Adolescents in the United States are engaging in sexual activity at early ages and with multiple partners.
Approximately 47% of high school students have had sexual intercourse, 7.4% of them before the age of 13 years, and 14% with ≥4 sexual partners.1
Overall, ∼822000 pregnancies occurred among women aged 15 to 19 years in 2000; approximately one third of these pregnancies were among girls <18 years old.2
Sexually active adolescents are at immediate risk for pregnancy and acquiring sexually transmitted infections. In the United States the risk of acquiring a sexually transmitted infection is higher among teenagers than among adults.3
A critical review of the scientific literature and other sources shows that a largely unexplored factor that may contribute to adolescent sexual activity is their exposure to the mass media.
The average American youth spends one third of each day with various forms of mass media, mostly without parental oversight.8
The mass media have been shown to affect a broad range of adolescent attitudes and behaviors including violence, eating disorders, and tobacco and alcohol use.
Few studies, however, have examined the effects of mass media on adolescent sexual attitudes and behaviors. An extensive systematic review of the relevant biomedical and social science literature shows that only 12 of 2522 research-related documents (<1%) involving media and youth address the effects of mass media on adolescent sexual attitudes and behaviors; in addition, there are several studies of college students, which were outside the scope of this review.
Several studies suggest an association between media exposure and adolescent sexual behaviors, but they are limited because of their study designs, sampling procedures, and small sample sizes.
To date, there has been only 1 longitudinal study of such effects,9 although others are in process (see “Appendix” in Impact of the Media on Adolescent Sexual Attitudes and Behaviors later in the supplement).
What follows is a summary, based on the last 21 years of research (1983–2004), of the little that science knows concerning
the exposure of American adolescents 11 to 19 years old to various forms of mass media;
the sexual content of those media; and
the effects of that exposure on their sexual attitudes and behaviors.
The gaps in our knowledge are then identified and a program of needed research outlined.
WHAT WE KNOW
Television (Broadcast and Cable) and Music Videos
The average teenager spends 3 to 4 hours per day watching television.8
In the programming most frequently watched by adolescents, 83% contains some sexual content—not just passing references but an average of 6.7 scenes that include sexual topics per hour—and 20% explicitly or implicitly portrays couples engaging in sexual intercourse.10,11 This is after a major reduction in the sexual content of television.12
Adolescents who are exposed to television with sexual content are more likely than other adolescents to
overestimate the frequency of some sexual behaviors13; and
have more permissive attitudes toward premarital sex.14
Moreover, the 1 longitudinal study to date finds that watching sex on television (or even hearing about it) does predict adolescent initiation of sexual behavior.9
However, most studies are of limited generalizability because of their study designs, sampling procedures, and small sample sizes. They therefore cannot serve as the foundation for data-based policy formulation.
Exposure to R-rated Movies
According to a 1993 study, two thirds of Hollywood movies made each year are R-rated, and most young people have viewed these movies before they reach the required age of 17 years (previously 16 years).15 Recent reductions by theaters on under-age ticket sales have not reduced the ability of adolescents to buy such films.16
Exposure to X-rated Movies
In 2001, 30% of sexually active minority adolescent females said they had seen an X-rated movie in a theater or on videotape in the 3 months before the survey.17
Content of R-rated Movies
Two studies have analyzed the content of the top movie videotape rentals and R-rated movies frequently viewed by youth15,18; both reported a high amount of sexual content, with the most common sexual activity being intercourse between unmarried partners.
In at least 1 group of adolescents, those exposed to X-rated movies were more likely to
have multiple sexual partners;
have sex more frequently;
test positive for chlamydia;
have more negative attitudes toward using condoms; and
not use contraceptives.17
We do not know the effects of the sexual content of R-rated movies on adolescent sexual attitudes and behaviors.
In 1999, 22% of teen-oriented radio segments contained sexual content, 20% of which were “pretty explicit” or “very explicit.”20
We do not know the effect of exposure to radio on adolescent sexual attitudes and behaviors.
