Entertainment Television as a Healthy Sex Educator: The Impact of Condom-Efficacy Information in an Episode of Friends
Rand Health, Santa Monica, California
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ABSTRACT |
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 TOP ABSTRACT METHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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Context. Television is often decried as a negative influence on the sexual attitudes and behavior of America’s adolescents. However, television occasionally includes messages about the risks of having sex that may have a positive effect on youth.
Objective. To assess the impact of condom-efficacy messages in an episode of Friends on teens.
Design, Setting, and Participants. A national sample of 506 adolescents 12 to 17 years old who had been regular viewers of Friends the previous year were surveyed by telephone shortly after the episode aired.
Outcome Measures. Viewership of the Friends episode, recall of the condom-efficacy message, beliefs about condoms, self-reported change in condom knowledge, and discussions of condom efficacy with parents.
Results. At least 27% of the sample saw the episode, and 65% of these viewers recalled its depiction of condom failure resulting in pregnancy. Forty percent of the viewers watched with an adult. Ten percent of viewers talked to an adult about condom efficacy as a result of the show. Compared with other viewers, youth who talked with an adult were more likely to report learning about condoms from the episode and appeared less likely to reduce their perceptions of condom efficacy after the episode.
Conclusions. Entertainment television can serve as a healthy sex educator and can work in conjunction with parents to improve adolescent sexual knowledge.
Key Words: entertainment television • condoms • teens • media • sex
Abbreviations: TAS, Television and Adolescent Sexuality (study)
Forty-six percent of all high school students in the United States have had sex, and rates of sexually transmitted diseases and unintended pregnancy are high among these youth.1 One factor thought to contribute to adolescent sexual risk is television.2 It has been argued that television has become a sex educator to America’s children, usurping the role of parents.3 Adolescents 14 to 18 years old watch an average of 2
hours of television a day.4 Seven of ten primetime network programs contain sexual content, and the average primetime show with such content contains six scenes with sex per hour.5 This high prevalence of sexual content has raised concern, in part, because of fear that the lessons taught by television are inaccurate and that, even when it is accurate, television is providing information more appropriately conveyed by parents. However, the same reasoning that supports these concerns can be used to argue that television is sometimes a healthy sex educator and may aid parents rather than usurp their roles.
The idea that television presents a distorted picture of sexuality is strongly supported by content analyses. Sex is largely portrayed on television as a casual activity, without health or other life consequences. The vast majority of scenes with sexual content fail to depict the responsibilities concomitant with sexual activity or to note the risks of pregnancy and contraction of sexually transmitted diseases.5 Nonetheless, portrayals of sexual risk and responsibilities are sometimes present on television. Such portrayals were included in 15% of programs with sexual content in the 2001 to 2002 season and in 34% of shows with sexual content that involve teen characters.5 This raises the possibility that television can be a healthy sex educator, teaching valuable lessons to adolescent audiences by modeling responsible behavior or pointing out the consequences that can result from careless sexual activity.6 Consistent with this notion, 60% of teens participating in a recent survey said that they learned about how to say "no" to a sexual situation by watching television, and 43% said they learned something from television about how to talk to a partner about safer sex.7
Clearly, parents are able to put information about sexuality in a context appropriate to family beliefs, values, and culture, which may differ from the television mainstream. However, the concern that television is usurping parents’ role as sex educators can also be countered. Rather than substituting for parents, television may act as a catalyst to conversation, giving parents and their children an entrée to topics they find difficult to broach with one another. Thirty-three percent of 15- to 17-year-olds report that they have had a conversation about a sexual issue with one of their parents because of something they saw on television.7 These conversations not only give parents a chance to provide their own input on sexual health issues, but also give them an opportunity to challenge any negative media messages and to reinforce positive messages. Thus, television may promote the role of parents as sex educators, rather than undermine it.
