3. FROM THE AMERICAN ACADEMY OF PEDIATRICS
content, yet only 14% of sexual inci- per issue to sexual topics.19 Cover- erectile dysfunction drugs are ubiq-
dents mention any risks or responsi- age of sex as a health issue in mag- uitous. In the first 10 months of
bilities of sexual activity.8,9 Talk about azines is more common than on TV, 2004, the makers of these drugs
sex on TV can occur as often as 8 to 10 but the overarching focus seems to spent nearly $350 million on adver-
times per hour.10 Between 1997 and be on deciding when to lose one’s tising.32 At the same time, advertise-
2001 alone, the amount of sexual con- virginity.12,20 ments for birth control products
tent on TV nearly doubled.9 ● The Internet has become an abun- are rare.2
So-called reality TV has also entered dant source of both sexual informa- Because so many sex education pro-
the picture. In 1997, there were only 3 tion and pornography that cannot grams have recently been focused on
reality dating shows; by 2004, there be regulated.21,22 Online pornogra- abstinence only, the media have argu-
were more than 30.11 Some shows, phy is now a $1 billion industry.12 In ably become one of the leading sex ed-
such as Temptation Island, bring par- a national sample of 1500 10- to 17- ucators in the United States today.2 Ad-
ticipants together for the sole purpose year-olds, nearly half of the Internet olescents frequently cite the media as
of seeing who “hooks up.” A study of users had been exposed to online a source of sexual information.2 For ex-
college students revealed that viewing pornography in the previous year.23 ample, in a national survey the media
such shows correlated with beliefs in a In addition, unwanted sexual solici- rivaled parents and schools as a
double standard—that men are sex tations and harassment are not un- source of information about birth con-
driven and that men and women are common,24 although they may not be trol.33 The media are powerful sources
sexual adversaries.11 It is interesting to as frequent as parents fear.25 for behavioral “scripts” concerning
note that the less sexually experienced ● Social networking Web sites and sexual situations, especially for inex-
students were more likely than sexu- home pages enable teenagers to perienced teenagers.2,34 Yet, parents
ally experienced students to be watch- present themselves publicly, some- and legislators fail to understand that
ing reality shows, which suggests the times in sexually suggestive although they may favor abstinence-
importance of such programs for sex- ways.12,26 One study of 233 teen only sex education (despite the lack of
ual socialization.12,13 home pages revealed that nearly any evidence of its effectiveness),35 the
In addition to TV, other media provide 10% mentioned sex, and girls were 3 media are decidedly not abstinence
frequent messages about sexual times more likely to do so than only. In fact, the United States has
behavior. boys.27 A recent study of 500 publicly some of the most sexually suggestive
available MySpace profiles revealed media in the world.2 American media
● Music continues to be a major
that nearly one-quarter of them ref- make sex seem like a harmless sport
source of sexual suggestiveness. In in which everyone engages, and re-
erenced sexual behaviors.28 Also, a
1 study, 40% of lyric lines contained sults of considerable research have in-
national survey of nearly 1300 teen-
sexual material, and only 6% con- dicated that the media can have a ma-
agers and young adults revealed
tained healthy sexual messages.14 jor effect on young people’s attitudes
that 20% reported having sent or
An analysis of the 279 most popular posted nude pictures or videos of and behaviors.12–18 In fact, the media
songs in 2005 revealed that 37% themselves (“sexting”).29 may function as a “superpeer” in con-
contained sexual references and vincing adolescents that sexual activity
● Advertisements often use sex to sell.