In 2000, teenagers spent an average of almost 18 hours per week listening to music on the radio, CDs, and audiotapes.8
In 1999, 42% of the songs on 10 top-selling CDs contained sexual content, 41% of which were “pretty explicit” or “very explicit.”20
We do not know the effects of sexually explicit lyrics on adolescent sexual attitudes and behaviors.
Eighty-five percent of teenagers have read or looked at a magazine in the last 6 months.21
There are few scientific data on the content of the magazines that adolescents read.
We do not know the effects of either sexually explicit “adult” magazines or “mainstream” publications on adolescent sexual attitudes and behaviors.
American adolescents are a specific target audience for much consumer advertising because they spend approximately $153 billion per year, an average of $89 per week per teenager.22
The average American child sees an estimated 20000 advertisements each year. By the age of 19 years, the average American adolescent has absorbed nearly 300000 advertisements.23
There are no systematic data concerning the sexual content of the advertising to which adolescents are exposed, although impressions are that it is high.
We do not know the effect of the sexual content of advertising on adolescent sexual attitudes and behaviors.
Video and Computer Games
In 1999, 70% of households surveyed with children aged 8 to 18 years reported having a video-game system.8
There are no systematic data concerning the sexual content of the video and computer games most popular with adolescents.
We do not know the effects of the sexual content of video and computer games on adolescent sexual attitudes and behaviors.
On average, children aged 9 to 17 years use the Internet 4 days per week and spend almost 2 hours online at a time.24
Although pornography is widely available on the Internet, there are no systematic data concerning the sexual content of the sites that are visited by adolescents.
We do not know the effects of Internet sexual content on adolescent sexual attitudes and behaviors.
WHAT WE DO NOT KNOW
Several gaps in our knowledge have been identified:
We do not know the extent of sexual content in the radio segments, advertising, magazines, or the Internet to which American adolescents are exposed.
We do not know the extent of American adolescents’ exposure to such content.
We do not know the success of various social-cultural, technologic, and media approaches to minimizing that exposure (eg, V-Chips on television, Internet-blocking software, parental supervision, rating systems) or minimizing the effects of that exposure (eg, media-literacy programs).
There is a notable scarcity of well-conducted, scientifically rigorous studies that examine the effects of sexual content in the media on adolescent sexual attitudes and behaviors.
There are no studies that have examined the cumulative effects of sexual content in different types of media over time on developing youth.
Based on this review of the scientific literature, research is needed to
refine methodologies to measure mass media exposure and exposure to sexual content in the media;
survey children and adolescents to determine their exposure to forms of mass media for which such data are lacking;
determine the sexual content of those media;
survey parents and adolescents to assess the effectiveness of parental involvement, communication, supervision, and monitoring of media sexual content on these adolescent exposures;
evaluate media-literacy programs for their effectiveness in reducing exposure or mitigating the media’s effects and determine best-practice interventions;
evaluate the effectiveness of other technologic, sociobehavioral, and media practices (eg, V-Chips and rating systems) in reducing exposure; and
discover in long-term longitudinal studies the cumulative effects of mass media on child and adolescent sexual attitudes and behaviors.
- Accepted April 14, 2005.
- Address correspondence to S. Liliana Escobar-Chaves, DrPH, Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center, PO Box 20036, Houston, TX 77225-0036. E-mail:
No conflict of interest declared.
Dr Eitel’s current address is: Foote Cone & Belding, New York, NY 10001.
