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The evidence that media contribute to child and adolescent behaviour is substantial and can no longer be ignored. Half a century of research shows that the media can have an impact on virtually every concern parents and paediatricians have about children and teenagers—early sexual activity, drug use, aggressive behaviour, suicide, obesity, eating disorders, even attention-deficit disorder and poor school performance.1 Yet the entertainment industry, parents and society as a whole would prefer to think that the media represent harmless entertainment. Here is what every parent and every clinician needs to know about media effects:
Nearly 3000 studies and reviews have found a significant relationship between media violence and real-life aggression.1 Young people learn their attitudes about violence at a very young age, and once learnt, those attitudes are difficult to unlearn.2 3 Conservative estimates from meta-analyses and other studies show that media violence may be causing 10% of real-life violence—not the leading cause by any means, but a significant factor that is worth diminishing if possible.1 4 In addition, new research in the USA shows that just a minute or two of office-based counselling by clinicians about media violence and guns is effective and could impact nearly a million American children per year.5
As with violence, young people learn their attitudes about sex at a young age.1 6 In the USA—which has had a disturbing tilt towards abstinence-only sex education in the past decade—the media have arguably become the leading sex educator of young people.6 There are now five longitudinal studies linking exposure to sexy media to earlier onset of sexual intercourse and one to teen pregnancy.7 8 9 10 11 12 Eight studies now document that giving teenagers access to condoms does not lead to earlier or more frequent sexual activity,13 14 15 16 17 18 19 20 yet the major American networks continue to balk at airing condom advertisements.6 Fortunately, other Western countries are more sanguine in their view of contraceptive advertising. Consequently, they have lower rates of teen pregnancy.1 Does it not seem odd that tobacco products are still widely advertised in the USA, yet contraceptive advertisements are either banned or severely restricted? This is a situation that would have made Lewis Carroll proud.
Tobacco and alcohol represent the two biggest drug-related threats to adolescent health. Abundant research attests to the impact of alcohol advertising and cigarette advertising on preteens’ and teenagers’ favourable opinion and use of these products.21 Several countries have successfully banned the advertising of tobacco in all media and restricted alcohol advertising. In addition, new research shows that witnessing smoking scenes in movies may be the leading cause of smoking among teenagers.22 23 Similarly a recent study of nearly 3000 German teenagers found that viewing alcohol use in movies is a significant predictor of teenage drinking.24
Numerous international longitudinal studies—several conducted over a period of 25–30 years—show that media use is contributing to the current epidemic of obesity worldwide.1 25 Unfortunately, the mechanism remains unclear. Many researchers feel that the thousands of food ads that children and teens see per year, most of which are for junk food or fast food, contribute significantly.26 Viewing television is also associated with unhealthier eating habits.27 Surprisingly, the evidence that media use displaces more active physical pursuits is mixed.28 For example, some recent research shows that sedentary children and teens will remain sedentary, even if the TV set and internet connection are removed.25
Many young teen girls think they are fat when they are, in fact, normal weight,29 and the media can be a major contributor to the formation of a teen’s body self-image.30 The most powerful evidence was a naturalistic study in Fiji, which found that the prevalence of eating disorders increased dramatically after the introduction of American TV programmes like “Beverly Hills 90210” with its attractive and thin female role models.31
Early language development
Despite the existence of a multimillion dollar infant video industry, there are currently no studies that such videos contribute positively to early infant development.34 35 On the contrary—there are now six studies documenting possible language delays among babies exposed to TV or videos.36 37 38 39 40 41 The infant brain is “plastic” and develops in response to environmental stimulation. Surprisingly, infants are “smart” enough to be able to distinguish a live human being from a televised one.34
Media can be powerfully prosocial.42 Just as media can teach unhealthy or harmful attitudes, they can also teach empathy, respect for other races and ethnicities, the need for cooperation, as well as numbers, letters and geography.1 42 The tragedy of modern media is that they can be so powerfully good yet often are not. The entertainment industry is quick to point out the high quality of its best products yet takes no responsibility for the impact of its violent programming, for example.
