Edward Donnerstein

Health Effects of Media on Children and Adolescents

Youth spend an average of >7 hours/day using media, and the vast majority of them have access to a bedroom television, computer, the Internet, a video-game console, and a cell phone. In this article we review the most recent research on the effects of media on the health and well-being of children and adolescents. Studies have shown that media can provide information about safe health practices and can foster social connectedness. However, recent evidence raises concerns about medias effects on aggression, sexual behavior, substance use, disordered eating, and academic difficulties. We provide recommendations for parents, practitioners, the media, and policy makers, among others, for ways to increase the benefits and reduce the harm that media can have for the developing child and for adolescents.

Children, Adolescents, and the Media:: Health Effects

The media can be a powerful teacher of children and adolescents and have a profound impact on their health. The media are not the leading cause of any major health problem in the United States, but they do contribute to a variety of pediatric and adolescent health problems. Given that children and teens spend >7 hours a day with media, one would think that adult society would recognize its impact on young peoples attitudes and behaviors. Too little has been done to protect children and adolescents from harmful media effects and to maximize the powerfully prosocial aspects of modern media.

Sexual Socialization Messages on Entertainment Television: Comparing Content Trends 1997–2002

Previous content analyses of sex on television have relied on differing measures and sampling strategies, which makes it difficult to compare patterns of sexual portrayals over time. This large-scale study (N = 2,817 programs) examines the sexual messages presented on television across both broadcast and cable channels over a 5-year period, applying identical measures to three biennial samples of program content. Results demonstrate that sexual talk and behavior are highly frequent aspects of the television environment. Talk about sex is shown more often than sexual behavior, though both types of content increased significantly from 1997/1998 to 2001/2002. Over that time span, the percentage of shows portraying sexual intercourse doubled from 7 to 14%. Results also show that topics related to sexual risks or responsibilities (e.g., condom use, abstinence) are increasingly included on television, but nonetheless remain infrequent overall. Such safe sex messages occur most frequently in program environments where they are most relevant (i.e., when sexual intercourse is included in the story). The content analysis findings are discussed in terms of their implications for audience effects.

Report of the Media Violence Commission

Editor’s Note: In December, 2011, the International Society for Research on Aggression appointed a special commission to prepare a report on media violence. Their charge was as follows: “The ISRA Violent Media Effects Commission is charged with the task of producing a public statement on the known effects of exposure to media violence, based on the current state of scientific knowledge. If the Commission finds sufficient evidence of harmful effects, then the Commission’s public statement may include public policy recommendations, keeping in mind that effective policies may well differ across countries because of their different legal and cultural traditions and systems. The statement could be an original statement by the Commission, or could be an endorsement or modification of one or more similar statements offered in recent years by other major scientific bodies and/or groups of scientists who have appropriate expertise in the media violence domain. The statement (if sufficiently brief) or an Executive Summary statement (of a longer, more detailed statement) will be published in ISRA’s journal Aggressive Behavior and will appear on the ISRA web site. It may also be published in the ISRA Bulletin.” What follows is the final report of the Media Violence Commission, delivered in May, 2012. This statement was written by a group of internationally recognized active researchers in the field of media violence to summarize current knowledge about the strength of the link between violent media use and aggression, explain the psychological processes by which violent media may increase the risk of aggressive behavior, and offer practical advice on how parents and policy makers can deal with the issue.

Why Is It So Hard to Believe That Media Influence Children and Adolescents

The perpetrator of the Naval Yard shooting, who killed 12 people in September 2013, spent up to 16 hours a day playing violent video games (eg, “Call of Duty”). CNN asked Dr Bushman to write an OpEd piece about the possible role of violent video games in violence.1 In response to that OpEd, over 1400 people made comments denying any harmful effects of violent video games. Indeed, in the US Supreme Court’s 2011 decision on video games ( Brown v. Entertainment Merchants Association et al , No. 08-1448), Justice Scalia compared violent video games like “Call of Duty” to Grimm’s Fairy Tales and Homer’s Odyssey . A Super Bowl ad costs ∼

Sexual Media and Childhood Well-being and Health.

