1. Sexually-charged media and early sexual activity © Copyright 2010

2. The sexualized world of teens Adolescents live in a highly sexualized world Mass-media is full of sexy and sexually-active people Teens frequently watch TV and surf the internet

3. Sex on TV 75% of prime-time TV shows have sexual content Only 11% address the risks of sex* Strasburger V, Pediatrics. 2006. Kunkel et al. Kaiser Family Foundation. 2003.

4. Teen shows: where most of the sex is Strasburger V. Pediatrics. 2010.

5. Sex in high school Percentage of high school seniors who say that they have had sexual intercourse: 1991: 54.1% 1995: 53.1% 1999: 49.9% 2001: 45.6% (lowest since 1991) 2005: 46.8% 2009: 46.0% Centers for Disease Control and Prevention

6. Teen sex around the world Percent whod had sexual intercourse by 20 years of age/were not sexually active: Sub-Saharan Africa: 83/17 Asia, N. Africa, Middle East: not available/52 Latin America/Carribbean: 56/44 Five Western nations *: 77/23 (* France, Germany, Britain, Poland, U.S.) Guttmacher Institute

7. Is there a connection between watching sex on TV or on the internet and engaging in it?

8. Some studies find associations National longitudinal survey 1792 adolescents, age 12-17 Baseline and 1-year follow-up interviews –TV viewing habits –sexual experience –factors associated with adolescent sexual initiation Outcome Measures at 1 year: –initiation of intercourse –advancement in non-coital sexual activity level Collins RL et al. Pediatrics. 2004.

9. Predicted probabilities of intercourse initiation among virgins exposed to high versus low levels of TV sexual content Collins RL et al. Pediatrics. 2004.

10. Noncoital advancement among those exposed to high versus low levels of TV sexual content Collins RL et al. Pediatrics. 2004.

11. Some curious findings Exposure to TV that included only talk about sex was associated with the same risks as exposure to TV that depicted sexual behavior African American youths who watched more depictions of sexual risks or safety were less likely to initiate intercourse in the following year

12. Reverse causality Teens who are having sex early might be especially interested in watching sexy media This study controlled for that by measuring each subjects sexual activity at baseline

13. Conclusions Youths in the 90th percentile of TV sex-viewing were twice as likely to have had intercourse than youths in the 10th percentile, for all ages studied Watching TV sex predicts and may hasten adolescent sexual initiation Collins RL et al. Pediatrics. 2004.

14. Speculations Reducing adolescent exposure to this content, or increasing references to possible negative consequences of sexual activity, could delay the initiation of coital and non-coital activities Parents may be able to reduce the effects of sexual content by watching TV with their teens and discussing their own values about sex Collins RL et al. Pediatrics. 2004.

15. Reducing the amount of sexual talk and behavior on TV or the amount of time that adolescents are exposed to this content is likely to appreciably delay the initiation of both coital and noncoital sexual activities. - Rebecca Collins Implications Collins RL et al. Pediatrics. 2004.

16. Nagging questions 1- It is still hard to distinguish correlation from causation, despite longitudinal structure and efforts to control variables 2- Even if television watching seems to be associated with earlier initiation of sexual activity, we dont know the effect of changes in viewing habits or content 3 - In European countries with liberal sexual content on television, age of first sexual intercourse is on par with that in the U.S. Teen pregnancy rates are lower. If watching sex on TV leads to early sexual activity, shouldnt that age be lower in Europe?* Darroch JE et al. Fam Plann Perspect. 2001.

18. Second longitudinal study looks at relationship between sexual activity and exposure to four media

19. Study design 1,074 youths, 12-14 years old Equal numbers by race and gender Surveys about media use (TV, movies, magazines, music) and sexual activity Researchers calculated a sexy media diet (SMD) rating for each child Youths were divided into equal-sized quintiles, based on SMD ratings

20. Study design (contd) Two years later, 1,017 (95%) responded to a second survey about sexual behavior Those responses were correlated with each childs SMD Outcome measures: –sexual intercourse –noncoital forms of intimate contact Brown JD et al. Pediatrics. 2006.

21. Proportion of white adolescents reporting sexual intercourse by age and SMD Brown JD et al. Pediatrics. 2006.

22. Proportion of black adolescents reporting sexual intercourse by age and SMD Brown JD et al. Pediatrics. 2006.

23. Results Among whites, SMD was highly predictive of early sexual activity. Whites in top quintile for SMD when 12-14 yrs of age were 2.2 times more likely to have had intercourse when 14-16 than those in the lowest quintile for SMD, even after other relevant factors were introduced. Among blacks: No statistically significant relationship after controlling for factors that were more predictive, such as parental disapproval of teen sex and perceived permissive sexual norms among peers. Brown JD et al. Pediatrics. 2006.

