PEDIATRICS Vol. 108 No. 1 July 2001, pp. 179-180

COMMENTARY:
For a Child, Every Moment Is a Teachable Moment

We are brought to a rude awakening by Thompson and Yokota's content analysis of G-rated animated feature films.¹ The use of alcohol, tobacco, and other drugs is so deeply ingrained in the American lifestyle that these health risk behaviors are portrayed for comedy, drama, or as normal everyday activity even in entertainment that most parents provide unquestioningly to their youngest children. Nearly half of the 81 films produced since 1937 contained portrayals of alcohol and/or tobacco use. Only 3 contained pro-health messages; all 3 warned only of tobacco. Remembering that children under the age of 8 years are developmentally incapable of making a clear distinction between fantasy and reality, we need to reexamine what even our "safest" media are portraying as the ways of the world.

Alcohol consumption is rife in recent films like "All Dogs Go to Heaven" and "The Great Mouse Detective," and it is played for laughs in the classics "Sleeping Beauty" and "Fantasia." In this context, is it so surprising that 1 in 7 fourth graders has been drunk and 1 in 3 believes that alcohol consumption is a "big problem" in their age group?² Research has shown that children are more inclined to accept alcohol consumption after exposure to television portraying such behaviors.^3,4 Alcohol is the mood-altering drug most frequently used by children 12 to 17 years old.⁵ Thirty-eight percent of eighth graders and 60% of ninth graders have started drinking alcohol.⁶ By high school graduation, two thirds are regular drinkers and 40% are frequent binge drinkers.⁷ Alcohol-related motor vehicle collisions are the number one cause of death among teenagers.⁸

Animation exerts a powerful pull on the attention and imaginations of young people. When tobacco was advertised using cartoon characters, children as young as 6 recognized Joe Camel as frequently as Mickey Mouse and associated him positively with smoking cigarettes.⁹ Smoking has long been used in entertainment media as a means of establishing characters' "coolness." Animated features are no exception, portraying tobacco-using heroes from the ruggedly individualistic cowboy "Pecos Bill" to the brilliant and thoughtful "Great Mouse Detective." Young smokers repeatedly cite that they started smoking because it made them appear "mature" or "cool." More than 3000 adolescents initiate smoking each day, and >85% of all long-term habitual smokers started before the age of 18.¹⁰ With increasing exposure to media portrayals of tobacco use, seventh graders report increasingly positive attitudes toward and higher rates of smoking.¹¹ During the 1990s, cigarette smoking among youth increased by 30% in the United States, and one third of all young people who smoke will suffer premature deaths from tobacco-related diseases.¹² It is encouraging that Thompson and Yokota found only 5 implications of other drug use in animated feature films, but the 40 000 deaths attributed to illegal drugs pale in comparison to those associated with alcohol (100 000) and tobacco use (400 000). These acquired behaviors account for over half a million avoidable deaths each year, many of them among people who initiated their drinking or smoking at an early age. As pediatricians, we usually do not care for patients in the end stages of alcohol and tobacco-related diseases, but we do care for them when they become "infected." The lifestyles they adopt as children and adolescents will affect their whole lives. Part of our task is to respond to environmental influences on child and adolescent health and to prevent disease through anticipatory guidance.

Media are a more ubiquitous and powerful presence in the physical and psychosocial environments of children and adolescents than lead, passive smoke, or toxic waste. More than 99% of American households have television and 89% of households with children between 2 and 17 years of age have 2 or more television sets. Each day, children between the ages of 2 and 7 years spend 3 hours and 34 minutes using media, and those between 8 and 18 spend 6 hours and 43 minutes.¹³ There is a large and growing body of research data that shows strong associations between media use and interpersonal violence, risky sexual behavior, obesity, body image problems, and substance use. When this country was formed, it was determined that to keep it strong and safe, its citizens needed to be literate. Our founders ensured public education for all, so that we could be informed and critical consumers of information, protecting ourselves and society from dangerous misrepresentation. Today, we receive >95% of our information from nonprint media. Our kids can read and write, but few can protect themselves by being similarly literate to nonprint media. Recent pediatric research has demonstrated the positive health effects of media literacy on aggressive behavior¹⁴ and decision-making around alcohol use.¹⁵

In America, we make a distinction between education and entertainment. We learn important values and serious information in school, at church, and in the doctor's office, but television, movies, and other media are entertainment, relaxing "down time" for our minds. Unfortunately, the education/entertainment dichotomy is both artificial and false. As early as 1933, Herbert Blumer recognized that "motion pictures are a genuine educational institution ... educational in the truer sense of actually introducing [the young person] to and acquainting him with a type of life which has immediate, practical, and momentous significance. In a genuine sense, motion pictures define his role, elicit his direct impulses, and provide substance for his emotions and ideas. Their modes of life are likely to carry an authority and sanction which make them formative of codes of living." As pediatricians, we experience this when boys hurt themselves practicing wrestling moves or girls starve themselves to look like models in teen magazines. We patch kids up after a bike accident and we take advantage of the "teachable moment" to encourage wearing helmets. What we have come to realize is that there is no "down time" for a young person's developing brain. They are always curious, always learning. For a child, every moment is a teachable moment. Children spend more time using media than they spend at school, with parents, or in any other activity except for sleep. Media are teaching our children and they are incorporating what they learn into their lives. We must pay more attention to the lessons they are learning.

Michael Rich, MD, MPH
Division of Adolescent and Young Adult Medicine
Children's Hospital
Boston, MA 02115

FOOTNOTES

Received for publication May 14, 2001; accepted May 14, 2001.

Reprint requests to (M.R.) Division of Adolescent and Young Adult Medicine, Children's Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail: michael.rich{at}tch.harvard.edu

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