4 million for 30 seconds. Clearly, advertisers believe that a mere 30 seconds will lead consumers to buy their products. However, the media industry claims that the programming surrounding the ads has no impact on viewers. This is a paradox. How is it possible for the media to have no effect on children and adolescents when they spend an average of >7 hours/day with media (>11 hours/day if they have bedroom media)2 consuming it? Thousands of studies now exist, and the literature is increasingly clear about the potential impact of media on a variety of health issues (Table 1).3,4 Part of the problem may be that the general public, and even some academics, don’t know how to interpret this vast literature. The studies are epidemiologic in nature, meaning that predicting the greater … Address correspondence to Victor C. Strasburger, MD, Distinguished Professor of Pediatrics, University of New Mexico School of Medicine, MSC 10 5590, 1 University of New Mexico, Albuquerque, NM 87114. E-mail: vstrasburger{at}salud.unm.edu

The New Media of Violent Video Games Yet Same Old Media Problems

Sexual content is highly prevalent in traditional media, and portrayals rarely depict the responsibilities and risks (eg, condom use, pregnancy) associated with sexual activity. Exposure to such content is linked with shifts in attitudes about sex and gender, earlier progression to sexual activity, pregnancy, and sexually transmitted infection among adolescents. However, little information is available about moderators and mediators of these effects. We also know little about digital media, their sex-related content, and their potential influence on youth. Data from a few studies of older youth indicate that sexual displays on social media sites are related to problematic beliefs and behaviors among those who post this content and among viewers. Online pornography appears to be more problematic for youth than off-line sources. Given the vast and increasing amount of time youth spend online and their developmental openness to influence, more research attention to digital sexual media is needed. Those who undertake this work should identify potential negative consequences of use and opportunities to improve adolescent sexual health through digital media. Studies of on- and off-line media in which researchers examine younger media audiences, identify processes explaining sexual media effects on behavior, and moderators of effects are needed. Such studies could be used to inform interventions to reduce negative outcomes and increase positive media effects. Policy makers should stimulate the development of such interventions, including tools to help parents identify and manage negative media influences on their children’s sexual well-being and development and dissemination of innovative media literacy programs related to sexual health.

The media and aggression: From tv to the internet

Mass shootings from Jonesboro, Arkansas in 1998 to Aurora, Colorado and Newtown, Connecticut in 2012 have brought the issue of media effects (particularly violent video games) on young people to the forefront once again. Although discussion about the issue of media and their impact extends at least as far back as 1954, when the US Senate held formal hearings on whether media violence leads to juvenile delinquency, and encompasses thousands of research studies, reviews, and commentaries, conclusions remain elusive, particularly to policy makers and the media industry. While the majority of parents in the United States believe that there is a relationship between exposure to violent media and aggression, a substantial minority (48%) disagrees or are not sure. By contrast, a recent survey of psychologists and pediatricians found that the majority agree that violent video games may have harmful effects (B. J. Bushman and C. Carlos, unpublished data, 2013). The past decade has given us excellent new theoretical models and sophisticated research on the effects (both positive and negative) of new technology on children and adolescents. Yet, in spite of these advances, there still exists “gaps” in our—and it appears the public’s—knowledge and conclusions about the effects of some of these newer media technologies. Perhaps no area is more central and publicly debated then that of violent video games. This brief commentary will attempt to elucidate some of the problems and concerns in the current public debate but is not intended to be an exhaustive review of the literature.

A Plea for Concern Regarding Violent Video Games

Part 1. Introduction and Basic Issues. J.P. Forgas, A. Kruglanski, K.D. Williams, The Psychology of Social Conflict and Aggression: Homo Aggressivus Revisited. M. Mikulincer, P. Shaver, An Attachment Perspective on Interpersonal and Intergroup Conflict. K. Williams, E.D. Wesselman, The Link Between Ostracism and Aggression. D.S. Richardson, G.S. Hammock, Is It Aggression? Perceptions of and Motivations for Passive and Psychological Aggression. D. Ames, Pushing Up to a Point: The Psychology of Interpersonal Assertiveness. Part 2. Cognitive and Affective Influences on Conflict and Aggression. L.N. Pontus, T.L. Chartrand, Nonconscious Battles of Will: Implicit Reactions Against the Goals and Motives of Others. A.D. Galinsky, D. Gilin, W.W. Maddux, Using Both Your Head and Your Heart: The Role of Perspective-Taking and Empathy in Resolving Social Conflict. J.P. Forgas, H.B. Tan, Affective Influences on the Perception, Management and Resolution of Social Conflicts. T.F. Denson, E.C. Fabiansson, The Effects of Anger and Anger Regulation on Negotiation. A. Kruglanski, E. Orehek, The Role of the Quest for Personal Significance in Motivating Terrorism. Part 3. Conflict and Aggression in Relationships. C. Eckhardt, Intimate Partner Violence: Cognitive, Affective and Relational Factors. G. Fitzsimmons, J.E. Anderson, Interdependent Goals and Relationship Conflict. L. Zadro, Silent Rage: When Being Ostracized Leads to Aggression. L.B. Luchies, E. Finkel, The Doormat Effect: On the Dangers of Resolving Conflict via Unilateral Forgiveness. Part 4. Social, Cultural, and Evolutionary Factors in Social Conflict and Aggression. M. Van Vugt, The Male Warrior Hypothesis. C.A. Anderson, M. De Lisi, Implications of Global Climate Change for Violence in Developed and Developing Countries. E. Donnerstein, The Media and Aggression: From TV to the Internet. R. Kurzban, J. Christner, Are Supernatural Beliefs Commitment Devices for Intergroup Conflict? R. Huesmann, E. Dubow, P. Boxer, The Effect of Religious Participation on Aggression Over Ones Lifetime and Across Generations.D uring the past decade, there has been a burgeoning interest in the role of religiosity in family functioning and child and adolescent adjustment (e.g., bridges & moore, 2002; mahoney, Pargament, swank, & Tarakeshwar, 2001) and as a resource for adults coping with stress (Pargament, 1997, 2007). The focus of this chapter is on the role of religiosity across the life span in predicting adulthood aggressiveness. we use data from a 40-year prospective longitudinal study to examine (1) the extent to which parental religiosity when a child is 8 years old is related to the child’s religiosity at ages 19, 30, and 48, and the grandchild’s religiosity; and (2) the extent to which grandparental, parental, and child religiosity act as long-term protective factors against aggressive behavior in childhood, youth, and adulthood.Exposure to violence in media, including television, movies, music, and video games, represents a significant risk to the health of children and adolescents. Extensive research evidence indicates that media violence can contribute to aggressive behavior, desensitization to violence, nightmares, and fear of being harmed. Pediatricians should assess their patients’ level of media exposure and intervene on media related health risks (p.1495).

