Media Literacy and Teen Health Education
Author: Colleen Symanski-Sanders, RN, Forensic Nurse Specialist
Objectives: Upon completion of this CNE article, the reader will be able to
- Discuss media literacy and how messages from the media and other sources influence health behavior.
- Describe the adverse health effects of the media and its advertisements and their impact on teen body image.
- Develop interventions for teen health education by being media literate.
Media has an audience and included in that audience is our youth. It captures their attention at a time when they growing, maturing and vulnerable. In the year 2000, about one fourth of the population (70.4 million) were children under the age of 18 in the United States. Children are projected to remain a substantial percentage of the total population in 2020. The mental and physical health risk factors that teens face jeopardizes their well-being. From a very young age, children get much of their information from various media sources, such as television, movies, magazines, the Internet, books, videos, and advertising. Media does offer opportunities to learn in addition to being entertainment, but how our youth interpret media images and messages can be a contributing factor to a variety of health concerns. There is concern that ramifications of overuse or frequent media exposure can cause emotional immaturity, difficulty communicating, violent behavior, low self-esteem and poor math and science skills. The Key areas of concern can be classified into the five categories below
- Advertising, marketing, and consumerism;
- Violence, aggressive behaviors, and the desensitization to violence;
- Self-image and sexuality;
- Substance use and abuse; and
- Nutrition, obesity, and dieting.
Media is not to blame for the disconcerting health status of teens today, just as health clinicians are not to be blamed for the content of advertising. We do not need to prove that the media has an impact, but our oaths require us to act as advocates.
Advertising, Marketing, And Consumerism: Youth’s Exposure to Media
Media advertising and commercialism entice people by using powerful visual images and audio effects. This can be compelling, especially for children under the age of 8; because developmentally, they are unable to understand the true intent of commercials and advertising – which is to get them or their parents to buy a product. Children are also frequent targets of product merchandising for new movies, TV shows, and musical groups. The sole purpose of advertising is to sell, and an effective marketing approach is to sell anxiety, particularly to teens and young adults. Effective advertising can promote an insatiable hungering for more.
The increase in media mergers produced intricate business relationships that have the power to define media and pop culture. These relationships offer an immense opportunity for cross promotion and selling of talent and products among different companies owned by the same parent corporation. The list below describes some of the largest U.S. media giants and what they control (as of 02/2001). All of these companies have a vested interest in the Internet, TV, music, radio, publishing and or video.
- Viacom – the 2nd largest global media conglomerate. Owns MTV.
- Walt Disney – the 3rd largest global media conglomerate, with 2000 revenues that topped $25 billion.
- AOL Time Warner – $165 billion merger between AOL and Time Warner, approved by the FCC in Jan. 2001. The largest media merger in history and promises to be a powerhouse of integrated communication, media and entertainment across all platforms – computer, phone, TV, and handheld wireless devices.
- Vivendi Universal – This giant’s subsidiary, Universal Music Group, is the #1 music company in the world with roughly 22% of the 1999 global market.
- Sony – Made its name in electronics – has more than 1,000 subsidiaries worldwide. Sony Pictures Entertainment is 1 of the 7 major movie houses in Hollywood and is 1 of the top 5 distributors of albums.
A CBS Programming Chief, said it well, "The number one priority in television is not to transmit quality programming to viewers, but to deliver consumers to advertisers." Children spend more time in front of a TV screen than in school. They average 5 hours a day with media (television, computers, videotaped movies, and video games). By the time they turn 18, children will have witnessed more than 100,000 violent acts and more than 300,000 commercials. About 1 in 5 youth aged 10 to 17, who are regular Internet users, report having received at least one unwanted sexual solicitation on the Internet. Girls, older teens, troubled youth, frequent Internet users, chat room participants, and those who communicate online with strangers are at greater risk, according to an article in The Journal of the American Medical Association.
The American Academy of Pediatrics, a professional organization that is dedicated to the health and well-being of children/youth, developed media education guidelines for pediatricians and launched a media literacy education campaign in 1997 called "Media Matters". Their action was prompted by research that supported the existence of a relationship between media and the health of youth. In 2001, they released this statement; "Children and Adolescents are particularly vulnerable to the messages conveyed through television, which influence their perceptions and behaviors." The AAP's revised policy on Children and Television Violence proposed that health care professionals, the federal government, and the entertainment industry, work together to promote healthy television viewing for children.
"Children Now", a research and action organization, released research findings on the impact of media on today’s male teens. In their 1999 conference report, "Media Messages About Masculinity", they listed the various influences seen in media, such as:
- Sports coverage emphasizes the notion that violence is to be expected.
