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PEDIATRICS Vol. 107 No. 1 January 2001, pp. 191-194

AMERICAN ACADEMY OF PEDIATRICS:
Sexuality, Contraception, and the Media

Committee on Public Education



    ABSTRACT
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Abstract
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References

Early sexual intercourse among American adolescents represents a major public health problem. Although early sexual activity may be caused by a variety of factors, the media are believed to play a significant role. In film, television, and music, sexual messages are becoming more explicit in dialogue, lyrics, and behavior. In addition, these messages contain unrealistic, inaccurate, and misleading information that young people accept as fact. Teens rank the media second only to school sex education programs as a leading source of information about sex. Recommendations are presented to help pediatricians address the effects of the media on sexual attitudes, beliefs, and behaviors of their patients.

Early sexual intercourse among American adolescents represents a major public health problem. According to the most recent data, 61% of all high school seniors have had sexual intercourse, about half are currently sexually active, and 21% have had 4 or more partners.1 Although other developed countries have similar rates of early sexual intercourse, the United States has one of the highest teenage pregnancy rates in the world.2 In addition to pregnancy, early sexual intercourse carries the risk of contracting a sexually transmitted disease (STD), including human immunodeficiency virus (HIV). Adolescents have the highest STD rates.3 Approximately one fourth of sexually active adolescents become infected with an STD each year, accounting for 3 million cases,4,5 and people under the age of 25 account for two thirds of all STDs in the United States.6

One study found that the younger a girl is at first sexual intercourse, the greater the chance that she has had involuntary or forced sex.7 In another study, 74% of female adolescents who had sex before age 14 reported that it was involuntary.4 In another high school sample, 10% of adolescents reported a sexual experience in which they did not give consent.8 Sexual assault is one of the fastest growing crimes in the United States, with an annual incidence of 80 per 100 000 women and a peak incidence among 16- to 19-year-olds.9,10 Acquaintance rape and date rape account for 70% to 80% of rape crisis center contacts.11

Although early sexual activity may be caused by a variety of factors,12,13 the media are believed to play a significant role. The media also represent the most easily remediable influence on young people and their sexual attitudes and behaviors.14


    THE MEDIA AND SEXUAL LEARNING

A recent study found that American children spend more than 38 h/wk using media (television, videos, music, computers, and video games).15 Adolescents view television for an average of nearly 17 h/wk16 and listen to music for several hours per day (usually as background music).17 On average, children between 9 and 17 years old use the Internet 4 d/wk and spend almost 2 hours online at a time.18 By the time adolescents graduate from high school, they will have spent 15 000 hours watching television, compared with 12 000 hours spent in the classroom.19

In contrast to the large number of studies relating media violence to real-life behavior, only 4 studies have explored a possible relationship between sexual content in the media and adolescents' behavior.20-23 However, there are numerous studies that illustrate television's powerful influence on adolescents' sexual attitudes, values, and beliefs.14,24-26 In film, television, and music, sexual messages are becoming more explicit in dialogue, lyrics, and behavior. Too often, these messages contain unrealistic, inaccurate, and misleading information that young people accept as fact. Adolescents have ranked the media second only to school sex education programs as a leading source of information about sex.27

American media are thought to be the most sexually suggestive in the Western Hemisphere.28 The average American adolescent will view nearly 14 000 sexual references per year, yet only 165 of these references deal with birth control, self-control, abstinence, or the risk of pregnancy or STDs.29,30 In a recent content analysis, 56% of all programs on American television were found to contain sexual content.31 The so-called "family hour" of prime-time television (8:00 to 9:00 PM) contains on average more than 8 sexual incidents, which is more than 4 times what it contained in 1976.32 Nearly one third of family-hour shows contain sexual references, and the incidence of vulgar language is also increasing.33

Soap operas, which are extremely popular with adolescents and preadolescents, might be one ideal venue for responsible sexual portrayals, yet a recent study of 50 hours of daytime dramas found 156 acts of sexual intercourse with only 5 references to contraception or safe sex.34 Unmarried partners outnumbered married partners by 3 to 1.34 On talk shows, sexual themes are common, including unusual sexual habits.35

