Children,Adolescents,andtheMedia Contributors GUEST EDITOR VICTORC.STRASBURGER,MD ProfessorofPediatrics,ProfessorofFamily&CommunityMedicine,Chief,Department ofPediatrics,DivisionofAdolescentMedicine,UniversityofNewMexicoSchoolof Medicine,Albuquerque,NewMexico AUTHORS CRAIGA.ANDERSON,PhD DistinguishedProfessor,DepartmentofPsychology,IowaStateUniversity,Ames,Iowa CARSONA.BENOWITZ-FREDERICKS,BA DepartmentofHealth,BehaviorandSociety,JohnsHopkinsBloombergSchoolofPublic Health,Baltimore,Maryland DINAL.G.BORZEKOWSKI,EdD AssociateProfessor,DepartmentofHealth,BehaviorandSociety,JohnsHopkins BloombergSchoolofPublicHealth,Baltimore,Maryland JEFFCHESTER,MSW ExecutiveDirector,CenterforDigitalDemocracy,Washington,DC EDDONNERSTEIN,PhD DepartmentofCommunication,UniversityofArizona,Tucson,Arizona LORIDORFMAN,DrPH Director,BerkeleyMediaStudiesGroup,Berkeley,California KAYLORGARCIA,BA DepartmentofHealth,BehaviorandSociety,JohnsHopkinsBloombergSchoolofPublic Health,Baltimore,Maryland DOUGLASA.GENTILE,PhD AssociateProfessor,DepartmentofPsychology,IowaStateUniversity,Ames,Iowa SONYAA.GRIER,MBA,PhD AssociateProfessor,DepartmentofMarketing,KogodSchoolofBusiness,American University,Washington,DC MELANIEHINGLE,PhD,MPH,RD AssistantResearchProfessor,DepartmentofNutritionalSciences,UniversityofArizona, Tucson,Arizona MARJORIEJ.HOGAN,MD DepartmentofPediatrics,HennepinCountyMedicalCenter;AssociateProfessorof Pediatrics,UniversityofMinnesota,Minneapolis,Minnesota vi Contributors AMYB.JORDAN,PhD MediaandDevelopingChildSector,AnnenbergPublicPolicyCenter,Universityof Pennsylvania,Philadelphia,Pennsylvania JENNIFERKOLB,MD PediatricResident,DepartmentofPediatrics,UniversityofWisconsin–Madison,Madison, Wisconsin DALEKUNKEL,PhD Professor,DepartmentofCommunication,UniversityofArizona,Tucson,Arizona ALEXISR.LAURICELLA,PhD PostdoctoralFellow,NorthwesternUniversity,Evanston,Illinois MEREDITHMASSEY,EdM DepartmentofHealth,BehaviorandSociety,JohnsHopkinsBloombergSchoolofPublic Health,Baltimore,Maryland CATHYMCCARTHY,MPH MorristownMedicalCenter,AtlanticHealthSystem,Morristown,NewJersey KATELYNA.MCDONALD Student,DepartmentofPsychology,IowaStateUniversity,Ames,Iowa KATHRYNC.MONTGOMERY,PhD Professor,SchoolofCommunication,AmericanUniversity,Washington,DC MEGANA.MORENO,MD,MSEd,MPH AssistantProfessor,DepartmentofPediatrics,UniversityofWisconsin–Madison, Madison,Wisconsin GWENNSCHURGINO’KEEFFE,MD,FAAP CEOandEditorinChief,PediatricsNow,Wayland,Massachusetts SARAPROT,MA DoctoralStudent,DepartmentofPsychology,IowaStateUniversity,Ames,Iowa WALTERD.ROSENFELD,MD GoryebChildren’sHospital,AtlanticHealthSystem,Morristown,NewJersey VICTORC.STRASBURGER,MD ProfessorofPediatrics,ProfessorofFamily&CommunityMedicine,Chief,Department ofPediatrics,DivisionofAdolescentMedicine,UniversityofNewMexicoSchool ofMedicine,Albuquerque,NewMexico BRINTHAVASAGAR,MD,MPH DepartmentofHealth,BehaviorandSociety,JohnsHopkinsBloombergSchoolofPublic Health,Baltimore,Maryland ELLENA.WARTELLA,PhD Al-ThaniProfessorofCommunication,ProfessorofPsychology;ProfessorofHuman DevelopmentandSocialPolicy;Director,CenteronMediaandHumanDevelopment, NorthwesternUniversity,Evanston,Illinois Children,Adolescents,andtheMedia Contents Preface xi VictorC.Strasburger Children,Adolescents,andtheMedia:HealthEffects 533 VictorC.Strasburger,AmyB.Jordan,andEdDonnerstein 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 causeofanymajorhealthproblemintheUnitedStates,buttheydocon- tributetoavarietyofpediatricandadolescenthealthproblems.Giventhat childrenandteensspend>7hoursadaywithmedia,onewouldthinkthat adultsocietywouldrecognizeitsimpactonyoungpeople’sattitudesand behaviors. Too