- Athletes who "play with pain" or "give up their body for the team" are often portrayed as heroes.
- Commercials seen during sports programming typically play on the insecurities of the audience, convincing them that purchasing a particular product will help overcome fears, embarrassments, and shortcomings.
- Commentators consistently use martial arts metaphors and language of war and weaponry to describe sports action.
Violence, Aggressive Behavior, and Desensitization
The January 17, 2001 Surgeon General’s report states that 61% of all programming contains some violence. The American Academy of Child and Adolescent Psychiatry reported that numerous studies on the effects of television violence have found that children and teens can:
- Become immune to the horror of violence;
- Gradually accept violence as a way to solve problems;
- Imitate the violence they observe on television, and/or
- Identify with certain characters, victims and/or victimizers.
The Centers for Disease Control (CDC) Injury Center defined violence as the "threatened or actual physical force or power initiated by an individual that results in, or has a high likelihood of resulting in, physical or psychological injury or death." The epidemic of violent behavior that existed in the 1990’s is not over and reports on crime rates disclose that involvement in violent behavior remains as high as the peak seen in 1993, though youth violence is less lethal. Adolescents between the ages of 12 and 17 remain twice as likely as adults to be victims of serious violent crimes. These are crimes of aggravated assault, rape, stealing by force or threat of violence, and homicide. The AAP’s policy, "Care of the Adolescent Sexual Assault Victim," published in June 2001 in Pediatrics, points out that adolescents continue to have the highest rates of rape and other sexual assaults of any age group, and that 66% to 75% of all adolescent rapes and sexual assaults are perpetrated by an acquaintance or relative of the adolescent.
It is disquieting that suicide is the third leading cause of death for young people aged 15 to 24. Suicide rates for males have decreased over the last 10 to 12 years, while the trend for females has remained the same. Of males 18 to 19 years of age, 66% abused alcohol and/or cocaine prior to suicide. Research indicates that overall, teens are not accessing suicide hot lines due to the impulsivity of the act, and this is often influenced by the use of alcohol.
Self-Image and Sexuality
Advertising hits the basic human need for a sense of belonging. It has been financially rewarding to send messages to the public, including teens. "Cool" is what the media promotes and teens need to feel a sense of belonging and acceptance from their peers. It is in these developing years that teens secure their identity and separation from adults. Many teens turn to their peers first and then to media such as MTV and the Internet for information (especially sexual issues). Knowledge of sexual and health risk factors is not sufficiently advertised nor communicated in cinema and TV shows. More than half (a reported 56%) of TV programs contain sexual content. Healthy and accurate information and media education is needed to help youths and perhaps their parents identify inappropriate sexual images portrayed in the media, including Internet access.
It has been reported that teenagers in the United States are more likely to have sexual intercourse before age 15 and have shorter and more sporadic sexual relationships than teenagers in Canada, France, Great Britain and Sweden and are more likely to have more than one partner in a given year. Though teenagers in the United States have levels of sexual activity similar to peers in other countries, it is believed that they are more likely to engage in shorter and more sporadic sexual relationships and are less likely to use contraception. According to the AAP policy statement "Sexuality, Contraception, and the Media", early sexual intercourse among American adolescents represents a major public health problem. Nearly 65% of high school seniors have had sexual intercourse, about half are currently sexually active, and 21% have had four or more partners. By their 18th birthday, 6 in 10 teenage women and nearly 7 in 10 teenage men have had sexual intercourse.
Conversely, 83% of students in the 7th and 8th grade reported they have not had sexual intercourse. Some teens that report abstinence engage in other sexual behaviors. In one study of urban high school students, who defined themselves as virgins, more than one-third of these students had participated in masturbation with a partner, fellatio with ejaculation, and/or cunnilingus. Teens are exposing themselves to riskier practices without fully understanding the risk. To avoid pregnancy, teens are engaging in unprotected anal sex.
Teen’s account for a significant proportion of the 15 million sexually transmitted diseases (STD’s) seen in the United States each year. If a partner is infected with an STD that causes discharge of pus and mucus, the risk of HIV transmission is three to five times greater. If one of the partners is infected with an STD that causes ulcers, such as syphilis or genital herpes, the risk of HIV transmission is nine times greater. In addition, STDs that are not detected and treated can increase the probability of pelvic inflammatory disease, infertility, ectopic pregnancy, and HIV transmission. The CDC estimates that half of all HIV infections in the U.S. occur among young people under the age of 25, and AIDS is the sixth leading cause of death among 15 to 24 year olds. Research provides clinicians with valuable statistics that can either be addressed or ignored (but, hopefully it won’t be ignored).
