Media exposure feeding children's violent acts, AAP policy states

ARTICLE REPRINT • From the January 2002 AAP News, the official news magazine of the American Academy of Pediatrics

Playing violent video games is to an adolescent's violent behavior what smoking tobacco is to lung cancer.

That's according to information included in the revised AAP Policy Statement Media Violence, which indicates that playing violent video games accounts for a 13% to 22% increase in adolescents' violent behavior compared to a 14% increase in lung cancer from smoking tobacco.

"When the surgeon general originally reported that there was a relationship between smoking and cancer, tobacco companies said there wasn't conclusive proof about an association between the two," said Michael Rich, M.D., M.P.H., FAAP, member of the AAP Committee on Public Education. "It took a long time for there to be studies that proved a direct correlation.

"There are people who have smoked for 60 years and are fine and others who have died from smoking. We're saying the same thing with media violence because we can't pick out exactly which children may be harmed from exposure to media violence," he added.

According to the policy statement, "Extensive research evidence indicates that media violence can contribute to aggressive behavior, desensitization to violence, nightmares and fear of being harmed."

The policy statement reports that children between the ages of 2 and 18 years spend an average of six hours and 32 minutes each day using media, which includes television, commercial or self-recorded video, movies, video games, print, radio, recorded music, computer and the Internet. In fact, they spend more time using media than any other activity, with the exception of sleeping, notes the policy.

"Children are replacing other activities with new types of media," Dr. Rich said. The statistics for violence in media are shocking:

• 61% of broadcast programming produced from 1995 through 1997 portrayed interpersonal violence in an entertaining or glamorized manner, with the highest proportion of violence in children's programs (University of California, Center for Communications and Social Policy. National Television Violence Studies I, II, and III. Thousand Oaks, CA: Sage Publications; 1996, 1997 and 1998);
• 100% of all animated feature films produced in the United States between 1937 and 1999 featured violence ( Yokota F, Thompson KM. JAMA. 2000;283:2716-2720: and
• 21% of the 33 most popular video games feature violence against women ( Dietz TL. Sex Roles. 1998;38:425-442).

"Pediatricians deal with child development and behavior so pediatricians need to help parents understand the influences of a variety of factors on children," Dr. Rich said. "Emotional and mental health are every bit as important as physical health.
"There are many demands made on pediatricians' time," he added. "Media is just one of the things we have to introduce to families. It can't be brought up at every visit, which would be nice, but we should at least let parents know to pay attention to their children's media exposure. Then, when there is a problem, we can go into whatever depth is necessary."

The policy statement recommends that pediatricians:

• remain aware of the influence of media on children, incorporate media histories into annual well-child visits and suggest healthy alternatives;
• encourage parents to make thoughtful media choices and limit children's media exposure to one to two hours per day;
• ensure that only nonviolent media choices be provided in outpatient waiting rooms and inpatient settings;
• encourage parents, schools and communities to educate children to be media literate;
• collaborate with other state and national level health care organizations, educators, government and research funding sources to keep media violence on the public health agenda;
• advocate for more child-positive media, not censorship;
• advocate for simplified content-based media ratings; and
• avoid buying and using entertainment media that are harmful to children in the hope of eliminating the production of these types of materials.

"The problem with the rating system is that each type of media uses different types of ratings," Dr. Rich said. "We'd like a common rating system that will tell parents the reason for the rating."

Education is the key to changing the current situation with media violence, according to Lt. Col. Dave Grossman. As executive director of the Killology Research Group, Grossman studies violent behavior and educates the public to build a safer society.
"I remember when my first grade teacher taught us that cigarettes can kill," said Grossman, who authored a book titled "Stop Telling Our Kids to Kill." "I went home that day and told my dad I wanted him to stop smoking. Once we get children educated about media violence, this generation will do to the television industry what my generation did to the tobacco industry," he said.

At a presentation at the AAP National Conference & Exhibition in October, Grossman cited a Stanford University study that compared groups of third- and fourth-grade students: an intervention group that had reduced, limited television, video and video game exposure and a control group whose media exposure was not limited. Researchers discovered that the students whose media time was restricted experienced a 50% decrease in verbal aggression and a 40% decrease in physical aggression ( Robinson TN, et al. Arch Pediatr Adolesc Med. 2001;155:17-23).

"We need to look at the cause of violence like a doctor looks at the cause of heart disease," Grossman said. "We're living in an era of juvenile mass murderers like we've never seen before. We believe that the amount of violence and mass murders today predicts the amount of mass murders in the workplace in the future."

Although the amount of media violence is distressing, the Academy believes that media can communicate positive messages to children and can be used for educational purposes. David Kaplan, M.D., FAAP, chair of the AAP Committee on Adolescence, recently represented the Academy at this year's Soap Opera Summit to encourage daytime drama writers and producers to include story lines that interest teen-agers, including bullying, depression, suicide, sexuality, pregnancy and sexually transmitted disease prevention, patient confidentiality and obesity.

The AAP Committee on Public Education's Media Resource Team also is available for members who would like to help spread the message. For details, visit www.aap.org/mrt/default.htm.

Reprinted with permission. American Academy of Pediatrics, AAP News, January 2002.