little has been done to protect children and adolescents fromharmfulmediaeffectsandtomaximizethepowerfullyprosocialas- pectsofmodernmedia. Overview:NewMedia 589 Gwenn Schurgin O’Keeffe Pediatricians care for children’s growth and development from the time they are born until they become adults. In addition, pediatricians must be vigilant for external influences. Technology influences children of all ages.Seventy-fivepercentofteenagersowncellphones,with25%using themforsocialmedia.Technologycanleadtoanincreaseinskillsandso- cialbenefitsbutthereisalsothepotentialforharmsuchassexting,cyber- bullying, privacy issues, and Internet addiction, all of which can affect health.Pediatriciansmustbecomewellversedinthenewmediatoprovide media-orientedanticipatoryguidanceandadviceonmedia-relatedissues. SocialNetworkingSitesandAdolescentHealth 601 Megan A. Moreno and Jennifer Kolb Socialnetworkingsitesarepopularamongandconsistentlyusedbyado- lescents.Thesesitespresentbenefitsaswellasriskstoadolescenthealth. Recently,pediatricprovidershavealsoconsideredthebenefitsandrisks ofusingsocialnetworkingsitesintheirownpractices. ShouldBabiesBeWatchingTelevisionandDVDs? 613 Ellen A. Wartella and Alexis R. Lauricella Should babies be watching television and DVDs? This is a reasonable questiontoaskbutadifficultonetoanswer.Thisarticlereviewsthetheo- ries and related research to examine what is known about infant media use. The review provides evidence both for and against each theory. Theimportanceofinfantslearninghowtowatchandlearnfromscreenme- diapresentationsisindicatedandthenewworldofmediatowhichbabies areexposedisdiscussed. viii Contents InternetBullying 623 Ed Donnerstein There is substantial literature on the impact of the mass media on chil- dren’s and adolescents’ health and development. The question of what role new technology plays in the media’s influence is now a subject of bothreviewanddiscussion,particularlyregardinghealthrisksandinter- vention.Thisarticletakesabrieflookatonlineusageandthetheoretical mechanismsthatmightmakeInternetaccessmoreproblematicinterms of risks, compared with more traditional media such as television and film.Oneoftheserisks,knowntodayascyberbullyingorInternetharass- ment,isscrutinizedindetail. ProsocialEffectsofMedia 635 Marjorie J. Hogan Parents, teachers, health care providers, and other caring adults worry about the harmful influence of media messages and images on children and teens and wonder how to recognize and encourage positive and healthyuseofmedia.Fordecades,expertshavecommentedonthepower ofmedia.Mediadepictionscanleadtonegativeattitudesandbehaviorin some young viewers. This article discusses whether prosocial, tolerant, andcooperativeattitudesandbehaviorcanbelearnedandimitatedbychil- drenandadolescentsandwhethermediacannurtureorstimulatecreativity oractivelypromotehealthandwell-beinginyoungconsumers. VideoGames:Good,Bad,orOther? 647 Sara Prot, Katelyn A. McDonald, Craig A. Anderson, and Douglas A. Gentile Videogamesareapervasivepastimeamongchildrenandadolescents.The growingpopularityofvideogameshasinstigatedadebateamongparents, researchers,videogameproducers,andpolicymakersconcerningpoten- tial harmful and helpful effects of video games on children. This article providesanoverviewofresearchfindingsonthepositiveandnegativeef- fectsofvideogames,thusprovidinganempiricalanswertothequestion, arevideogamesgoodorbad?Thearticlealsoprovidessomeguidelines tohelppediatricians,parents,andothercaregiversprotectchildrenfrom negativeeffectsandtomaximizepositiveeffectsofvideogames. TheNewThreatofDigitalMarketing 659 Kathryn C. Montgomery, Jeff Chester, Sonya