Music Television (MTV) and other sources of music videos often display suggestive sexual imagery. In one content analysis, 75% of concept videos (videos that tell a story) involved sexual imagery, and more than half involved violence, usually against women.36 Although a recent content analysis found less eroticism in violent videos,37 experimental studies have found that viewing music videos may, in fact, influence adolescents' attitudes concerning early or risky sexual activity.38 Greater sexual content is also found in videos that depict alcohol use.39 Music lyrics have become increasingly sexually explicit as well,40 and at least 2 studies have shown a correlation between risky adolescent behaviors and a preference for heavy metal music.17,41

Advertising also contains a significant amount of sexual imagery, including the inappropriate use of children in provocative poses.42 Sex is used to sell most common products from shampoo to hotel rooms, yet when children and adolescents respond to the cues and become sexually active too young, society seems to blame young people, not the advertisers.14 Research also shows that heavy exposure to media sex is associated with an increased perception of the frequency of sexual activity in the real world.43 As a result, television may function as a kind of "super-peer," normalizing these behaviors and, thus, encouraging them among teenagers.14,43

The Internet offers unparalleled access to hard-core pornography with just a few keystrokes.44-46 One recent study found that a child exploring the Internet may be trapped in an adult site by a new marketing technique that disables options such as the "back," "exit," or "close" navigation buttons.46


    CONTRACEPTIVE ADVERTISING

Despite American adults' willingness to have birth control information discussed and advertised on television, the networks continue to resist.47 In a poll by the Centers for Disease Control and Prevention, 86% of adults surveyed supported airing of information about HIV and acquired immunodeficiency syndrome (AIDS) prevention and 73% favored condoms being discussed on television.48

There is no evidence that increased sexual knowledge or increased access to birth control affects the likelihood of adolescents having sexual intercourse at a younger age. Four recent studies have found that allowing access to condoms in school-based clinics did not affect rates of sexual activity but did increase use of condoms with intercourse.49-52

Teaching that adolescents should not have intercourse at a young age but, if they do, they should use contraception is a double message. But it is a double message that every teenager in America can understand and benefit from, and it is consistent with normal adolescent psychology, because it acknowledges that adolescents do not always listen to their elders.28


    EVIDENCE FOR MEDIA'S POSITIVE INFLUENCE

Television has been effective in promoting the use of family-planning clinics in selected American communities.53 Trial advertising of barrier-contraceptive methods for women on local radio, local television, and national cable television has elicited few viewer complaints and many positive comments.53 Such advertising has been carefully developed, is generally considered to be in good taste, and focuses on adult women who choose to delay childbearing until a more appropriate time in their lives.

In the absence of effective, comprehensive sex education at home or in the schools, television and other media have become the leading sex educators of children and adolescents today.28 With a large number of sexual messages found in television programming and contained in music and music videos, it seems incongruous for national networks to avoid or censor any reference to responsible sexual behavior. Broadcast media should provide messages that support and encourage the delay of first coitus. Media also should present information on the use of methods to avoid unintended pregnancies and STDs and their consequences. A few prime-time programs have done this. Promoting responsible and healthy sexual behavior by adults and adolescents may result in a greater percentage of wanted and well-spaced pregnancies, with improvement in the health and well-being of many children and their families.


    RECOMMENDATIONS
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Abstract
Recommendation
References

  1. Pediatricians should encourage discussions between patients and their families on the effect of media on sexual attitudes, beliefs, and behaviors.
  2. Pediatricians should help parents and adolescents identify inappropriate use of sexual images in the media, including portrayals of unsafe sex.
  3. Pediatricians and the American Academy of Pediatrics should encourage the broadcast industry to produce programming with responsible sexual content (Table 1).
  4. Pediatricians should encourage the broadcast industry to use public service announcements that promote abstinence from sexual intercourse for adolescents. Just as strongly, the use of public service announcements and advertisements that promote the use of condoms to prevent STDs and pregnancy for adolescents and adults who are already sexually active should be encouraged.
  5. Pediatricians should encourage movie theater and video store owners to enforce the PG-13, R, and NC-17 ratings designated by the broadcast industry.
  6. Pediatricians should encourage schools to create media education programs that, for older children and adolescents, will include discussions of sexual content in the media. Schools should be encouraged to add a media education component to their sex education program content.
  7. Pediatricians and the broadcast industry should support further research into the impact of sexual content in the media on children's and adolescents' knowledge and behavior. In particular, a national task force on children, adolescents, and the media should be convened by the Academy alone or in conjunction with the Centers for Disease Control and Prevention or the National Institutes of Health to study this issue, devise new research, locate funding sources, and make recommendations to Congress, the broadcast industry, and the American people.