This article explores these positive opportunities for sex education via the entertainment media by studying the impact of one episode of the sitcom Friends that contained information about sexual risk. At the time the episode aired, Friends was the most watched program on television, and was popular with adolescents. The particular episode we studied attracted 1.67 million US viewers 12 to 17 years of age on its first air date (Nielsen Media Research, unpublished raw data, 2002). The episode focuses on a pregnancy resulting from condom failure. It was part of the season’s main story line, in which one of the characters, Rachel, experiences an unplanned pregnancy as a result of a single night of sex with Ross, another main character and her former boyfriend. In the episode, Rachel tells Ross about the pregnancy for the first time. Ross responds with disbelief and exclaims "but we used a condom!" A statement that "condoms are only 97% effective" appears in this scene and also a subsequent one, reinforcing the condom use and condom failure elements of the story. Thus, the possibility of condom failure and the resulting consequence of pregnancy were communicated to a very large adolescent audience in a highly vivid manner and could potentially have had a powerful effect on young people’s sexual knowledge.
Other studies of health information contained in entertainment programming (sometimes termed "edu-tainment") suggest that this may have occurred. Most such studies have been conducted outside the United States, where health educators can more easily influence program content.8 For example, information about family planning was conveyed to large numbers of Africans as part of existing entertainment programming and apparently changed health behavior as a result.9 Although there have been many laudable efforts to include reproductive health information in ongoing US entertainment programs, we know of only one such effort that included an evaluation. This study tested the impact of an episode of the emergency department drama ER that included a brief vignette about emergency contraception. Awareness of the availability of emergency contraception increased by 17 percentage points among regular ER viewers in the week immediately after the episode.10
These studies show that that it is possible to deliver health messages to a very large audience through edu-tainment. They also indicate a potential for influencing health-related awareness, knowledge, and beliefs in this manner. We expected to observe such effects for the Friends episode. We hypothesized that adolescent Friends viewers would demonstrate enhanced awareness of condom failure, in that a substantial percentage of viewers would note and retain the condom-efficacy messages included in the episode. We also expected a substantial percentage of viewers to report learning something about condoms as a result of the episode. Although some adolescents would have previously encountered information about condom efficacy, a large number would not have done so, and thus might acquire new knowledge through viewing the episode.
For similar reasons, we expected to find that many adolescents changed their beliefs about condom efficacy as a result of the episode, because the events portrayed might provide new information, inspire a search for information, or spur discussion regarding the issue of condom efficacy. Because the information conveyed in the Friends episode was fairly complex, we did not expect viewers’ condom-efficacy beliefs to be changed in a single direction. Like much information regarding sexual health, the condom message in the episode communicated that the outcome of condom use is uncertain. It (accurately) indicated that condoms are very effective and should be used if one has sex, and also that condoms cannot be relied on with absolute certainty, so even protected sex should involve a careful decision. Messages involving probabilities are difficult for even well-educated adults to understand and use.11 Thus, we expected the Friends episode to have a mixed effect on perceptions of condom efficacy among adolescents, precipitating changes toward both enhanced and reduced perceived efficacy. Given that the events of the episode turn on a time when condoms failed, we expected that many of those who changed their beliefs about condoms would come to see them as less effective. However, because the episode also made it clear that key Friends characters use condoms, and emphasized the characters’ surprise that condoms are not always effective, we also expected many viewers to see condoms as more effective than they had before viewing the episode.
We also hypothesized that the Friends episode would provoke conversation about the show between adolescent viewers and their parents, and result in discussions of pregnancy and condom efficacy that might not otherwise have occurred. Any presentation of a novel topic might have such an effect, but we expected that the ambiguous message presented might especially lead to conversation, as youth attempted to work through both sides of the risk information.
