Sex screen: the dilemma of media exposure and sexual behavior.

Worries about the influences that media may have on young people’s sexual knowledge, attitudes, and behaviors range back to the early days of motion pictures. The nickelodeon allowed anyone with 5¢ to view images that they might not see in the course of their everyday experience, short films of burlesque strippers, barebreasted natives of the South Pacific or Africa, and even a remarkably salacious Kiss made by Thomas Edison, the staid inventor of motion picture technology. The medical community began voicing its concern about the effects that entertainment media may have on sexual activity nearly 3 decades ago. After the 1972 Surgeon General’s report Television and Growing Up: The Impact of Televised Violence1 and a watershed 1975 review article on media violence in the Journal of the American Medical Association,2 the American Medical Association House of Delegates passed 2 media-related resolutions, one calling media violence “an environmental risk factor threatening the health and welfare of young Americans, indeed our future society”3 and another stating their opposition to “television programming that is sexually suggestive or pornographic.”4 The American Academy of Pediatrics (AAP), now the recognized leader among medical organizations on the issue of media effects on health, took another approach to the subject of sex and media. Concerned about media effects on the physical and mental health of children and adolescents, the AAP formed the Task Force on Children and Television in 1983. The Task Force issued the first AAP policy statement on media in following year. They asserted in their policy statement that, next to the family, television may be children’s most important source of information and the most powerful influence on their development.5 They also expressed the AAP’s concern that television’s portrayal of sex roles and sexuality was unrealistic and without health consequences such as pregnancy or sexually transmitted disease. Two years later, the AAP Committee on Adolescence issued another policy statement, Sexuality, Contraception, and the Media,6 implicating television as a powerful teacher of sexual behavior, but also indicating its potentially positive role in educating young people about responsible sexuality. In this statement, the AAP was joined by the American College of Obstetrics and Gynecology, the Society for Adolescent Medicine, and the American Public Health Association in “supporting and encouraging the airing of advertisements for nonprescription contraceptives on television” as long as the content was “educational, realistic and focused on responsible sexual behavior and decision-making.” The AAP urged television broadcasters to “alter the portrayal of sexuality in non-news programming to reflect realistic consequences and responsible behavior and to decrease the association of suggestive and stimulating sexual messages with product advertising.” The very different positions taken by the American Medical Association and the AAP demonstrate the strong opinions of clinicians who care for adolescents, the lack of confidence in the research evidence relating media and sexual behavior, and the ambivalence that the medical community feels about mass media as both a health threat and a powerful teaching tool. What the medical community did agree on, time and again, was the need for more research. As Escobar-Chaves et al demonstrate with their excellent survey, The Impact of Media on Adolescent Sexual Attitudes and Behaviors,7 the research to date is scant and the findings are difficult to translate into clinical applications. Less than 1% of the 2522 reviewed studies involving media and youth investigate the association between media use and sexual knowledge, attitudes, and behaviors. Studies of media exposure indicate that young people are using more media for longer periods of time at younger ages,8,9 and content analyses of television programming show that the prevalence of sexual content has been increasing over the past 2 decades.10–17 However, there are only 6 published research reports on the associations between media exposure and attitudes toward or beliefs about sex and only 7 more that investigated relationships between media use and sexual activity. Although their outcome measures differed widely, their findings are generally consistent: greater exposure to sexual content in media is associated with more permissive attitudes toward sexual activity, higher estimates of the sexual experience and activity of peers, and more and earlier sexual behavior among adolescents. Although the body of research evidence is small, the findings From the Center on Media and Child Health, Children’s Hospital Boston/ Harvard Medical School, Boston, Massachusetts. Accepted for publication Apr 14, 2005. doi:10.1542/peds.2005-0355F No conflict of interest declared. Address correspondence to Michael Rich, MD, MPH, Center on Media and Child Health, Children’s Hospital Boston/Harvard Medical School, 300 Longwood Ave, Boston, MA 02115. E-mail: michael.rich@childrens. harvard.edu PEDIATRICS (ISSN 0031 4005). Copyright © 2005 by the American Academy of Pediatrics.