that degrading sexual references is a normative behavior for young teen-
Women are as likely to be shown in
were common.15 agers.2,36,37 In a survey of 2100 11- to
suggestive clothing (30%), partially
● Virtually every R-rated teen movie clad (13%), or nude (6%) as they are 17-year-old girls, only the 11-year-olds
since the 1980s has contained at to be fully clothed.30 As one expert reported that they did not feel pres-
least 1 nude scene and, often, sev- noted, “When sexual jokes are used sure from the media to begin having
eral instances of sexual intercourse to sell everything from rice to roach- sex.38
(eg, the American Pie movie se- killer, from cars to carpets, it’s hard
ries).16 Teen movies also contain to remember that sex can unite two IMPACT OF SEXUAL CONTENT ON
distorted views of romance and nor- souls, can inspire awe. Individually, ADOLESCENT BEHAVIOR
mal adolescent sexuality.16–18 these ads are harmless enough, Numerous studies have delineated the
● Teen magazines are popular with sometimes even funny, but the cu- media’s powerful influence on adoles-
preadolescent and adolescent girls mulative effect is to degrade and de- cents’ sexual attitudes, values, and be-
and devote an average of 2.5 pages value sex.”31 Advertisements for liefs.2,39– 42 Unlike the media violence re-
PEDIATRICS Volume 126, Number 3, September 2010 577
Downloaded from www.pediatrics.org. Provided by Chulalongkorn Univ on September 10, 2010
4. search literature, in which some 2000 rather than later,63 and sexually ex- that adolescents do not always listen
studies exist, there have been only a plicit media may be particularly to their elders.2 In 2007, both CBS and
handful of studies on the effects of sex- important.41,64 FOX refused a condom advertisement
ual content on actual behavior. At least as “inappropriate” because it men-
a dozen correlational studies have ex- CONTRACEPTIVE ADVERTISING tioned preventing pregnancy rather
amined the relationship between the The United States is the only Western than preventing HIV/AIDS.78 Advertise-
amount of sexual content viewed on TV nation that still subscribes to the dan- ments for emergency contraception
and early onset of sexual inter- gerous myth that giving teenagers ac- are virtually nonexistent on American
course.43–53 The most recent studies cess to birth control—and media rep- TV, despite the fact that every year,
have revealed that (1) listening to sex- resent a form of access—will make American women have 3 million un-
ually degrading lyrics is associated them sexually active at a younger age. planned pregnancies, which lead to 1.3
with earlier sexual intercourse,40,53 (2) Other countries advertise birth control million abortions. Advertising for
black female teenagers’ exposure to products widely and have a much emergency contraceptives could be an
rap music videos or X-rated movies is lower rate of teen pregnancy.12,16 Al- important way to reduce the number
associated with the likelihood of multi- though the teen birth rate had been of abortions in the United States.79
ple sexual partners or testing positive declining in the United States up until POSITIVE IMPACT
for an STI,49 (3) teenagers whose par- 2005–2006, it has declined just as
ents control their TV-viewing habits much or more in other countries. A re- The media can be powerful vehicles for
are less sexually experienced,51,52 and cent study revealed that 86% of the re- sexual health education. Socially re-
(4) exposure to sexual content in the cent decline in teen pregnancies could sponsible messages can be embedded
media is a significant factor in the be attributed to increased contracep- into mainstream programming—
intention to have sex in the near tive use, and only 14% was attributable a practice dubbed “entertainment-
future.52–54 to increased abstinence.65 The recent education” or “edutainment.”39 Collab-
3% increase in teen births could be a orative efforts between the Kaiser
Nine longitudinal studies have given
“blip,” or it could be attributable to an Family Foundation and the producers
potential answers to the question of of the hit TV show ER resulted in suc-
whether sexy media contribute to increase in abstinence-only sex edu-
cation and the concomitant reduc- cessful story lines about the risks of
early sexual activity, and the answer human papillomavirus and the useful-
seems to be “yes.”41,55– 62 Results of 7 of tion in accurate information about
ness of emergency contraception.80 In
these studies have shown that expo- contraception.66– 68
2002, Friends aired an episode about
sure to sexual content in TV and Eight peer-reviewed, controlled clini- condoms, and 27% of a national sam-