As many as 1 in 10 adolescent girls tested for chlamydia is infected and according to reports provided by states that collect age-specific data, teenage girls have the highest rates of chlamydial infection. In these states, 15 to 19 year old girls represent 46% of infections and 20 to 24 year old women represent another 33%. These percentages are consistent with high rates of other STD’s among teenagers. Compared to rates among teens in other developed countries, the occurrence of gonorrhea and chlamydia among U.S. teens is high. U.S. teenagers have higher STD rates than teenagers in other developed countries (including England, Canada, France, and Sweden) because they have more sexual partners and probably a lower level of condom use.
There has been a decline in the teen pregnancy rates in the United States. Contributory reasons for this decline include increased motivation of youth to achieve higher levels of education, employment training and goals, state mandated sexual education, greater knowledge about contraception, and greater social support for services related to both pregnancy and disease prevention among adolescents. However, despite the decline, the United States continues to have one of the highest teenage pregnancy rates in the developed world. Rates are twice those seen in England, Wales, or Canada and nine times as high as rates in the Netherlands and Japan. Despite the fact that effective interventions are in place, being first in this category still requires continued attention.
Substance Use And Abuse (Tobacco, Alcohol, & Drugs)
Cigarette companies, unable to use TV for advertising, use magazines for advertising to teens despite the 1998 Master Settlement Agreement. This was a landmark case between the tobacco industry and the nation’s state attorney general. Substantial censure from the public health community about that marketing approach did have some impact. Philip Morris stopped advertising in publications where the composition of those younger than 18 was 15% or more of the total readership, or where the audience included more than 2 million persons younger than 18 years or age, based on readership data. Research on teenager’s use of tobacco shows continued indications of decline from 2000 to 2001. In addition to adult interventions, teens have taken to the streets with their own anti-tobacco campaigns that appear to be effective. Who says media isn’t influential?
Rates of heavy/binge drinking amongst teens did not change much between 1999 and 2000. Subsequently, the percentage of high school seniors reporting heavy drinking declined significantly to a low of 28% in 1993. Since that time, the prevalence of heavy drinking has been fairly consistent. Heavy drinking (defined as having at least five drinks in a row at least once in the previous 2 weeks) was reported in 30-32% of 12th-graders, 26% of 10th-graders, and 14% of 8th-graders. Long-term trends for seniors indicated a peak in 1981, when 41% reported heavy drinking. Among 10th and 12th graders, males are more likely to drink heavily than are females. In 2000, 37% of 12th grade males reported heavy drinking, compared with 24% of 12th grade females. As adolescents get older, the differences between males and females in drinking behavior appear to become more distinct.
Youth who begin drinking before the age of 15 are four times more likely to develop alcohol dependence than those who wait until the age of 21. In the most recent federal survey of school-aged children, nearly 17% of 8th graders reported having been drunk at least once in the past year and nearly 40% of 10th graders reported the same. There are reports of parents who finance the cost of an apartment so that their teenager and his/her friends "have a place to go" if they are drinking. Combine media messages with some form of adult permission and a deadly mixture is developed. Research reveals that:
- 30% of drivers between the ages of 15 to 20, who died in motor vehicle crashes in the year 2000, had been drinking alcohol.
- More than one in three teens reported they had ridden with a driver who had been drinking alcohol in the past month (analysis of data from 1991–1997). One in six reported having driven after drinking alcohol within the same one-month time period.
- Among teen drivers who were killed in motor vehicle crashes in the year 2000, after drinking and driving, 80% were unrestrained.
- Alcohol is involved in about 40% of all adolescent drownings.
In September 1999, the Federal Trade Commission (FTC) issued a report reviewing the alcohol industry’s advertising and marketing practices. The FTC report requested the industry to "raise the current standards and reduce underage alcohol ad exposure," noting that some companies restrict advertising to venues where the underage audience is 25% or less. Mothers Against Drunk Driving (MADD) has asked for restricting the broadcasting of alcohol advertising to only shows that have a youth viewership of 10% or less. The American Medical Association (AMA) has called for a total ban on broadcast alcohol advertising. The FTC report shows that youth exposure to alcohol advertising in magazines is widespread. The numbers demonstrate that youth, ages 12 to 20, are more exposed to alcohol advertising than are adults over the age of 35. America’s teens saw more alcoholic beverage ads in magazines in 2001 than did people of legal drinking age. This pattern (of the alcohol industry exposing youth to more advertising than adults) cut across beverage types and brands, with the exception of wine. Teens were a major target audience for the industry’s magazine advertising in 2001, despite the industry’s claim to the contrary. The following analysis done by the FTC shows where and how the alcohol industry exposed teens to its products.
