming that is
educational for children. Unfortunately, broadcasters are currently
flaunting the will of Congress (e.g. F-Troop teaches teamwork; The Jetsons
teaches children about the future) (12). But local coalitions of parents
and health professionals, challenging television stations as they come
before the FCC for relicensure, may be able to change this sorry situation.
APPENDIX:
IMPORTANT ADDRESSES
Networks
- ABC:
Entertainment President, 2040 Avenue of the Stars, Fifth Floor, Los
Angeles, CA 90067
- CBS:
Entertainment President, 7800 Beverly Blvd., Los Angeles, CA 90036
- NBC:
Entertainment President, 3000 West Alameda, Burbank, CA 91523
- FOX:
President, Fox Broadcasting, P.O. Box 900, Los Angeles, CA 90213
Federal
Communications
- Commission
FCC/ Mass Media Bureau, Enforcement Division, Room 8210, 2025 M St.,
Washington, D.C. 20554
Activist
Groups
- American
Academy of Pediatrics, Committee on Communications, 141 Northwest
Point Blvd., P.O. Box 927, Elk Grove Village, IL 60009-0927
- Action
for Children's Television, 20 University Rd., Cambridge, MA 02138
- Center
for Media and Values, 1962 South Shenandoah, Los Angeles, CA 90034
- National
Coalition on Television Violence, P.O. Box 2157, Champaign, IL 61825
- Parents'
Choice Foundation, Box 185, Newton, MA 02168
- Parents'
Music Resource Center, 1500 Arlington Blvd., Arlington, VA 22209
- Coalition
for Quality Children's Videos, 535 Cordova Rd., Suite 456, Santa Fe,
NM 87501
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