We expected any interactions with parents that occurred to moderate the impact of the Friends episode. Previous research indicates that children who watch programming with their parents are differentially influenced by the content they see, as are children who discuss media content with their parents.12,13 This process, termed mediation, sometimes counteracts media effects and sometimes enhances them, depending on whether parents agree with the media message. We expected the Friends condom-efficacy episode to more strongly affect adolescents who watched with their parents, who discussed the episode with their parents, or who discussed condom efficacy with their parents as a result of seeing the episode. This hypothesis was based on the assumption that parents would reinforce the accurate program message and assist their teens with attending to and interpreting it.
Finally, although we expected the aforementioned effects, we also anticipated that many teens exposed to the episode would fail to process or retain the sexual health information it contained. This is typical in studies of people exposed to messages via mass communication channels.14 Thus, we hypothesized and tested for a few additional moderators that might determine who is most strongly affected. First, we predicted that all program effects (on condom awareness, condom beliefs, and talking to parents) would be stronger for more regular Friends viewers. Regular viewers are more likely to attend closely to the program, identify with the characters, and think later about its content.15 Second, we predicted that effects of the Friends episode would be greater among younger and sexually inexperienced adolescents, because they would have less real-life experience on which to draw. Finally, we conducted exploratory tests for differential reactions among males versus females.
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METHODS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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Sample
Respondents were drawn from the larger group of participants in the Rand Television and Adolescent Sexuality study (TAS). All procedures for both the TAS and the present study were approved by Rand’s Human Subjects Protection Committee. The TAS was a national longitudinal telephone survey of adolescents 12 to 17 years old. Participants in that study were sampled from a list of households likely to include one or more 12 to 17 year olds. Households were sent a letter describing the TAS study; oral consent from parents was later obtained by phone, followed by teen assent. Sixty-five percent of those contacted for TAS agreed to participate (baseline n = 2003). The overall TAS completion rate was 50%. Attrition at follow-up was 12% (longitudinal n = 1769) and was unrelated to a set of 32 sample characteristics. The TAS surveys asked about television-viewing habits, demographic and psychosocial characteristics, sexual attitudes, beliefs, knowledge, and behavior.
As a part of the TAS baseline survey, respondents indicated the frequency with which they watched the television show Friends (never, once in awhile, a lot, or every time it’s on). For this study, we sampled all 648 respondents who were regular Friends viewers at TAS baseline, defined as teens who watch Friends "a lot" or "every time." Oral parent consent and teen assent were obtained immediately before the Friends phone interview. We interviewed 506 individuals; 13 others agreed to the interview but could not complete it within the field period, 101 could not be reached during the field period, and 28 refused to be interviewed, for a completion rate of 78%. A regression equation attempting to predict nonresponse from a set of 32 sample characteristics, including demographics and measures of television viewing patterns, was not significant, suggesting that nonresponse to the Friends survey was random.
Of the 506 teens interviewed for the Friends study, 323 recalled seeing the condom-effectiveness episode, 181 did not, and 2 were unsure. Most analyses for this study focused on the 323 adolescents who reported seeing the episode and a subset of 155 of adolescents whose viewership could be confirmed with an additional question about the episode’s content (see "Results"). In one additional statistical test, the analysis sample consisted of the 472 Friends survey participants (305 self-reported and 150 confirmed viewers) who were surveyed at the TAS follow-up.
The TAS sample slightly underrepresented Hispanics, and slightly overrepresented two-parent households, compared with the nation as a whole. This is typical of listed samples, which consist of more stable, middle-income families. To account for this bias, data for this study were weighted to more accurately reflect the characteristics of US teens and their households. Nonetheless, regular Friends viewers are a select group of teens. Characteristics of the sample and each subgroup of respondents are displayed in Table 1. As the table indicates, Friends viewers are white and female more often than the US population. Respondents who recalled seeing the episode are very similar to those who did not. However, confirmed viewers were more likely to be female, to come from somewhat more educated families, and to be current regular viewers of Friends.