other media in early adolescence— cal trials have revealed that giving ple of teenagers saw the program;
particularly for white teenagers— can teenagers freer access to condoms many of them reported that they talked
as much as double the risk of early does not increase their sexual activity about condom effectiveness with an
sexual intercourse. Adolescents whose or encourage virginal teenagers to be- adult as a direct result of the episode.81
parents limit their TV-viewing are less gin having sex, but it does increase the In 2008, a study showed that viewers of
likely to engage in early sex.58 Younger use of condoms among those who are a Gray’s Anatomy episode learned that
children who have viewed adult- already sexually active.69–76 Advertising HIV-positive women could still have
oriented TV shows and movies are condoms, birth control pills, and emer- HIV-negative infants.82 The Soap Opera
more likely to begin having sexual in- gency contraception on TV and radio Summit in Hollywood and international
tercourse earlier.61 The study samples could further decrease the teen preg- efforts to embed story lines into popu-
together total nearly 10 000 teenagers nancy rate. Yet, several networks lar soap operas are other examples of
nationwide, and the most ambitious refuse such advertisements.77,78 prosocial efforts. The media giant Via-
studies included other media such as Telling teenagers, “Wait until you’re com and the Kaiser Family Foundation
movies, music, and magazines.57 In ad- older to begin having sex, but if you have launched an ambitious project to
dition, a recent study revealed that can’t wait, use birth control” is a dou- produce $120 million worth of public
early exposure to sexual content dou- ble message. But, it is a double mes- service announcements and print ad-
bled the risk of teen pregnancy.60 sage that every teenager in America vertisements concerning HIV/AIDS and
Clearly, the media play a major role in can understand and benefit from, and to encourage Viacom producers to in-
determining whether certain teenag- it is consistent with normal adolescent clude story lines in their TV shows that
ers become sexually active earlier psychology, because it acknowledges will raise AIDS awareness.83 Such ef-
578 FROM THE AMERICAN ACADEMY OF PEDIATRICS
Downloaded from www.pediatrics.org. Provided by Chulalongkorn Univ on September 10, 2010
5. FROM THE AMERICAN ACADEMY OF PEDIATRICS
forts demonstrate that the entertain- networking sites and how they basic principles of media literacy
ment industry can be receptive to out- work so that they can effectively into their sex education pro-
side input and that healthier content counsel children and adolescents grams. Studies have shown that
can be introduced into mainstream about them.89 effective media literacy programs
media without government pressure 3. Pediatricians and child advocacy can be protective against un-
or the threat of censorship. groups should encourage the enter- healthy media effects.90,91 Federal
Mass media have also been used pro- tainment industry to produce more money should be spent on com-
actively to increase parent-child com- programming that contains respon- prehensive sex education pro-
munication about sex. In North Caro- sible sexual content and that focuses grams but not on abstinence-only
lina, a mass media campaign using on the interpersonal relationship in programs, which have been found
billboards and radio and TV public which sexual activity takes place (Ta- to be ineffective.35,65– 68,92–94
service announcements delivered the ble 1). One way to do this would be to 5. Pediatricians should urge the
message, “Talk to your kids about sex. hold annual seminars for writers, broadcast industry to air advertise-
Everyone else is.” In follow-up re- producers, and directors in Holly- ments for birth control products.
search, exposure to the message cor- wood, perhaps in cooperation with The federal government also needs
related significantly with parents talk- other groups. Similarly, Madison Ave- to encourage the advertising of
ing to their children about sex during nue and advertisers need to be en- birth control, especially emergency
the following month.84 couraged to stop using sex to sell contraceptives.
products. Educational seminars
might help to achieve this goal. 6. Pediatricians should urge the
RECOMMENDATIONS
broadcast industry to limit adver-
1. Pediatricians can help parents and 4. Pediatricians should urge schools
tisements for erectile dysfunction
teenagers to recognize the impor- to insist on comprehensive sex ed-
drugs until after 10 PM.