Screen Violence and Youth Behavior.

To the Editor: In the April issue of Mayo Clinic Proceedings, Hall et al1 authored a “plea for caution” in the interpretation of research on the impact of viewing video violence on the development of children and youth. The authors enumerated a series of investigations and reports on the impact of violence in media, including concerns about violence in comic books, movies, television, and video games. Additionally, they noted that the US Supreme Court was reviewing a California law that would ban the rental or sale of certain violent video games to those younger than 18 years. Hall et al pleaded for caution and expressed the hope that the Supreme Court would not be swayed by the evidence offered in support of the California law and suggested that the evidence was inconclusive on the effects of video violence and children. Indeed, the authors implied that all the research programs undertaken on the media violence topic during the past 50 to 60 years were merely examples of what they described as “moral panic” that emanated from well-intentioned but misguided concerns about society. Hall et al went so far as to chastise the American Academy of Pediatrics (AAP) and the American Psychological Association (APA) for publishing reports and recommendations that urged their professional members to alert their patients and clients to the dangers of media violence. The authors argued that the evidence of harmful effects was so weak and confused that these professional organizations were being irresponsible (and perhaps incompetent) in expressing their concern about the dangers that viewing media violence pose for children and youth. As professionals in communications, pediatrics, psychology, psychiatry, and public health, we are astounded by the inaccuracies evident in the conclusions offered by Hall et al. For example, they completely dismiss the extensive body of evidence accumulated during the past half century, starting with the Surgeon Generals research program on television violence and children in the late 1960s,2,3 the National Institute of Mental Health review in the 1980s,4 the review undertaken by the Group for the Advancement of Psychiatry in the 1980s,5 and the comprehensive review by the APA in the 1990s.6 In addition to overlooking these reviews by government and professional organizations, Hall et al raise an “old chestnut” of the catharsis hypothesis, suggesting that viewing media violence results in a purging of aggressive feelings and thereby reduces the likelihood of subsequent aggression. The catharsis hypothesis was popular in the 1960s and 1970s and was often cited by the media violence industry and its supporters. However, even the “father” of this notion, Seymour Feshbach,7 abandoned this theory and recanted his claims concerning “catharsis” as early as the 1980s. Finally, the fact that Hall et al suggest that large scientific and professional organizations, such as the AAP or APA, produced frivolous or ill-considered reports on policy and practice is an indication that the authors are poorly informed about the processes involved in developing and disseminating such reports. In the case of the APA report, 2 of us (E.D. and J.P.M.) can verify, from first-hand experience, that the APA spent almost 6 years and supported the work of a task force of 9 psychologists before reaching the conclusions that were finally passed by the 170 members of the Council of Representatives of APA. Similarly, 2 of us (M.R. and V.S.) were involved in the rigorous reviews undertaken by the AAP. One of us (R.W.M.) was chair of the Group for the Advancement of Psychiatry report and can attest to the rigorous deliberations of that group. These reports were undertaken in a very serious manner, and Hall et al simply dismiss these reports casually. We have collectively more than 200 years of professional experience in research, public health interventions, and communication concerning the effects of media violence on children and youth. Indeed, one of us (B.B.) was honored with the Order of Australia for advocacy for childrens media. We have reviewed evidence from hundreds of studies, both behavioral and neurologic, in both laboratory and natural environmental settings, both cross-sectional and longitudinal. For example, we refer readers to the reviews and commentary by Kunkel and Wilcox,8 Pecora et al,9 Rich,10 and Strasburger.11 The overwhelming conclusion to be drawn from this research is the fact that there are, indeed, harmful effects of viewing violence, as we noted in the aforementioned reviews.4-6 As such, there is a great need for concern on the part of parents, policy makers, and professionals in regard to the unbridled expansion of media violence directed to youngsters. Hall et al cite several reviews of research, notably that of Ferguson,12 which suggest that the state of research