The federal government’s health priorities for the first decade of the 21st century are described in the Healthy People 2010 initiative.1 Among these priorities are reducing pregnancies in adolescent females (objective 9-7) and increasing the proportion of adolescents who have never engaged in sexual intercourse (objectives 9-8 and 9-9). The following study is relevant to the leading health indicator of responsible sexual behavior2 and to several objectives of the family-planning focus area (objectives 9-7, 9-8, 9-9, and 9-11).1
In 2003, the US Congress requested the Centers for Disease Control and Prevention (CDC) to oversee a study to explore how mass media (including television, the Internet, and magazines) impact the sexual attitudes and behaviors of adolescents. The CDC contracted with the Medical Institute for Sexual Health (MISH) in Austin, Texas, under contract H75/CCH623007-01-1, to prepare a report. In turn, MISH awarded a research contract to the Center for Health Promotion and Prevention Research, School of Public Health (CHPPR), which is part of the University of Texas Health Science Center at Houston. CHPPR was asked, among other tasks, to (1) evaluate the available research on the topic by conducting a critical review of the scientific literature and other data sources to explore the impact of mass, entertainment, and electronic media on the sexual knowledge, beliefs, behaviors, and attitudes of adolescents; (2) make recommendations for future research to address information gaps identified by this process; and (3) make recommendations for strategies to mitigate any negative effects.
The research team comprised 4 CHPPR researchers and 1 outside consultant.
S. Liliana Escobar-Chaves, DrPH, principal investigator
Susan R. Tortolero, PhD
Christine M. Markham, PhD
Barbara J. Low, DrPh
Patricia Eitel, PhD
Bibliographic and editorial support was provided by Karyn Popham of the CHPPR staff.
The team did a literature review to find out what we did and did not know, based on scientific evidence, about the subject. The answers were startling. Our findings were summarized in a report, co-authored by the researchers, that was submitted to MISH on January 30, 2004, and in turn given to the CDC. On February 11, 2004, members of the research team met with Senators Rick Santorum (Republican, Pennsylvania) and Sam Brownback (Republican, Kansas) regarding the findings.
On August 5th and 6th, 2004, MISH sponsored an expert panel meeting in Washington, DC; the goal was the preparation of a future research agenda by noted researchers in the area, with key stakeholders invited to participate with the objective of bridging the gap between research and practical application.
The members of the expert panel were
Edward Donnerstein, PhD
Victor C. Strasburger, MD
Jennifer Stevens Aubrey, PhD
Michael Rich, MD, MPH
Kristie M. Farrar, PhD
Deborah A. Fisher, PhD
Patricia Thickstun, PhD
S. Liliana Escobar-Chaves, DrPH
The research panel reviewed and commented on the report submitted to MISH and made numerous recommendations for its improvement. Their comments and suggestions have been invaluable, and we thank them for their contributions to our revised report, presented here as a supplement to Pediatrics. This revised report has an updated literature review, through 2004, but does not differ substantially in content from the version originally submitted to Congress in 2004.
Although a great deal is known about the effects of mass media on other adolescent behaviors such as eating, smoking, and drinking, we know basically nothing of the effects of mass media on adolescent sexual behaviors. Evidence-based public policy requires evidence in the form of scientific data, not “it seems self-evident” assumptions. In this arena of great debate and concern, we simply do not have the facts. We are especially in the dark about long-term effects. Some longitudinal studies are under way (see “Appendix” in Impact of the Media on Adolescent Sexual Attitudes and Behaviors later in the supplement), and we suggest in our discussion how relevant data could be collected as part of other ongoing efforts such as the Youth Behavioral Risk Survey.
However, the limited data we do have are certainly suggestive and a cause for concern. Regardless of whether exposure to the sexual content of mass media generates early and inappropriate sexual behaviors in adolescents, we already know that children who spend their time with televisions and DVDs have more significant health problems than those who occupy their time with physical activity and family. Obesity and diabetes top the list, but such children also are more likely to act out aggressive behaviors, drink, and smoke, all of which is evidence that the content of mass media does influence behavior and in ways that are unhealthy for both the child and society as a whole.
In 1997, the American Academy of Pediatrics recommended that physicians incorporate a media history into the standard evaluation for adolescent patients.3 Since 1984 the American Pediatrics Association’s guidelines for practitioners have suggested reducing a child’s exposure to television, videotapes, movies, and electronic entertainment of all sorts.4,5 As Joe S. McIlhaney, Jr, MD (MISH), and Michael Rich, MD, MPH (Center for Media and Child Health at Harvard), suggest in their commentaries following Impact of the Media on Adolescent Sexual Attitudes and Behaviors, those guidelines are as timely and as important as ever.
- 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.
- ↵US Department of Health and Human Services. Healthy People 2010. Vols1 and 2 , 2nd ed. Washington, DC: US Department of Health and Human Services, Office of Disease Prevention and Health Promotion; 2000. Available at: www.healthypeople.gov/Document/tableofcontents.htm. Accessed May 7, 2004
- ↵US Department of Health and Human Services. Leading health indicators…touch everyone. Available at: www.healthypeople.gov/lhi/LHITouchEveryone.pdf. Accessed February 3, 2005
- ↵American Academy of Pediatrics. Media matters: national media education campaign. 1997. Available at: www.aap.org/advocacy/mediamatters.htm. Accessed February 3, 2005
- ↵American Academy of Pediatrics, Task Force on Children and Television. Children, adolescents, and television. News Comment.1984;35 :8
- ↵American Academy of Pediatrics, Committee on Public Education. Children, adolescents, and television. Pediatrics.2001;107 :423– 426
- Copyright © 2005 by the American Academy of Pediatrics