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Procedures
The condom-effectiveness episode first aired on October 11, 2001. The Friends survey field period was from October 30 through November 7, 2001. Fifty percent of participants were interviewed within 3 weeks of the air date (ie, within the first 3 days of interviewing), and the remainder were interviewed within 4 weeks of the air date. The Rand TAS baseline survey was fielded in March through June of 2001. The TAS follow-up was fielded in March through May of 2002. Median time between TAS baseline and the Friends survey was 6 months, as was the median time from the Friends survey to TAS follow-up.
Measures
Viewership of Friends and of the episode of interest were established at the outset of the Friends interview. We began with a short introduction informing respondents that we were interested in their responses to a recent episode of Friends. We then repeated the item from the TAS survey that was used to select our sample: "How often do you watch the television show Friends? (never, once in a while, a lot, every time it’s on)." To assess whether respondents saw the key episode, we asked two questions: "Did you see the episode a few weeks ago when Rachel told Ross she’s pregnant?" and "Did you see the episode where Phoebe and Joey got the fire department to break down Monica and Chandler’s door?" The latter event took place during the condom-efficacy episode, but was unrelated to the plot. Respondents who reported seeing the pregnancy episode were classified as self-reported viewers. The subset who also reported seeing the fire department episode were classified as confirmed viewers. Both groups continued with the survey after answering these 2 questions; those who said they had not seen the pregnancy episode were asked a few questions about condoms and thanked for their time.
Among both self-reported and confirmed viewers, we assessed interpretation and recall of the key reproductive health information with a set of three items: "According to the episode, did Ross and Rachel use a condom when they had sex?," "What percent of the time did the Friends episode say condoms work in preventing pregnancy, from zero to 100%?," and "Which comes closer to the main message you took from this episode: lots of times condoms don’t prevent pregnancy, or condoms almost always prevent pregnancy?" The order of the 2 response options for the latter question was counterbalanced across respondents. There was a wide range of responses to the percent-effectiveness question. Based on the distribution, we recoded it to a dichotomous measure reflecting responses of >95% but <100% versus all other responses, rather than requiring respondents to respond with the exact percent (97%) in the episode. Responses to the question about whether Ross and Rachel used a condom were coded to reflect "yes" versus all other responses.
We assessed the effects of the episode on condom beliefs with three measures, based on two items in the Friends survey. To tap perceived learning, we asked, "In thinking about that episode, did you learn anything new about condoms that you didn’t know before? Would you say yes or no?" To measure changes in perceived condom efficacy we asked, "In real life, how effective are condoms for preventing pregnancy? Would you say very effective, somewhat effective, not very effective, or not effective at all?" This same item had been asked in the earlier TAS survey. We derived a dichotomous variable that reflected any change in condom-efficacy beliefs versus no change from a comparison of responses to the item at these 2 time points. Using the same repeated item, we also assessed the direction of belief change among those with any change, creating a dichotomous indicator of reduced perceptions of condom efficacy (less effective versus more effective).
Parental mediation surrounding the episode was tapped with a set of four items. Coviewing was assessed with, "When you watched the Friends episode in which Rachel told Ross she was pregnant, were you with a parent or other adult?" Parental discussion was assessed with three items: "Did you talk with a parent or another adult about that episode?," "Because of that episode, did you talk to a parent or another adult about how effective condoms are in preventing pregnancy?," and "Did you talk with a parent or another adult about whether it’s good or bad that Rachel is pregnant, or did you not talk about this?"
We drew some additional data from the Rand TAS survey. For comparison with the Friends survey item concerning discussions of condom effectiveness, we drew responses to the baseline item: "Have you talked with a parent about condoms in the last 12 months (yes/no)?" Respondent gender, race/ethnicity, age in years, and experience with sexual intercourse (yes/no) were also measured with the TAS baseline survey and used in the present analyses. Finally, we asked respondents to the TAS follow-up, "What percent of the time do you think condoms work in preventing pregnancy, from zero to 100%?" Responses were categorized as for the parallel item in the Friends survey.