A. Grier, and Lori Dorfman Because of their avid use of new media and their increased spending power,childrenandteenshavebecomeprimarytargetsofanew“media andmarketingecosystem.”Thedigitalmarketplaceisundergoingrapidin- novation as new technologies and software applications continue to re- shapethemedialandscapeanduserbehaviors.Theadvertisingindustry, inmanyinstancesledbyfoodandbeveragemarketers,ispurposefullyex- ploitingthespecialrelationshipthatyouthhavewithnewmedia,asonline marketingcampaignscreateunprecedentedintimaciesbetweenadoles- centsandthebrandsandproductsthatnowliterallysurroundthem. Contents ix ChildhoodObesityandtheMedia 677 Melanie Hingle and Dale Kunkel Thisarticleassessestheroleplayedbymediaincontributingtothecurrent epidemicofchildhoodobesity.Electronicmediause,oftenreferredtoas screen time, is significantly correlated with child adiposity. Although the causalmechanismthataccountsforthisrelationshipisunclear,itiswell establishedthatreducingscreentimeimprovesweightstatus.Mediaad- vertising for unhealthy foods contributes to obesity by influencing chil- dren’s food preferences, requests, and diet. Industry efforts have failed toimprovethenutritionalqualityoffoodsmarketedontelevisiontochil- dren,leadingpublichealthadvocatestorecommendgovernmentrestric- tionsonchild-targetedadvertisementsforunhealthyfoods. BodyImage,EatingDisorders,andtheRelationshiptoAdolescentMediaUse 693 CarsonA.Benowitz-Fredericks,KaylorGarcia,MeredithMassey, BrinthaVasagar,andDinaL.G.Borzekowski Historicallyandcurrently,mediamessagesaroundbodyshapeandsize emphasize the importance of being below-average weight for women and hypermuscular for men. The media messages around physical ap- pearance are not realistic for most and lead to body dissatisfaction for mostadolescents.Interventionsdesignedtomitigatetheinfluenceofneg- ativemediamessagesonadolescents’bodyimagearepresented;how- ever,mosthaveshownlimitedsuccess. SchoolDaze:WhyareTeachers andSchoolsMissingtheBoatonMedia? 705 Victor C. Strasburger MostAmericanschoolsare50yearsbehindinincorporatingnewtechnol- ogyintotheclassroomandusingmediawisely.Someexpertsestimatethat 65%oftoday’sgrade-schoolstudentsmayendupdoingjobsthathavenot evenbeeninventedyet.Abundantevidencenowexiststhatchildrenand teenslearnpreferentiallyfromthemedia,yetthemediaareoftenfrowned onastoodistractingforstudentsortoodistantfromthebasic3Rs.Amer- icanschoolsarefailingintheirfundamentalresponsibilitytostudents.Ed- ucatorsneedtolearnhowtousemediaandnewtechnologywisely. TenYearsofTeenHealthFX.com:ACaseStudyofanAdolescentHealthWebSite 717 Dina L.G. Borzekowski, Cathy McCarthy, and Walter D. Rosenfeld TheInternet,incontrasttoin-personinteractionswithhealthproviders,al- lowsanonymousandnonpunitive easeofaccess.Adolescentshavelong sought honest, direct answers to important but embarrassing questions abouthealth;emergingtechnologiesprovideavenuetoobtainrelevantinfor- mationwithoutgeographic,time,financial,andpersonalbarriers.Thisarticle isacasestudyofTeenHealthFX.com.Thoseinterestedinhowyouthaccess onlinehealthinformationcanlearnofthepositiveandnegativeaspectsof deliveringmessagesthroughtheInternet.Thisarticlediscussestheprocess involved in creating and maintaining TeenHealthFX and the challenges of providingonlinehealthinformationtoadolescentsvianewtechnology. Index 729 Children,Adolescents,andtheMedia Preface VictorC.Strasburger,MD GuestEditor Itisacompletemysterytomewhysomepeopledon’t“getit”—themediarepresentone ofthemostpowerfulforcesshapingyoungpeople’slivestoday.Potentially,themedia canhaveaneffectonvirtuallyeveryconcernthatparentsandpediatricianshaveabout