Pediatricians should 'tune in' to patients' media habits

ARTICLE REPRINT • From the January 2001 AAP News, the official news magazine of the American Academy of Pediatrics

Teen-agers rank media as their second leading source of information about sex, indicating a need for pediatricians to help patients and parents identify inappropriate sexual images portrayed in the media, according to a revised AAP Policy Statement.

"If the media is that important to how they (adolescents) learn about sex, then pediatricians need to recognize that and talk to their patients about how sex images are portrayed in the media as being unrealistic without consequences," said Miriam Bar-on, M.D., FAAP, chair of the AAP Committee on Public Education.

According to the policy statement, Sexuality, Contraception, and the Media (Pediatrics. 2001; 107:191-194), early sexual intercourse among American adolescents represents a major public health problem. Nearly two-thirds of high school seniors have had sexual intercourse, about half are currently sexually active, and 21% have had four or more partners (Singh S, Darroch JE. Fam Plann Perspect. 2000; 32:14-23).

"Because teen-agers follow the behaviors they observe in the media without seeing the known consequences, they may end up pregnant, with HIV or with other sexually transmitted diseases," Dr. Bar-on said. "These are big medical issues, and if the public doesn't recognize the significant health effects media has on children and adolescents, then it's the pediatricians' job to inform them of the potential health effects.

"Media is certainly the one factor contributing to early sexual behavior that is most easily altered," Dr. Bar-on said.

According to Dr. Bar-on, pediatricians should ask patients what they're watching, reading and listening to, how much time they spend watching television, playing video games and listening to music, and about the images they perceive in the media, then explain the discrepancies between realistic and media images.

Dr. Bar-on also recommends confirming that parents know what their children are watching and seeing in the media. "Parental knowledge is a powerful tool," she added.

A media history form available from the AAP Media Matters campaign can be completed by parents or adolescents in the waiting room to help expedite the process.

Victor Strasburger, M.D., FAAP, professor of pediatrics at University of New Mexico School of Medicine, even recommends beginning media education with parents of 6- to 12-month-old infants.

"In 30 seconds, pediatricians can tell parents that media is an increasingly important issue and inform them about Academy recommendations such as waiting until children are older than 2 to watch television and then to limit the amount of time spent watching television," Dr. Strasburger said. "Pediatricians are most successful with their constituents - parents of infants and small children - and can teach parents about the tremendous influence media has on young minds."

By the time teen-agers graduate from high school, they will have spent 15,000 hours watching television, compared to 12,000 hours spent in the classroom (Strasburger VC. Adolesc Med. 1993;4:479-493).

Although teen-agers rank school sex education programs as their leading source of information about sex, recent reports indicate that the increasing number of sex education programs are not comprehensive enough, according to Dr. Strasburger. In fact, the AAP Policy Statement now recommends that pediatricians encourage schools to add a media education component to current sex education programs or to create media education programs.

It's estimated that the average American adolescent views nearly 14,000 sexual references per year but only 165 of these references deal with birth control, self-control, abstinence, or the risk of pregnancy or STDs (Harris L. Sexual Material on American Network Television During the 1987-'88 Season. New York, NY: Planned Parenthood Federation of America; 1988, and Lowry DT, Shidler JA. Journalism Q. 1993;70:628-637).

According to the policy statement, media can have a positive influence on children and families by promoting responsible and healthy sexual behavior by adults and adolescents. It recommends pediatricians encourage the broadcast industry to produce programming with responsible sexual content and to air public service announcements (PSAs) that promote abstinence or the use of condoms.

"Pediatricians can have a huge impact on the local level. Local television station managers are very sensitive to their local constituency and are perfectly willing to air PSAs that national networks won't touch," Dr. Strasburger said.

"The American public needs to move beyond its hysteria that talking about birth control will lead to increased sexual activity. We need to think about media as an access point for birth control."

According to the policy, "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.

"If we changed the nature of how sex is portrayed in the media by 90 degrees, we could have a significantly healthier population," Dr. Strasburger said.

The policy statement also recommends encouraging movie theater owners and video store owners to enforce movie ratings and supporting further research into the impact of sexual content in the media.

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Media education needed

from the AAP Committee on Public Education

Although the effects of media exposure on children and adolescents have been identified as a public health issue, a majority of pediatric residents do not receive training in this area. Members of the AAP Committee on Public Education, Michael Rich, M.D., M.P.H., FAAP, and Miriam Bar-on, M.D., FAAP, uncovered these findings in a recent survey.

In the survey of pediatric program directors (97% response rate) Drs. Rich and Bar-on discovered that only 58 of the 204 responding programs offered education on one or more medium. Television was the medium most often discussed as having effects on children and adolescents. Although these results are discouraging, the number of programs that include information on the effects of television has doubled since 1986 (Smith RD, et al. Am J Dis Child. 1986;140:78-79). More than 70% of residents have curricula devoted to the discussion of specific health behaviors such as sexual risks, behavioral disorders, eating disorders, obesity, tobacco, alcohol and violence; fewer than 20% learn about media's influence on these behaviors.

Program directors identified not having trained faculty and lack of curricular materials as the two main barriers to having curricular units devoted to media and media education. An overwhelming majority of program directors were Academy members (95.1%), but only 29.9% were aware of the Media Matters initiative. Program directors who participated in media education training sessions, were significantly more likely to include media as part of the residency curriculum than those who did not. Residents develop lifelong habits during residency. The committee believes including curricular information on media may be a resource-effective means of improving health for children growing up in a media saturated environment.

The Committee on Public Education is committed to promoting media education to pediatricians, parents and their children/adolescents, and members of the community at large as a means to help mitigate the negative effects of media. The committee has published six statements on the effects of media on children. The most recent is Sexuality, Contraception and the Media (Pediatrics. 2001; 107:191-194).

Reprinted with permission. American Academy of Pediatrics, AAP News, January 2001.