Analyses
For most items, we computed prevalence of a response as a percentage of episode viewers with a margin of error as indicated. 
2 tests of homogeneity were used to test whether reactions to the episode differed across subgroups, as hypothesized.
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RESULTS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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The pregnancy episode may have reached more than half of teen Friends watchers in our sample of frequent viewers: Sixty-four percent recalled seeing the episode where Rachel told Ross she is pregnant. However, we could confirm viewership among only 27% of those surveyed (ie, this percentage also reported seeing the fire-department episode). Most of those who saw the episode (59% of self-reported and 54% of confirmed viewers) interpreted its message as "lots of times, condoms don’t prevent pregnancy." The percentage who recalled the specific health information from the episode varied considerably across our different viewer definitions (responses are displayed in Table 2). A substantial minority of self-reported viewers (32%) remembered that the episode described Ross and Rachel as having used a condom when they had sex. The majority of confirmed viewers (65%) recalled this information. Fifteen percent of self-reported and 31% of confirmed viewers recalled that the episode said condoms were between 95% and 100% effective.
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From 10% to 17% of viewers said they learned something new about condoms from the episode. About half of adolescents in both viewer groups rated the effectiveness of condoms differently than they had in the TAS survey 6 months before. Among these individuals, perceptions of condom effectiveness changed in both directions (more or less effective) about equally often. This was true regardless of how viewership was defined (Table 2). When asked as part of our earlier survey, most adolescents saw condoms as very or somewhat effective, and this was still true after the Friends episode.
Forty percent of those who reported watching the episode said they watched with an adult. From 16% to 24% of viewers talked with an adult about the episode, 
10% talked with an adult about Rachel’s pregnancy, and 10% talked with a parent or other adult about condom effectiveness because of the episode. Reactions to the episode were modified by viewing or discussing it with an adult. We tested for these effects among both confirmed and self-reported viewers; results were very similar. For simplicity, we present only confirmed-viewer effects. In this group, we found that teens who watched the condom episode with an adult (versus those who watched alone or with another youth) were twice as likely to recall that condoms were said to be between 95% and 100% effective (40% vs 20%, 2(1) = 5.53, P < .05). Those who watched with an adult were also far more likely to talk to an adult about the episode (33% vs 12%, 2(1) = 6.38, P < .05). Coviewing was not related to changes in condom beliefs or self-reports of learning something new about condoms. Differential response to the episode among those who talked about it with an adult also occurred. Almost half (47%) of adolescents who discussed the episode with an adult recalled that condoms were described as >95% effective, nearly twice the number who remembered this information among those who did not talk with an adult (26%); 2(1) = 4.41, P < .05). Many adolescents who talked about the episode with an adult reported talking about condom effectiveness (31%), and many (33%) talked about Rachel’s pregnancy. These percentages were substantially higher than those observed among adolescents who didn’t specifically discuss the Friends episode with adults, P < .0001.
Participants who had a condom-effectiveness discussion with an adult as a result of watching Friends were more than twice as likely to say they learned something new about condoms from the episode (38% vs 15%, 2(1) = 3.86, P < .05). This was the only group in the study who may have experienced a directional change in their condom beliefs. Among those who changed their perceptions of condom efficacy after the episode, 75% of teens who talked to an adult about condom efficacy came to see condoms as more effective, whereas only 35% of those who did not discuss condoms with adults came to see condoms as more effective (2(1) = 2.75, P < .10). Surprisingly, discussions of condom effectiveness were unrelated to the likelihood of remembering that condoms were described as between 95% and 100% effective (2 < 1).
