Adolescent sexuality and the media

There is growing concern about young people's exposure to sexual content through television and other electronic media and about its potential effects on their sexual attitudes, beliefs, and behaviors. Researchers have documented the growing prevalence of sexual talk and portrayals of sexual behavior in televised media, as well as associations between adolescent viewing patterns and their sexual activities.^{1,2,3,4,5,6,7}

METHODS

We reviewed the current scientific literature on adolescents and sex in the media—using searches of MEDLINE—and the psychological and media literature. The emphasis was on rigorous research and included accessing the expertise of health care professionals and other knowledgeable sources on the media. These sources included the Kaiser Family Foundation, Menlo Park, California; the Center for Media Education (Washington, DC); and professional societies and organizations from medicine, psychiatry, and psychology. The available research does not adequately address the effects of exposure to sexual content in the media on adolescent beliefs, knowledge, intentions, and behaviors. Similarly, research on sexual content of the Internet, in video games or other handheld devices, or in the multitude of other electronic media has been scant.⁷

SEXUALITY IN THE MEDIA

Although sexual content in the media can affect any age group, adolescents may be particularly vulnerable. Adolescents may be exposed to sexual content in the media during a developmental period when gender roles, sexual attitudes, and sexual behaviors are being shaped.¹ This group may be particularly at risk because the cognitive skills that allow them to critically analyze messages from the media and to make decisions based on possible future outcomes are not fully developed.

Analyses of broadcast media content indicate that, on average, teenaged viewers see 143 incidents of sexual behavior on network television at prime time each week,⁸ with portrayals of three to four times as many sexual activities occurring between unmarried partners as between spouses.⁹ As much as 80% of all movies shown on network or cable television stations have sexual content.² An analysis of music videos indicates that 60% portray sexual feelings and impulses, and a substantial minority display provocative clothing and sexually suggestive body movements.¹⁰ Analyses of media content also show that sexual messages on television are almost universally presented in a positive light, with little discussion of the potential risks of unprotected sexual intercourse and few portrayals of adverse consequences.^11,12

Survey data show that adolescents' access to and use of media as sources of information are substantial. In a national study,⁸ high school students reported an average of 2.9 television sets, and 1.3 of 10 (13%) of American children reported living in homes with two or more televisions, 97% had videocassette recorders in their homes, 75% had access to cable television, and more than half had a television set in their own rooms.⁷ Further, more than 80% of adolescents report that their peers find out some or a lot about sex, drugs, and violence from television shows, movies, and other entertainment media.¹³ About 10% of teens acknowledge that they have learned more about the acquired immunodeficiency syndrome (AIDS) from these media sources than from parents, school personnel, clergy, or friends.¹³

ADOLESCENT SEXUALITY AND CONSEQUENCES

Policy makers and health professionals have long been concerned about premarital sexual activity in the teenaged population and the risks of pregnancy and sexually transmitted diseases, including infection with the human immunodeficiency virus (HIV).^14,15 Nationwide, nearly half of all high school students have had sexual intercourse,¹² with African Americans significantly more likely to be sexually experienced (72%) than Hispanics (52%) or whites (47%).¹⁶ Research suggests that even among teenagers who have not experienced vaginal intercourse, substantial numbers engage in other intimate sexual behaviors that carry health risks.¹⁷

Among adolescent girls in the United States aged between 15 and 17 years, 75 per 1,000 become pregnant each year,¹⁸ a rate two to seven times higher than rates in other industrialized nations.¹⁹ Those adolescents (19% of the adolescent population) who report four or more lifetime sexual partners are at greater risk for contracting sexually transmitted diseases, including HIV infection.²⁰ Overall, 25% of sexually active teenagers and 13% of all adolescents between the ages of 13 and 19 become infected with sexually transmitted diseases each year, representing 3 million cases or about 25% of all new cases reported annually.²¹

WHAT WE KNOW ABOUT SEXUAL CONTENT IN THE MEDIA

What we know about the potential effects of televised sexual content on adolescents is based largely on content analyses of media that quantify levels of sexual material and track trends from year to year.^4,22 This work includes studies of network and cable programming,^2,4 rock music and music videos,²³ and R- and X-rated films available on videocassette.²⁴