on media violence is complex and confused. They dismiss other reviews, such as those by Anderson et al13 and Huesmann,14 as irrelevant or perhaps biased. This strategy is similar to the writings of authors who have submitted amicus curia briefs to the Supreme Court in support of the video game industry. One of those amicus briefs, authored by Patricia A. Millett as Counsel of Record, claimed to have 82 signatories who were experts in media violence and were opposed to the belief that there are demonstrable effects of video violence on children and youth. In this instance, the so-called Millett Brief15 stood in clear opposition to the briefs of the State of California, the petitioners in the Supreme Court case, and the so-called Gruel Brief16 filed by Steven F. Gruel as Counsel of Record for the amicus brief of State Senator Leland Y. Yee, PhD, the California Chapter of the AAP, and the California Psychological Association. These dueling briefs would be worrisome if it were not for the fact that the 82 signatories of the Millett Brief have relatively little expertise in research or writing on the topic of media violence. In contrast, a large percentage of the 115 signatories of the Gruel Brief have outstanding credentials and are experts on the issue of media violence. A recent article in the Northwestern University Law Review17 has provided a detailed comparison of the professional competence of the signatories of the 2 amicus briefs. Clearly, the professionals supporting the Gruel Brief are providing competent and thoughtful analyses that urge professional concern about the harmful effects of media violence. On June 27, 2011, the Supreme Court issued its decision18 on the California Law restricting the distribution of some violent video games to minors. The Court, in a 7 to 2 decision (Justices Stephen Breyer and Clarence Thomas dissenting), determined that the California law was overly broad in restricting access to protected free speech by minors. It noted that the evidence of harmful effects of violent video games was not any stronger than the evidence showing harm from other violent video media and therefore the proposal from California was actually “underinclusive” because it did not propose to restrict those other violent video media such as Saturday morning cartoons. On this point, the Court noted that Underinclusiveness raises serious doubts about whether the government is in fact pursuing the interest it invokes, rather than disfavoring a particular speaker or viewpoint....Here, California has singled out the purveyors of video games for disfavored treatment—at least when compared to booksellers, cartoonists, and movie producers—and has given no persuasive reason why..18,p14, para 1 In his dissent, Justice Breyer noted that the evidence on video game violence being harmful was sufficient, and he appended a listing of about 150 research and review articles to support his claim. He concluded, But what sense does it make to forbid selling to a 13-year old boy a magazine with a picture of a nude woman [as the Supreme Court did in Ginsberg v. New York] while protecting a sale to that 13-year-old of an interactive video game in which he actively, but virtually, binds and gags the woman, then tortures and kills her.18, p19, para 1 Nevertheless, the Court was firm in its majority opinion that violent video games are a form of speech protected by the First Amendment. Given the outcome of the Supreme Court deliberations, it is clear that both government and industry are unlikely to find a common way to solve the problem of protection from harm. Also, given the strong conclusions from research that viewing violence can lead to harmful effects, such as changes in attitudes, values, and behavior favoring the use of aggression to resolve conflicts,4-6 as well as possible neurologic changes produced by viewing violence,19-22 it is imperative that health care professionals become knowledgeable about video violence and share that information with their patients. Thus, it is our considered opinion that the Hall et al article urging caution in giving advice about the harmful effects of media violence is overly cautious, if not foolish. Additionally, it is our considered opinion that we need to be very concerned about the impact of media violence on children and youth, for all the reasons identified in the professional reports and research reviews cited. Of course, it is true that there are no easy solutions to these problems, but we must remember that children and youth represent our future and that they depend on us to provide a healthy and safe environment in which they may grow and develop. Given the complexity of the issues, we may err no matter what choice we make, but should we not err on the side of concern by following the Hippocratic advice to “do no harm?” Thus, we end this commentary with “A Plea for Concern.”