To test whether the episode had enduring effects on viewers’ condom-related knowledge, we examined responses to the condom efficacy item in the TAS follow-up survey. At TAS follow-up, 24% of self-reported and 30% of confirmed viewers rated condoms as 95% to 100% effective. In comparison, only 18% of the Friends sample who did not see the condom episode (before the Friends survey) rated condoms as 95% to 100% effective at follow-up (self-reported viewer P > .10, confirmed viewer P = .01)
To explore the generalizability of the effects observed, we tested for differences between frequent and occasional viewers within our sample. Although the sample was selected to include only frequent viewers, those teens who watch Friends "a lot" or "every time it’s on," the TAS item used for sampling reflected viewing during the television season before that in which the studied episode appeared. The identical item from the current survey revealed that only 58% of those surveyed still reported watching Friends frequently. Among the subsample of those whom we could confirm saw the condom efficacy episode, 86% were frequent viewers. Because nearly all of our confirmed viewers were frequent viewers, we had limited power to detect differences based on viewing frequency for most variables. Nonetheless, we found that 72% of frequent viewers versus 21% of occasional viewers recalled that Ross and Rachel used a condom, 2(1) = 15.59, P < .0001, and that frequent viewers who changed their condom beliefs were less likely than occasional viewers to view condoms as less effective than they had 6 months previously (2(1) = 5.61, P < .05). No other differences were significant, but the pattern was such that frequent viewers were more likely to recall that condoms were described as 95% to 100% effective, less likely to change their condom efficacy beliefs, and more likely to talk with an adult about the episode. Differences between frequent and occasional viewers were similar among self-reported viewers.
The other moderators we tested had few effects. Conversations about condoms were equally likely among viewers who had spoken with parents and those who had not spoken with parents about condoms in the recent past (2 in both viewer groups < 1, P > .62; not shown in Table 2). Thus, many of the conversations with adults that were sparked by the episode included a discussion of sexual health issues that had not been breached for at least several months. When we compared adolescents who had ever had intercourse (12%) with those without sexual experience, we found no difference in their responses to any of the measures described herein (although, as with frequent viewership, the distribution of sexual experience rendered such tests fairly weak). Gender was also unrelated to responses to the episode. However, we did find that older adolescents were more likely than younger ones to retain the information that condoms are between 95% and 100% effective (43% vs 20%, 2(1) = 7.39, P < .01).
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DISCUSSION |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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The episode we studied was watched by 1.67 million 12- to 17-year-olds, according to Nielsen ratings. We found that from one to two thirds of adolescent viewers recalled that the episode portrayed a pregnancy resulting from condom failure, depending on how viewership was defined. From 10% to 17% of sampled viewers said they learned something new about condoms from watching the Friends episode. From 15% to 31% of viewers recalled that, in the episode, condoms were said to be >95% and <100% effective. Confirmed viewers were more likely to know this condom-efficacy information 6 months later. These are potentially huge numbers of adolescents learning about or being reminded of the risks accompanying sexual activity. The episode we studied has since been re-aired at least twice, potentially exposing additional adolescents as well as reinforcing the message in repeat viewers. Thus, sexual health information was delivered to a very large teen audience with only a single edu-tainment episode, and its effects were lasting.
Entertainment television is often presumed to have an exclusively negative influence on America’s adolescents and is sometimes blamed for high rates of sexual activity, sexually transmitted disease, and unplanned pregnancy in this group. The jury is still out on whether television has such effects. Clearly, television is saturated with sexual content,5 but empirical evidence that such content affects adolescent sexual behavior is still preliminary.16,17 Although sexual content may eventually prove to affect sexual behavior, this study suggests that television can also be a positive force in the sex education of youth and has the potential to affect a broad cross section of teens. Television can teach the risks and responsibilities that accompany sexual activity in a way that books, pamphlets, and classroom instruction cannot, by portraying the experiences of sexually active individuals with whom adolescents identify. This vivid illustration of sexual consequences is hard to come by in other ways, because information about specific individuals’ condom use is rarely available in real life. Entertainment television also has the advantage of being able to model socially responsible behavior without explicitly advocating it. Advocacy messages can produce resistance among adolescents.