24. Other factors associated with later initiation of sexual activity Whites: Getting good grades Perceived peer norms Parent disapproval Blacks: Perceived peer norms Parental disapproval Brown JD et al. Pediatrics. 2006.

25. Chicken or egg? None of these studies answer the question of whether watching sex in the media leads teens to get interested in sex, or whether teens who are interested in sex are drawn to media portrayals

26. In either case… Parents can have a strong influence on teens attitudes and behavior Pediatricians can help parents play a positive role

27. Many parents are unaware of their teens sexual activity A survey of middle-school students attending an adolescent clinic: - 58% of teens reported being sexually active - 98% of parents thought their teen was not sexually active Young TL et al. Arch Pediatr Adolesc Med. 1998.

28. Many parents dont discuss sex 2004 survey of 530 parents Nearly half of middle-school parents, one-fourth of high-school parents, had never spoken with children about sex or birth control Kaiser Family Foundation. Sex Education in America. 2004.

29. Survey of school principals 275 school principals: 10% of schools provide no sex education Of 90% providing some sex education: 30% abstinence only 20% comprehensive 47% abstinence plus (some mention of birth control) Kaiser Family Foundation. Sex Education in America. 2004.

30. Media fill the vacuum A 2004 survey of 519 teens, aged 15 to 17, found the media far outranked parents or schools as their primary source for information about birth control Kaiser Family Foundation. Seventeen Magazine. 2004.

31. Message from the media The media make sexual intercourse seem like normative behavior even for teens. Everyone does it on television and in the movies, or so it seems, yet the need for birth control, the risks of pregnancy or sexually transmitted infections, or the need for responsibility are rarely discussed. Strasburger V. Pediatrics. 2006.

32. Message from the media The media function as a "super peer," putting additional pressure on young people to have sex at a young age.* Most teenage girls feel pressure from the media to have sex.** *Strasburger V. Adolesc Med Clin. 2005 **Haag P. Voices of a Generation: Teenage girls on Sex, School & Self.1999.

33. Ethical issues If we assume that media portrayals of sex and sexuality are harmful, should we support censorship? Are there other responses to the media problem?

34. Parents role If parents discuss their expectations that teens will delay intercourse, teens have to take that opinion into serious consideration and may, in fact, begin intercourse later. If parents do not discuss sex with their children and teens, particularly the need for responsibility and the need for birth control, then the media will pick up the slack. Strasburger V. Pediatrics. 2006.

35. Role for the pediatrician Monitor television watching Take a media history: How much time do you spend in an average day with different media? Is there a television set or internet connection in your bedroom? Strasburger V. Pediatrics. 2006.

36. Role for the pediatrician Encourage parents to talk with their teens Talk in an age-appropriate manner Begin in early adolescence Answer questions honestly and completely Use correct anatomical terms Address at opportune moments, e.g. birth of a sibling or pet Strasburger V. Pediatrics. 2006.

37. Help parents Counsel parents and teens about risk factors associated with earlier sexual activity, e.g. early dating, excessive unsupervised time, truancy, and alcohol use

38. Advocacy Lobby for more responsible media portrayals of sexuality and sexual activity Advocate for condom ads on TV

39. Resources Brown JD, LEngle KL, Pardun CJ, Guo G, Kenneavy K, Jackson C. Sexy Media Matter: Exposure to Sexual Content in Music, Movies, Television, and Magazines Predicts Black and White Adolescents' Sexual Behavior. Pediatrics. 2006;117(4):1018-27.Sexy Media Matter: Exposure to Sexual Content in Music, Movies, Television, and Magazines Predicts Black and White Adolescents' Sexual Behavior. Collins RL, Elliott MC, Berry SH, Kanouse DE, Kunkel D, Hunter SB, Miu A. Watching Sex on Television Predicts Adolescent Initiation of Sexual Behavior. Pediatrics. 2004 Sept.;114(3):280-9.Watching Sex on Television Predicts Adolescent Initiation of Sexual Behavior Committee on Psychosocial Aspects of Child and Family Health and Committee on Adolescence. Sexuality Education for Children and Adolescents. Pediatrics. 2001 August;108(2):498-502.Sexuality Education for Children and Adolescents. Strasburger V. "Clueless": Why Do Pediatricians Underestimate the Media's Influence on Children and Adolescents? Pediatrics. 2006 April; 117(4):1427-1431"Clueless": Why Do Pediatricians Underestimate the Media's Influence on Children and Adolescents?