Managing the Media Monster: The Influence of Media (from Television to Text Messages) on Teen Sexual Behavior and Attitudes

"The media are the air our young people breathe. That air should include accurate information about the risks and responsibilities of sexual behavior."

This report is intended to share with practitioners and programmes research about how the media influence the sexual knowledge, attitudes, and behaviour of young people (defined here as ages 12 to 24) - both positively and negatively.

The report, published by the United States (US)-based National Campaign to Prevent Teen and Unplanned Pregnancy, notes that the media are "powerful sex educators for young people....Television, music, movies, magazines, the Internet, and other kinds of media are not always healthy sex educators, however, because in the media sex rarely occurs inside loving, long-term relationships, and potentially negative outcomes or contraceptives are almost never discussed or depicted..." The three chapters in this report examine this reality in detail:

• Chapter 1, written by Dr. Michael Rich, a paediatrician and director of the Center for Media and Child Health at Children's Hospital Boston, Harvard Medical School (US), provides an overview of what is currently known about the effects of sexual content in the entertainment media young people typically use. As Dr. Rich documents, one content analysis of a variety of media that young adolescents in the US use frequently found that less than one percent of the sexual content could be construed as portraying healthy sexual behaviour."
• Chapter 2, written by Drs. Tilly Gurman and Carol Underwood - both of Johns Hopkins University - reviews 25 evaluated, peer-reviewed interventions from 19 countries that focus specifically on how effective media interventions have been in addressing adolescents' reproductive health. Using the evidence from these interventions, Drs. Gurman and Underwood offer four recommendations to consider when developing media interventions.
• Chapter 3, written by Dr. Sarah Keller of Montana State University-Billings, reviews more than 20 media-based interventions for sexual and reproductive health that have been conducted in the US. Dr. Keller draws not only from the US sexual health campaigns, but also from media campaigns designed to improve other aspects of adolescents' health, principally the truth® smoking prevention campaign. Dr. Keller's review also includes recent interventions for sexual health that use some of the newest forms of media, such as cell phones and Internet social networking sites.

An exerpt from the report follows: (footnote numbers have been removed by the editor)

"Specific recommendations based on the reviews of international and domestic interventions are provided in both Chapter 2 and 3. Those recommendations can be summarized into six broad elements that will help develop successful media campaigns.

1. Use Theory to Design, Implement, and Evaluate: ...Some of the most frequently used theories, such as the Theory of Planned Behavior, Social Cognitive Theory, and the Health Belief Model, identify the important factors that keep people from changing their current behavior and what may stimulate them to change. Media campaigns can be designed to focus on the most relevant of these factors: (1) external constraints or barriers (e.g., lack of access to contraceptives); (2) skills (e.g., how to put on a condom correctly); (3) self-efficacy (e.g., 'I think I can put on a condom correctly'); (4) attitudes (e.g., the benefits of using a condom are perceived as outweighing the risks); (5) perceived social pressure or norms (e.g., 'Everybody else, including in the media, is already having sex, so maybe I should, too.'); (6) self-image (e.g., 'Only stupid people don't wear condoms and I'm not stupid.”); (7) emotional reaction (e.g., 'I'm scared I might get pregnant.'); and (8) intention (e.g., 'I will use a condom every time.')....More information on health behavior theories is available in the Appendix of this report (see page 122).
2. Know and Involve the Target Audience:...Planners of effective media interventions know a lot about their target audiences. Such knowledge is gathered through formative research with target audience members - one-on-one interviews, focus groups - and through secondary analyses of existing surveys. Increasingly, campaign planners include members of the target audience in the planning as well as implementation phases....Knowledge of cultural and sub-cultural audience differences in sexual values and beliefs is especially important for crafting effective messages about sexual health....Formative research should be used to find out whether males and females may react differently to messages and appeals used in media interventions...
3. Use Multiple Media Channels as Well as Interpersonal Communication: ...[S]ome of the newest interventions for adolescents' sexual health in the United States are using cell phones and the Internet in novel ways that attract and engage youth. These are indeed promising approaches to increasing the frequency with which campaign planners can reach young people. Campaigns also tend to be more successful when they stimulate communication among the target audience. Interpersonal communication is especially important for sexual health campaigns because young people who want to engage in safe and healthy sexual behavior will need the social support of their peers and partners...
4. Strive for Long-term Exposure and Sustainability: ...A media campaign's chances of success are boosted when it reaches the target audience multiple times with consistent, clear messages, and when reinforcing messages and environmental supports are employed to sustain the desired changes in knowledge, attitudes, and behaviors...
5. Focus on the Environment as Well as Individuals: ...Young people need the endorsement of their parents, peers, and sexual partners to practice safe sex. They also need the means to practice healthy sexual behavior....[S]exual health advocates can use media techniques to lobby policy-makers to fund and expand sexual health services. Influential advocates and experts can write op-ed essays for newspapers and the blogs that policy makers read. They can meet with editorial boards and serve as guests on talk radio shows...
6. Evaluate Your Efforts: ...Evaluation at all steps in an intervention, including design (formative research), implementation (process evaluation), and effects (outcome evaluation) is important..."