Solutions do exist, but they vary in their feasibility. The entertainment industry would like to hold parents 100% accountable for any problems related to media, but the industry must accept some responsibility for the products they produce and their public health impact. Less graphic violence, more sexual responsibility, less smoking and casual drug use, less emphasis on thinness—all would produce healthier viewing for young people. There is also tremendous positive potential to relay accurate health information through TV shows and movies.43 The British Medical Association forum with producers and fashion industry leaders that produced a voluntary agreement to limit the use of actresses and models with eating disorders is one example of how public health activists and industry people can work cooperatively.44 No one’s creative freedoms need be abridged to produce healthier media.
Parents need to be far more aware of media influence and understand that if they are not teaching their children about sex, drugs and violence, the media are. The internet was created specifically so that it cannot be regulated; therefore, it is up to parents to inculcate values in their children and teach them how to use media wisely. According to the American Academy of Pediatrics, total entertainment screen time should be limited to no more than 1–2 h per day, and TV sets and internet connections do not belong in children’s or teenagers’ bedrooms.45 Parents need to coview media with their children and discuss what they are seeing. One major help for parents would be a universal ratings system in individual countries that would encompass TV, movies and videogames. Parents need to avoid screen time for infants under the age of 2 years.
Schools have not kept pace with the revolution in media technology. Shakespeare wrote his plays to be seen and performed, not to be read; and there are dozens of plays available on DVD. Yet many young students are still forced to read Shakespeare before they see Shakespeare. Documentary footage of world war battles seems far more effective in teaching students history than unillustrated textbooks. Languages can be more easily learnt from video and audiotapes than in the classroom. If teachers are so concerned about assignments being turned in late, they could email or text-message reminders to their students.
The advertising industry needs to get busy advertising products which protect young people from harm—oral contraceptives, condoms and emergency contraception. Such products need to be advertised worldwide. At the same time, advertisements for products which may be harmful to young people—junk food and fast food—must be curtailed. The epidemic of childhood and adolescent obesity is worldwide, and food ads may contribute significantly.1 25
Given the amount of sexual suggestiveness on TV and in movies, schools no longer have any excuse for not providing comprehensive school-based sex education programmes for children and adolescents, including full discussions of contraception and discussions of how sex and sexuality are portrayed in the media. Similarly, drug education programmes must progress beyond Drug Abuse Resistance Education to incorporate principles of media literacy, teaching young people how to deconstruct alcohol and tobacco ads and therefore become more resilient.
Governments can intervene when there is a compelling public health problem—for example, to ban cigarette advertising in all media (as Australia and the UK have done), or restrict alcohol, food or toy advertisements. Governments can also provide funding for media research, which is urgently needed.
Paediatricians need to recognise that discussing media with parents may be even more important than whether the car seat is facing forwards or backwards. Traditionally, continuing medical education programmes are programmed along subspecialty lines. But since the media cut across virtually all areas, some mention needs to be made when discussing adolescent drug use or sexual activity or suicide, for example. The topic also needs to be included in CME courses as a stand-alone discussion. In their clinical practices, paediatricians need to ask at least two key questions: (1) How much entertainment screen time does the child or teen spend per day? (2) Is there a TV set or internet connection in the bedroom?46
Researchers need to do more studies to understand what determines individual, ethnic and racial differences in processing media among children and teens. Why are African–Americans relatively resistant to cigarette advertising and to depictions of abnormally thin body images, for example? Content and qualitative analyses are needed to assess media violence, sex in the media and drug depictions over time. Researchers also need to incorporate measures of media use into their studies of aggressive behaviour, sexual behaviour, drug use, obesity and eating disorders.47 More information is needed on the impact of infant media use on early brain development, language acquisition and learning problems. More documentation of prosocial uses of media would also help enlighten the industry about its power in communicating healthy messages.
Finally, media education is crucial. A century ago, to be “literate” meant one could read and write. In 2009, to be literate means possessing the ability to text-message, IM, surf the Web, as well as decipher a bewildering array of media including books, radio, TV, movies, music and videos. Several countries—the UK, Canada, Australia—mandate such education. Most countries do not. It is quite possible that media education in the new millennium will ultimately prove to be more important than the “3 Rs”—reading, writing and arithmetic. The media have become powerful teachers of children and adolescents. The only questions remaining are: (1) what are they learning and (2) how can harmful media effects be minimised and prosocial effects be maximised?
Competing interests None.
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