children and adolescents—sex, drugs, aggressive behavior, school performance, obesity, eating disorders, even sleep. And when young people are now spending 7-11hours a day with media, it seems like a no-brainer. So why don’t some people understandthis? IhopethisissueofPediatricClinicswillgoalongwayinconvincingthenay-sayers that media are not onlyimportant, theyare now crucial in young people’s lives. And that media can be a force for good or not-so-good. Yo—Hollywood and Madison Avenue—wedonothateyou.Wejustwishyouwouldunderstandthatwiththebillions ofdollarsyoumakeeveryyear,youhaveapublichealthresponsibilityaswell.Aswe adolescent medicine specialists always counsel parents never to say to their teen- agers: we wish you would dobetter! American media are absolutely amazing some- timesinagoodandpositiveway(I’lljustmentionTVshowslikeSesameStreet,The Wire, Modern Family, Glee, and Nature and a few recent movies like March of the Penguins,ToyStory,Hugo,WarHorse,TheKing’sSpeech,andBully). I want to thank Kerry Holland at Elsevier for her support and encouragement for doingthisissueandalloftheauthors—whoaresomeofthefinestmindsinthefield ofAmericanmedia—forcontributingtheirexpertise. VictorC. Strasburger,MD Departmentof Pediatrics Division ofAdolescent Medicine Universityof NewMexicoSchool ofMedicine MSC10 5590,1Universityof NewMexico Albuquerque,NM87131,USA E-mail address: [email protected] PediatrClinNAm59(2012)xi doi:10.1016/j.pcl.2012.03.028 pediatric.theclinics.com 0031-3955/12/$–seefrontmatter(cid:1)2012ElsevierInc.Allrightsreserved. Children, Adolescents, and the Media: Health Effects Victor C. Strasburger, MDa,*, Amy B. Jordan, PhDb, Ed Donnerstein, PhDc KEYWORDS (cid:1)Media (cid:1) TV (cid:1) Newtechnology (cid:1)Internet (cid:1) Cyberbullying (cid:1) Sexting (cid:1) Medialiteracy KEYPOINTS (cid:1) Youngpeoplenowspend7to11hoursperdaywithavarietyofdifferentmedia—more timethantheyspendinschoolorsleeping. (cid:1) Researchhasshownthatchildrenandteenagerslearnfromthemedia,andtheirbehavior canbeinfluencedbymedia. (cid:1) Mediacanhavesignificanteffectsonhealth:eg,obesity,aggressivebehavior,substance use,earlysexualactivity,eatingdisorders. (cid:1) Mediacanbepowerfullyprosocialattimes. (cid:1) Parents,clinicians,andschoolsneedtoadapttotheworldofnewtechnologyandunder- standtheinfluencethatmediacanhaveonyoungpeople. True,mediaviolenceisnotlikelytoturnanotherwisefinechildintoaviolentcrim- inal.But,justaseverycigaretteonesmokesincreasesalittlebitthelikelihoodof alungtumorsomeday,everyviolentshowonewatchesincreasesjustalittlebit thelikelihoodofbehavingmoreaggressivelyinsomesituation. —PsychologistsBradBushmanandL.RowellHuesmann1(p248) “Something’sintheair,andIwouldn’tcallitlove.Likeneverbefore,ourkidsare being bombarded by images of oversexed, underdressed celebrities who can’t seem to step out of a car without displaying their well-waxed private parts to photographers.” —Leadarticle,Newsweek,February12,20072 OneerectpenisonaUSscreenismoreincendiarythanathousandguns. —NewsweekcriticDavidAnsen3(p66) a DepartmentofPediatrics,DivisionofAdolescentMedicine,UniversityofNewMexicoSchool ofMedicine,MSC105590,1UniversityofNewMexico,Albuquerque,NM87131,USA;b Media andDevelopingChildSector,AnnenbergPublicPolicyCenter,UniversityofPennsylvania,202 South36thStreet,Philadelphia,PA19104-6220,USA;c DepartmentofCommunication,Univer- sityofArizona,1103EastUniversityBoulevard,POBox210025,Tucson,AZ85721,USA *Correspondingauthor. E-mailaddress:[email protected] PediatrClinNAm59(2012)533–587 doi:10.1016/j.pcl.2012.03.025 pediatric.theclinics.com 0031-3955/12/$–seefrontmatter(cid:1)2012ElsevierInc.Allrightsreserved. 