A second key set of findings addresses the role of parents in this educational process. Forty percent of adolescent viewers watched the episode with an adult, and from 16% to 24% discussed it with an adult. Both of these factors served to reinforce the educational value of the show’s content, helping teens to retain the information about how often condoms work. The 10% of viewers who were catalyzed by the episode into having a discussion of condom efficacy with an adult were also more likely to say they learned something new from the show. These interactions with adults apparently emphasized the effectiveness of condoms, more so than condom failure, because adolescents who reported them were the only group to see condoms as more effective than they had previously. The role of parents in altering television’s impact is noteworthy and is consistent with research showing that parents and adults can enhance learning from educational programming.18
Although it would certainly be a bad idea for television to substitute entirely for traditional sources of sex education, television may supplement and enhance the effects of information from other sources. In this study, television served this role by instigating discussions of condom efficacy between teens and their parents, opening the door for sex education within the family. Analyses exploring whether conversations resulting from the episode were occurring among adolescents and parents who had already talked about condom use revealed that discussions of condom efficacy as a result of viewing were unrelated to prior conversations on the topic. This suggests that the program reopened some existing channels of communication, providing the opportunity for reinforcement of prior education by parents, and also helped some families to broach the topic for what may have been the first time. We assume that more discussion is positive, especially from parents’ perspective, although we recognize this may not be true in all cases.
We observed few effects of the Friends episode on participants’ condom-efficacy beliefs. Approximately 40% of viewers changed their beliefs from what they had been a few months earlier, when we last surveyed them. These changes could be real effects of viewing the condom episode if the program led to a search for more information about condom efficacy, or questioned adolescents’ preexisting beliefs. However, these changes could also reflect instability in beliefs or their measurement over time that would have been observed regardless of episode viewing. We also observed little directional change in beliefs. Here we expected to find little change, because the complexity of the condom efficacy message could lead some adolescents to see condoms as more effective, and others as less. There was, however, a single exception to this null result: those who talked with parents about condom efficacy because of the Friends episode apparently came to see condoms as more effective. As noted, the episode accurately indicated both that condoms are effective and that condoms occasionally fail. Thus, parents could use the presented information to reinforce either or both of these messages. Although the episode itself did not sway teens either way on the issue, our finding concerning discussions with adults suggests that parents who talked to their kids may have emphasized condom effectiveness, rather than fallibility. This finding also reinforces the point that television may assist parents in their roles as sex educators, rather than substitute for them. Parents appear to have used the episode as a springboard for expression of their own views.
Although we did not observe strong effects of the Friends episode on condom beliefs, this should not be taken to indicate that television has little influence on sexual knowledge. Although the show we studied is one with which adolescents strongly identify, we looked at only one episode, and, as we have noted, the information it contained was ambiguous in its implications. Our finding that many young viewers retained the basic message about condoms and the more specific condom facts presented, even after 3 to 4 weeks, suggests that if sexual risk and responsibility portrayals were more prevalent on television and addressed subjects where the facts are less complex, the effects observed might well be powerful. A number of organizations are currently working to achieve this. The National Campaign to Prevent Teen Pregnancy and the Henry J. Kaiser Family Foundation currently work with television writers and producers to help them embed health messages in their entertainment programming.6 Recent research indicates that such content is increasing, especially in programs involving teen characters.5 Although our results suggest this content may have important positive effects, it also provides a warning flag: given that teens are influenced by television portrayals of sexual risk, it is critical that they be accurate and convey a clear message. Although the Friends episode was entirely correct in the facts it presented, the implications of these facts were ambiguous. This point underscores the need for those producers attempting to educate their audience to work closely with health experts. First amendment concerns and private ownership of television networks in the United States prevents health educators from placing their own messages in entertainment programs. And some television producers may be reluctant to involve researchers directly in the writing process for their own shows. But failing to do so may cause educational efforts to have weaker effects than could otherwise be realized. Indeed, some messages might backfire, despite good intentions.