Committee on Public Education, 2000-2001


                              
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TABLE 1
Guide to Responsible Sexual Content in Television, Films, and Music

Miriam E. Bar-on, MD, Chairperson

Daniel D. Broughton, MD

Susan Buttross, MD

Suzanne Corrigan, MD

Alberto Gedissman, MD

M. Rosario González de Rivas, MD

Michael Rich, MD, MPH

Donald L. Shifrin, MD

Liaisons

Michael Brody, MD

American Academy of Child and Adolescent Psychiatry

Brian L. Wilcox, PhD

American Psychological Association

Consultants

Marjorie Hogan, MD

H. James Holroyd, MD

Victor C. Strasburger, MD

S. Norman Sherry, MD

Staff

Jennifer Stone


    FOOTNOTES

The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.


    ABBREVIATIONS

STD, sexually transmitted disease; HIV, human immunodeficiency virus; MTV, Music Television; AIDS, acquired immunodeficiency syndrome.


    REFERENCES
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Recommendation
References
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  2. Singh S, Darroch JE Adolescent pregnancy and childbearing: levels and trends in developed countries. Fam Plann Perspect 2000; 32:14-23
  3. Braverman PK, Strasburger VC Sexually transmitted diseases. Clin Pediatr (Phila). 1994; 33:26-37
  4. The Alan Guttmacher Institute. Sex and America's Teenagers. New York, NY: The Alan Guttmacher Institute; 1994
  5. American Academy of Pediatrics, Committee on Adolescence Sexually transmitted diseases. Pediatrics. 1994; 94:568-572
  6. Sells CW, Blum RW Morbidity and mortality among US adolescents: an overview of data and trends. Am J Public Health. 1996; 86:513-519
  7. Miller BC, Monson BH, Norton MC The effects of forced sexual intercourse on white female adolescents. Child Abuse Negl. 1995; 19:1289-1301
  8. Roper Starch Worldwide Inc. Teens Talk About Sex. Adolescent Sexuality in the 90's: A Survey of High School Students. New York, NY: SIECUS; 1994
  9. Hampton HL Care of the woman who has been raped. N Engl J Med. 1995; 332:234-237
  10. American Academy of Pediatrics, Committee on Adolescence Sexual assault in adolescents. Pediatrics. 1994; 94:761-765
  11. Advocates for Youth. Health Futures in Jeopardy: Young People and Violence. Washington, DC: Advocates for Youth; 1994
  12. Coupey SM, Klerman LV, eds Adolescent sexuality: preventing unhealthy consequences. Adolesc Med 1992; 3:165-376
  13. Cohen MW Adolescent sexual activity as an expression of nonsexual needs. Pediatr Ann. 1995; 24:324-329
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  15. Roberts DF, Foehr UG, Rideout VJ, Brodie M. Kids and Media at the New Millennium: A Comprehensive National Analysis of Children's Media Use. Menlo Park, CA: Henry J. Kaiser Family Foundation; 1999
  16. 1998 Report on Television. New York, NY: Nielsen Media Research; 1998
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  18. Roper Starch Worldwide Inc. The America Online/Roper Starch Youth Cyberstudy 1999. Available at: http://corp.aol.com/press/roper.html. Accessed June 21, 2000
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  25. Brown JD, Steele JR. Sex and the Mass Media. Menlo Park, CA: Henry J. Kaiser Family Foundation; 1995
  26. Huston AC, Wartella E, Donnerstein E. Measuring the Effects of Sexual Content in the Media: A Report to the Kaiser Family Foundation. Menlo Park, CA: Henry J. Kaiser Family Foundation; 1998
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Pediatrics (ISSN 0031 4005). Copyright ©2001 by the American Academy of Pediatrics


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