- More beer and distilled spirits ads: Marketers of beer and distilled spirits delivered 45% more beer ads and 27% more for distilled spirits ads to youth than to adults in magazines in 2001.
- More "malternative" ads: Marketers of low-alcohol refreshers, the so-called "malternatives", such as Smirnoff Ice, delivered 60% more advertising to youth than to adults.
- Fewer wine ads: For wine, the second leading alcohol advertising category in magazines, youth saw 58% less advertising than adults. The ability of most wine advertisers to reach an adult audience, while minimizing reach to the underage audience, shows how advertisers can reach an adult target audience without overexposing youth.
- Underage youth saw nearly as much advertising as young adults, ages 21-34. Adults over age 35 were a distant third audience. For example, individuals of ages 21-34 saw 16% more beer advertising than did youth of ages 12-20; however, youth of ages 12-20 saw 95% more beer advertising than did adults aged 35+.
- Alcohol ad dollars follow youth audiences: Ten magazines with underage audience compositions at or above 25% accounted for nearly one-third of all alcohol advertising expenditures in measured magazines. In addition, more than half of the money spent on alcohol magazine advertising was in 24 magazines with youth audiences that exceeded 15%. In fact, twenty-five brands placed all of their magazine advertising in youth-oriented magazines.
Drugs of abuse are not a new social phenomenon. But as we look at other health issue trends, it is the drugs of choice and their desired effect culturally that need examining. Many of these drugs are appealing to our teens during a time of maturation and they feed upon their sense of well-being and acceptance. If male teens want to have a more masculine physique, they can turn to anabolic steroids for assistance. In today’s competitive school sports environment, illegal use of steroids offers a competitive edge for performance. Designer drugs (known as Club drugs) are also very popular. Methylenedioxyamphetamine (MDMA) is a synthetic, psychoactive drug with both stimulant and hallucinogenic properties. Street names for MDMA include Ecstasy, Adam, XTC, hug, beans, and love drug. Its chemical structure is similar to methamphetamine and mescaline, which are other synthetic drugs known to cause brain damage.
Designer/Club drugs are taken at raves, dance parties, nightclub-like settings, and other social events frequented by adolescents and young adults. Besides offering a recreational high, other drugs, specifically rohypnol, delivered a new dating tactic with its "date-rape" appeal, adding to increased aggressive behavior. Since about 1990, GHB (gamma-hydroxybutyrate) has been abused in the U.S. for euphoric, sedative, and anabolic (body building) effects. Like rohypnol, GHB has been associated with sexual assault in cities across the country.
From 1999 to 2000, the use of MDMA has increased and the perceived availability of MDMA amongst 12th graders rose from 40% in 1999 to 51% in 2000. The percentage of 8th, 10th, and 12th graders reporting illicit drug use in the prior 30 days increased substantially from 1992 to 1997, but remained stable from 1999 to 2000. In 2000, 25% of 12th graders reported using illicit drugs in the previous 30 days, as did 23% of 10th graders and 12% of 8th graders. Among 12th graders, males are more likely to use illicit drugs than are females (28% versus 22%, respectively, in 2000). For 8th graders, however, males and females are equally likely to report the use of illicit drugs (12% of males and 11% of females reporting use in the last 30 days).
Studies show that females of all ages worry about their weight. Many teens begin honing their dieting "skills" at early ages, prompted by observing behaviors and images to which they are exposed. Obesity in children can be associated with heavy TV viewing and the most commonly advertised foods on children’s programming are typically high in sugar, salt, and fat.
Sadly, media promotes an unrealistic image of how people should look. Often, the thin and perfect-looking individual on screen or in print is not even one whole person but parts of several people. Using body doubles, airbrushing, and computer-graphic techniques the "ideal and desired person" is created. It is not possible for teens to achieve the images portrayed. This adds to anxiety, feelings of imperfection, and the continued search for "more". Advertising has also been more effective in reaching males as advertisers expand their market. Eating disorders, once isolated to the female gender, may soon be non-gender specific as the trend in males with eating disorders increases.
Media Education Guidelines- A Clinical Starting Point
The guidelines, developed by the AAP for pediatricians, are a 5-step process that can be applied to all healthcare professionals involved in pediatric and adolescent services. The basic components of the 5-step process are as follows:
Step 1 – "to become familiar with the research that has been done on media, including advertising, and how the messages and images that media present correlate with various health attitudes and behaviors among young people.