Our study has a few limitations that must be noted. First, our sample was not a representative one, and it included a relatively small number of confirmed episode viewers. Thus, it may over- or underestimate the effects of the Friends episode. Although many of the characteristics of our sample are similar to national estimates, and we weighted our numbers to more closely match national numbers, even small deviations in sample composition can affect results, and results are less stable in small samples. So our estimates should be considered examples of possible rather than actual effect sizes.
We know of one clear bias in our estimates. Our sample was a group of regular Friends viewers during the previous season, and so was likely to be more affected by the episode than occasional viewers who happened to tune in that evening. Observed effects among those in our study who are not currently regular viewers may provide a lower bound for national estimates of those affected. The differences we observed between regular and occasional viewers argue strongly for a procedure of embedding edu-tainment messages in existing programs with a devoted audience made up of the target group for one’s message, rather than creating special programming to communicate about sexual health. Viewer involvement proved to be an important factor in explaining the episode’s effects.
It is important to note in this context that Friends viewers differ demographically from viewers of other programs. The show attracts disproportionate numbers of whites and females, and this is reflected in our sample characteristics. Although a focus on these groups is appropriate given our interest in this particular program, it should be kept in mind that results might not generalize to boys or to blacks.
We experienced some uncertainty identifying viewers within this sample, necessitating our consideration of both reported- and confirmed-viewer results. Viewers’ poor memory for the event was probably a function of several factors, including the delay between the episode and the survey, the frequent advertisements that aired before the episode, and the continuation of the pregnancy theme in subsequent episodes. The fact that Friends aired opposite Survivor may have also affected respondents’ memory for episode content, because we suspect that many flipped back and forth between the two programs. We tried to account for this by adopting both a liberal and conservative definition of "viewer." Our confirmed viewers may actually represent a subset of particularly attentive viewers, and our self-reported viewers may include a number of persons who never actually saw the episode. We suspect that effects on actual viewers lie somewhere between our estimates for these two groups.
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CONCLUSIONS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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The American Academy of Pediatrics has recommended that the broadcast industry adopt guidelines for responsible sexual content.19 The Friends episode studied herein would almost certainly meet these guidelines because of its portrayal of condom use. And our findings indicate that exposure to the program did have important educational effects. However, findings also highlight the importance of ensuring that the message conveyed is unambiguous. Merely following the guidelines does not ensure that a message will have a positive influence. The American Academy of Pediatrics also suggests that pediatricians encourage discussions between patients and their families about the effect of media on sexual behavior. Our results suggest that families should also watch and discuss television together. Pediatricians might point out to families that keeping televisions in children’s bedrooms decreases opportunities for such discussions and may therefore be problematic. Finally, pediatricians should be notified by producers of entertainment programming when educational material is going to air on programs popular with youth. This would allow them to discuss the content with their patients and their parents.
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ACKNOWLEDGMENTS |
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This research was funded by the Henry J. Kaiser Family Foundation. Financial support was also provided by grant R01HD38090 from the National Institute of Child Health and Human Development.
We are indebted to Vicky Rideout at the Henry J. Kaiser Family Foundation for her assistance with conceptualizing the study and the comments she provided on both the survey instrument and an earlier draft of this paper.
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FOOTNOTES |
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Received for publication Oct 24, 2002; Accepted Mar 13, 2003.
Reprint requests to (R.L.C.) 1700 Main Street, Box 2138, Santa Monica, CA 90407-2138. E-mail: collins{at}rand.org
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REFERENCES |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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- Trends in sexual risk behaviors among high school students: United States, 1991–2001. MMWR Morb Mortal Wkly Rep.2002; 51 :856 –859[Medline]
- Brown JD, Walsh-Childers K, Steele JR. Sexual Teens, Sexual Media: Investigating Media’s Influence on Adolescent Sexuality. Mahwah, NJ: L. Erlbaum; 2002
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