- ↵Grunbaum JA, Kann L, Kinchen S, et al. Youth risk behavior surveillance—United States, 2003 [published correction appears in MMWR Surveill Summ. 2004;53(24):536]. MMWR Surveill Summ.2004;53(2) :1– 96
- ↵Alan Guttmacher Institute. U.S. Teenage Pregnancy Statistics: Overall Trends, Trends by Race and Ethnicity and State-by-State Information. New York, NY: Alan Guttmacher Institute; 2004. Available at: www.agi-usa.org/pubs/state_pregnancy_trends.pdf. Accessed April 25, 2005
- ↵Centers for Disease Control and Prevention, National Center for HIV, STD, and TB Prevention, Division of STD Prevention. STD surveillance, 2000. Available at: www.cdc.gov/std/stats00/TOC2000.htm. Accessed February 3, 2005
- ↵Orr DP, Beiter M, Ingersoll G. Premature sexual activity as an indicator of psychosocial risk. Pediatrics.1991;87 :141– 147
- ↵Roberts DF. Media and youth: access, exposure, and privatization. J Adolesc Health.2000;27(2 suppl) :8– 14
- ↵Collins RL, Elliott MN, Berry SH, et al. Watching sex on television predicts adolescent initiation of sexual behavior. Pediatrics.2004;114 (3). Available at: www.pediatrics.org/cgi/content/full/114/3/e280
- ↵Cope-Farrar KM, Kunkel D. Sexual messages in teens’ favorite prime-time television programs. In: Brown JD, Steele JR, Walsh-Childers K, eds. Sexual Teens, Sexual Media: Investigating Media’s Influence on Adolescent Sexuality. Mahwah, NJ: Lawrence Erlbaum; 2002:59– 78
- ↵Kunkel D, Biely E, Eyal K, Cope-Farrar K, Donnerstein E, Fandrich R. Sex on TV 3: a biennial report to the Kaiser Family Foundation. 2003. Available at: www.kff.org/entmedia/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=14209. Accessed January 27, 2005
- ↵Parents Television Council. Sex loses its appeal: a state-of-the-industry report on sex on TV. 2003. Available at: www.parentstv.org/ptc/publications/reports/stateindustrysex/main.asp. Accessed January 27, 2005
- ↵Greeson LE, Williams RA. Social implications of music videos on youth: an analysis of the content and effects of MTV. Youth Soc.1986;18 :177– 189
- ↵Greenberg BS, Siemicki M, Dorfman S, et al. Sex content in R-rated films viewed by adolescents. In: Greenberg BS, Brown JD, Buerkel-Rothfuss N, eds. Media, Sex and the Adolescent. Cresskill, NJ: Hampton Press; 1993:45– 58
- ↵Federal Trade Commission. Marketing violent entertainment to children: a fourth follow-up review of industry practices in the motion picture, music recording & electronic game industries. A Report to Congress. 2004. Available at: www.ftc.gov/os/2004/07/040708kidsviolencerpt.pdf. Accessed January 27, 2004
- ↵Wingood GM, DiClemente RJ, Harrington K, Davies S, Hook EW, Kim OM. Exposure to X-rated movies and adolescents’ sexual and contraceptive-related attitudes and behaviors. Pediatrics.2001;107 :1116– 1119
- ↵Klein JD, Brown JD, Childers KW, Oliveri J, Porter C, Dykers C. Adolescents’ risky behavior and mass media use. Pediatrics.1993;92 :24– 31
- ↵Gentile DA. Teen-oriented radio and CD sexual content analysis. 1999. Available at: www.mediafamily.org/research/report_radiocontentanalysis.pdf. Accessed January 21, 2004
- ↵Simmons Market Research Bureau [available by subscription only, 230 Park Avenue, New York, NY 10003; summary provided by Patricia Eitel of Ogilvy and Mather]. Simmons Teen. 2000
- ↵Brown JD. Adolescents’ sexual media diets. J Adolesc Health.27(2 suppl) :35– 40, 2000
- ↵Zollo P. Getting Wiser to Teens: More Insights Into Marketing to Teenagers. 3rd ed. Ithaca, NY: New Strategist Publications; 2003
- ↵American Academy of Pediatrics, Committee on Public Education, American Academy of Child and Adolescent Psychiatry, American Psychological Association. Sexuality, contraception, and the media. Pediatrics.2001;107 :191– 194
- Copyright © 2005 by the American Academy of Pediatrics