tance of the media by asking at ucation programs (to counter the
least 2 media-related questions at influence of sexually suggestive and 7. Pediatricians should urge the
each well visit77: (1) How much time explicit media) that incorporate broadcast media to include healthy
do you spend daily with entertain- messages about sex and sexuality
ment media? and (2) Is there a TV in their programming, especially in
set or Internet access in your bed- TABLE 1 Guide to Responsible Sexual Content media that children and early teen-
in TV, Films, and Music: Some agers use most frequently.95
room? Research has shown that Suggestions for the Presentation of
bedroom TVs are associated with Responsible Sexual Content 8. Pediatricians, the broadcast indus-
greater substance use and sexual Recognize sex as a healthy and natural part of try, the federal government, and pri-
activity by teenagers.85 A recent life.
vate foundations should support fur-
Parent and child conversations about sex are
study revealed that office-based important and healthy and should be ther research into the impact of
counseling is effective and could re- encouraged. sexual content in the media on chil-
sult in nearly 1 million more chil- Demonstrate that not only the young, unmarried, dren’s and adolescents’ knowledge
and beautiful have sexual relationships.
dren and adolescents adhering to and behavior.96 A national task force
Not all affection and touching must culminate in
the American Academy of Pediat- sexual intercourse. on children, adolescents, and the me-
rics recommendation to limit me- Portray couples having sexual relationships with dia should be convened by child advo-
dia time to less than 2 hours/day.86 feelings of affection, love, and respect for one
another. cacy groups in conjunction with the
2. Pediatricians should counsel par- Consequences of unprotected sex should be Centers for Disease Control and Pre-
ents to recognize the importance of discussed or shown. vention and/or the National Institutes
Miscarriage should not be used as a dramatic
the media, exert control over their convenience for resolving an unwanted of Health to study the issue of chil-
children’s media choices, keep pregnancy. dren, adolescents, and media, devise
their children’s bedrooms free of Use of contraceptives should be indicated as a new research, locate funding
normal part of a sexual relationship.
TVs and Internet connections, and Avoid associating violence with sex or love. sources, and make recommenda-
avoid letting their children see PG- Rape should be depicted as a crime of violence, tions to Congress, the broadcast in-
13– and R-rated movies that are in- not one of passion. dustry, and the American people.
The ability to say “no” should be recognized and
appropriate for them.61,87,88 Pedia- respected.
tricians and parents also need to be Modified from Haffner DW, Kelly M. Adolescent sexuality in LEAD AUTHOR
aware of the importance of social the media. SIECUS Rep. March/April, 1987:9 –12. Victor C. Strasburger, MD
PEDIATRICS Volume 126, Number 3, September 2010 579
Downloaded from www.pediatrics.org. Provided by Chulalongkorn Univ on September 10, 2010
6. COUNCIL ON COMMUNICATIONS AND Gwenn S. O’Keeffe, MD Brian Wilcox, PhD – American Psychological
MEDIA EXECUTIVE COMMITTEE, Kathleen G. Nelson, MD Association
Victor C. Strasburger, MD
2009 –2010
Gilbert L. Fuld, MD, Chairperson CONTRIBUTING PAST EXECUTIVE CONTRIBUTOR
Deborah Ann Mulligan, MD, Chair-elect COMMITTEE MEMBERS Jane D. Brown, PhD
Tanya Remer Altmann, MD Regina M. Milteer, MD
Ari Brown, MD Donald L. Shifrin, MD
Dimitri A. Christakis, MD STAFF
Kathleen Clarke-Pearson, MD LIAISONS Gina Ley Steiner
Benard P. Dreyer, MD Michael Brody, MD – American Academy of Veronica Laude Noland
Holly Lee Falik, MD Child and Adolescent Psychiatry vnoland@aap.org
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582 FROM THE AMERICAN ACADEMY OF PEDIATRICS
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9. Sexuality, Contraception, and the Media
Victor C. Strasburger and The Council on Communications and Media
Pediatrics 2010;126;576-582; originally published online Aug 30, 2010;
DOI: 10.1542/peds.2010-1544
Updated Information including high-resolution figures, can be found at:
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