Step 2 – to become familiar with the basics of media education. The Academy’s "Media Matters" campaign offers of variety of resources and materials on media education.
Step 3 – to bring media education into the office or clinic setting. You can do this by using the simple Media History Form created by the Academy.
Step 4 – to relate specific behavioral, attitudinal, and health factors to an individual child or adolescent.
Step 5 – a result of step four in which counseling and guidance is tailored for the specific needs. (The guidelines and a media history form are available from the AAP)
It is estimated that teenagers make up approximately 9% of medical visits, however, according to studies, many teenagers today have undiagnosed eating disorders, depression, or sexually transmitted diseases, or are developing poor health habits, such as sedentary lifestyles or smoking, that carry into adulthood. However, a study published in a pediatric journal reported that almost one-half of adolescent office visits did not include counseling or education, and only 3% of teens received counseling on such issues as smoking, sexually transmitted diseases, and weight control. To disregard the power of the media would be like ignoring facts such as seat belts saving lives or helmets protecting heads from injuries.
- The Alan Guttmacher Institute (AGI): In Their Own Right: Addressing the Sexual and Reproductive Health Needs of American Men. New York. AGI. 2002. Unpublished tabulations of the 1995 National Survey of Adolescent Males and the 1995 National Survey of Family Growth.
- AGI: Why is Teenage Pregnancy Declining? The Roles of Abstinence, Sexual Activity and Contraceptive Use. New York. AGI. 1999.
- AGI: Teenage Sexual and Reproductive Behavior in Developed Countries: Can More Progress Be Made? New York. AGI. 2001.
- AGI: Teenagers' Sexual and Reproductive Health: Developed Countries. Facts in Brief.
- American Academy of Pediatrics: Media Education in the Pediatric Practice-An overview of Media and the Pediatricians Role. AAP 1997.
- American Academy of Pediatrics: Media Matters, AAP 1997.
- Lori O'Keefe: American Academy of Pediatrics: Pediatricians should "tune in" to patients' media habits. AAP News, January 2001.
- American Academy of Child and Adolescent Psychiatry: News Release; "AACAP Shares Important Facts on Children and Television Violence". February 14, 2001.
- America's Children: Key National Indicators of Well-Being. 2002. Developed by the Federal Interagency Forum on Child and Family Statistics.
- Shaffer D, Greenberg T: Teen Suicide Fact Sheet; Columbia University and New York State Psychiatric Institute. August 9, 2002.
- Department of Health and Human Services: Youth Violence: A Report of the Surgeon General.
- Ford CA: Limiting Confidentiality of Adolescent Services – What are the Risks? JAMA. 2002 Vol. 288 August 14, 2002.
- Frontline. A Report on the Creators and Marketers of Popular Culture for Teenagers. ©2001 http://www.pbs.org/wgbh/pages/frontline/shows/cool/
- Bushman B, Bonacci A: Violence and Sex Impair Memory for TV Ads. Journal of Applied Psychology. 2002;87:557-654.
- Klein N: No Logo – Taking Aim at Brand Bullies. St. Martin’s Press, LLC. 1999.
- CDC Press Release: "Most Teens Not Provided STD Or Pregnancy Prevention Counseling During Check-Ups". December 6, 2000.
- National Institutes of Health, National Institute on Drug Abuse.
- OverExposed: Youth a Target of Alcohol Advertising in Magazines.
- Reddy DM, Fleming R, Swain C: Effect of Mandatory Parental Notification on Adolescent Girls' Use of Sexual Health Care Services. JAMA Vol. 288 No. 6 August 14, 2002.
- Resnick MD, Bearman PS, Blum RW, et al: Protecting adolescents from harm: Findings from the National Longitudinal Study on Adolescent Health. JAMA 1997; 278:823-832.
- Schuster MA, Bell RM, Kanouse DE. The sexual practices of adolescent virgins: genital sexual activities of high school students who have never had vaginal intercourse. Am J Public Health 1996;86:1570-1576.
- AAP Policy Statement "Sexuality, Contraception, and the Media". Pediatrics 2001;107:191-194.
Colleen Symanski-Sanders, RN, Forensic Nurse Specialist, has been a Registered Nurse for over 18 years. She has extended her education into forensic nursing, criminal profiling, and psychopathy receiving a Certificate as a Forensic Nurse Specialist. She has over 16 years experience in public health and home care nursing.
Colleen has been an author of educational material for St. Petersburg College, St. Petersburg, Florida. She has also lectured on a variety of topics at numerous nursing symposiums and conferences across the country. She is on the Editorial Board for "Home Health Aide Digest" and "Private Duty Homecare" publications.