In addition to content analyses, correlational studies have linked sociodemographic factors (for example, sex, age, and ethnicity) to adolescents' viewing preferences and to their understanding and interpretation of sexual material in the media. Findings indicate that adolescent girls choose network television programs with sexual content more often than do adolescent boys²⁵ and spend more time watching it, often in the company of parents.⁵ Older adolescent boys, however, are more oriented to the hardcore sexual content found in explicit music lyrics and X-rated films.³ They are also more drawn to new media choices like handheld devices, the Internet, and computer games.²² Adolescents of both sexes who watch and listen to a lot of media are more likely to accept stereotypes of sex roles on television as realistic than are less frequent viewers.²⁶

Other research indicates that ethnicity plays an important role in media viewing choices. Compared with their white peers, African Americans spend more time watching television, are more likely to choose fictional programming with African American characters, and are more likely to perceive those characters as realistic.²⁷ Similarly, African American adolescents report watching more R-rated movies than white peers, with less parental involvement or mediation.²⁷ African American and white youths also find different features of video portrayals salient and disagree on story elements.²⁸ Higher rates of viewing by adolescent African American adolescents, especially of soap operas, make them more likely to see sexual content.^26,27 Comparable data are not available on Asian, Latino, or other ethnic subgroups.

Age or stage of development also influences comprehension and interpretation of sexual content. In a study of sexual innuendo on television,²⁹ 12-year-old youths were less likely to understand suggestive material than 14- and 16-year-olds. Similarly, in a qualitative study of adolescent girls aged 11 to 15, those who were at an earlier stage of physiologic development were less interested in sex portrayed in the media whereas more mature young women were intrigued and more actively sought out sexual content in the media as a means of “learning the rules, rituals, and skills” of romance and relationships.³⁰ Specifically, they reported that the media provided models for achieving the “right look” to become popular and attract boys, portrayed teen characters with problems similar to their own, showed how they solved those problems, and gave examples of how to behave in sexual situations. We could not find comparable studies of developmental influences on boys' understanding and interpretation of sexual content.

A few studies have assessed the associations between the degree and nature of adolescent exposure to sexual content and their sexual attitudes and behaviors. A recent study of African American girls aged 14 to 18 years found that teens with either multiple sexual partners or a history of sexually transmitted infections reported a higher rate of viewing television shows that depicted women as sexual objects or prizes.³¹ A few experimental studies have shown that viewing sexual content can have moderate effects on sexual knowledge or attitudes,^29,32,33 but it is unclear whether these effects are sustained over time or result in changes in sexual intentions or behavior. Brown and Newcomer³⁴ found that television viewing patterns differed by the sexual status of the adolescent (virgin versus sexually active), with sexually active teens viewing more television with a high level of sexual content. Determining whether exposure to sexual content encouraged sexual experimentation, or vice versa, was not possible. This is a key unanswered question because of the lack of longitudinal research in this field.

Many theories have been advanced to explain the effects of media on behavior.⁶ They are all based on the fundamental notion that greater exposure to the media leads to the adoption of the values, beliefs, and behaviors that are portrayed, particularly when they are shown to be reinforced or are unaccompanied by adverse consequences. Research on exposure to violent content in the media provides some support for these views.^23,35 Sexual activity, however, may not be learned by observation and modeling in the same way as aggression or violence. Other promising work appears in research on televised alcohol advertising and adolescent drinking.^36,37 Findings suggest that simple exposure to alcohol advertisements does not affect alcohol use. Rather, the effects of alcohol advertisements depend on the extent to which young people like and attend to them. Music and humor are key elements in determining liking and attention. Importantly, this research used statistical modeling that showed that attention to alcohol advertising increases adolescent drinking, whereas drinking does not influence attention to alcohol advertising.

APPROACHES WITH ADOLESCENTS AND PARENTS

Although research lags behind technology, resources are available that support interventions by medical professionals, parents, and others (table 1). Physicians should address preadolescent and adolescent patients' use of electronic media and the Internet, television viewing patterns, and viewing of R- or X-rated movies or videos when taking a thorough medical history to assess for risk behavior and as a mechanism for discussing sexual knowledge and plans.

Table 1.

Resources for further information on adolescents and the media

Author/Sponsor	Title/Publication	Web Address/Telephone
American Academy of Pediatrics	Sexuality, contraception, and the media: Policy Statement. Pediatrics 1995;95:298-300	www.aap.org/policy/00657.html tel: (847) 228-5005
Center for Media Education and Henry J Kaiser Family Foundation	A parent's guide to the TV ratings and V-chip	www.vchipeducation.org tel: (202) 331-7833
Children Now	Research reports on children and the media	www.childrenow.org tel: (510) 763-2444
Talking with kids about tough issues	www.talkingwithkids.org tel: (510) 763-2444
National Center for Missing and Exploited Children and Larry Magid	Teen safety on the information highway (free brochure)	www.safeteens.com tel: (800) 843-5678
American Academy of Child and Adolescent Psychiatry	The influence of music and rock videos	www.aacap.org/publications/factsfam/musicvid.html tel: (202) 996-7300

No guidelines exist on the recommended amount of time that adolescents should spend viewing television or other media. For many parents and physicians, the barometer of overuse is an amount greater than we or our children use the media. The main concern for practitioners should be whether television or other electronic media use is interfering with an adolescent patient's ability to function effectively in other spheres of life. Does media viewing cut into homework time or other recreational activities like athletics or hobbies? Are teenagers absorbed in long hours of solitary viewing or game playing in their bedrooms without supervision or oversight? Are they modeling their behavior on that of performers or dramatic characters? Is this behavior inappropriate or harmful for their age or stage of development? Are adults aware of the media influence? Asking adolescents about their media viewing can give the physician or parent the opportunity to detect any feelings of depression or alienation. The adolescent may reveal unrealistic expectations about physical attractiveness and unhealthy dieting and exercise practices. Suggested areas for inquiry are presented in table 2.

Table 2.

Questions to ask adolescents about their use of the media, issues to address, and concerns

Questions	Issues to address	Concerns
How many hours a week do you think you watch television (and cable television) and videos?	Is use excessive?	Possible interference with other activities
Isolation; alienation; depressive symptoms
How much time do you spend on the computer?	Lack of guidance and/or supervision
Inactivity leading to obesity
How much time do you spend playing electronic games, or with handheld devices?
What are your favorite game(s); website(s); chatroom(s)?	What is the adolescent potentially being exposed to and/or vulnerable to?	Prohibitive cost
Auctions or internet shopping
Ambling
Access to adult material
—sexual content
—political extremism
—violence
—substance use
Interactions with strangers who may take advantage of minors
Who is your favorite character or performer, program(s), or film(s)	Does the adolescent have an unhealthy association or preoccupation with media characters, personalities, or activities?	Inappropriate dress, makeup, speech, or gestures
Violent or sexual content inappropriate to age or stage of development
Excessive attention to weight or body image
—exercise or body building
—disordered eating and poor diet
—use of diet pils, laxatives, etc.
		Desire to relive or reproduce favorite plots or media events involving sex or violence

The importance of supervision and guidance in the media choices of adolescents and their volume of use should be emphasized to parents and concerned adults. Joint viewing or participation may be the best option. When joint viewing is not possible, parents and guardians should be encouraged to take advantage of the television V chip and screening software for computers to reduce inappropriate access. Finally, adults in all areas of adolescents' lives need to help teenagers critically evaluate the media and it's often unrealistic representation of characters, products, behavior, and life situations. Teaching adolescents to be critical consumers of electronic media is the best prevention strategy.

CONCLUSIONS

Simple exposure to sexual content in the media will not make teens deny or ignore values and information they have absorbed from families, school, religious teachings, and other respected adults. Longitudinal studies of young people could provide a better understanding of how sexual portrayals in the media are integrated into adolescents' beliefs about the risks and rewards of engaging in sex and their intention to act on these beliefs. Future research must also take into account the importance of parental involvement in adolescents' use of the media, the degree of adolescents' understanding of the unreal nature of the media, teens' possible identification with fictional characters or highly visible media personalities, the norms modeled by parents and peers, and adolescents' own understanding of the consequences of health risk behaviors.

Summary points

• Adolescents are exposed to many sexual images and messages on television that are almost universally presented in a positive light with little discussion of potential risks and adverse consequences

• Adolescents use the media as sources of information about sex, drugs, AIDS, and violence as well as to learn how to behave in relationships

• Research indicates that adolescent sexuality is associated with media use, but the direction of the relationship is not clear

• Practitioners should address preadolescent and adolescent patients' use of electronic media and the Internet, television viewing patterns, and R- and X-rated movie attendance or video rentals when assessing risk behavior for a thorough medical history

• Parents and guardians should be encouraged to supervise adolescents' media use, take advantage of the “V chip” and screening software to reduce inappropriate access, and help teenagers to critique what they see in the media