534 Strasburgeretal AcigaretteinthehandsofaHollywoodstaronscreenisagunaimedata12-or 14-year-old. —ScreenwriterJoeEszterhas4 Researchshowsthatvirtuallyallwomenareashamedoftheirbodies.Itusedtobe adult women, teenage girls, who were ashamed, but now you see the shame down to very young girls—10, 11 years old. Society’s standard of beauty is an imagethatisliterallyjustshortofstarvationformostwomen. —Best-sellingauthorMaryPipher5 [Mydoctor’s]onlygonetoonemedicalschool,butifyougoonline,youcanget advicefromallovertheworld. —TeenagerquotedinTECHsexUSA,20116(p17) Wearedoingouryouthadisserviceifwebelievethatwecanprotectthemfrom theworldbylimitingtheiraccesstopubliclife.Theymustenterthatarena,make mistakes,andlearnfromthem.Ourroleasadultsisnottobetheirpolicemen,but tobetheirguide. —danahboyd,20077 Mediarepresentoneofthemostpowerfulandunderappreciatedinfluencesonchild andadolescent development and health.More than 50yearsofmediaresearch and thousandsofmediaeffectsstudiesattesttothepotentialpowerofthemediatoinfluence virtuallyeveryconcernthatparentsandclinicianshaveaboutyoungpeople:aggressive behavior, sex, drugs, obesity, eating disorders, school performance, suicide, and depression.8Althoughthemediacannotbeaccusedofbeingtheleadingcauseofany of these health problems, they can make a substantial contribution. Yet media can alsobepowerfullybeneficialinthelivesofchildrenandadolescents.Notonlycanthey teachyoungchildrennumbersandlettersandincreaseschoolreadiness(eg,Sesame Street),9themediacanalsoteachmoreabstractconceptslikeempathy,acceptance ofdiversity,andrespectfortheelderly.10,11Clearly,muchmoreresearchisneeded,12 butclinicians,parents,schooladministrators,andgovernmentofficialsallneedtobe awareoftheresearchontheeffectsofmodernmediaandactaccordingly(Fig.1). “OLD”VERSUS“NEW”MEDIA Accordingtoarecentreport,mediarepresenttheleadingleisure-timeactivityforboth childrenandadolescents(Fig.2).13Youngpeoplespendmorethan7hoursadaywith a variety of different media, but despite the onslaught of new media “gadgets” Fig.1. (Copyright(cid:1)PatrickO’Connor/TheKent-Ravenna,OhioRecordCourier.Usedwith permission.) HealthEffects 535 Fig.2. Childrenspend>7hoursadaywithavarietyofdifferentmedia.(Reproducedwith permissionfromKaiserFamilyFoundation.) (Fig.3),14TVremainsthepredominantmedium,evenforteenagers(Fig.4).Presence ofabedroomTVincreasestheaveragenumberofhoursofmediausetomorethan11 hoursperday(Fig.5)13,15andincreasestheriskofobesityby31%,16doublestherisk ofsmoking,17diminishessleep,18andlessensparticipationinhobbiesandreading.8It alsolessenstheabilityofparentstomonitortheirchildren’sviewinghabits(Fig.6).19 Televisionviewingisnowatanall-timehighintheUnitedStates.20BlackandHispanic childrenspend5to6hoursperdaywatchingTV,comparedwith3.5hoursforwhite youth.13,21WhathaschangedisthatTVisnotnecessarilyviewedonthetelevisionset in the den anymore; increasingly, teens are downloading shows to their computers, their iPhones, their iPads, and their cell phones. About 60% of young people’s TV viewingconsistsofliveTVonaTVset,buttheother40%isnoweithertime-shifted orwatchedonline,onmobiledevices,orDVDs.13Lessthan30%saythatthereare parentalrulesabouthowmuchtimetheycanspendwatchingTV.13 But “new” technology has become increasingly important as well. Six years ago, nearly one-third of 8- to 18-year-olds surveyed had Internet access or a computer intheirbedroom.19Theincreasingavailabilityoflaptopcomputersinhomes,aswell as wireless Internet access, means that children today can go online anywhere, at Fig.3. Thepopularityofnewtechnologywithteenagers.(FromLenhartA,LingR,Campbell S, et al. Teens and Mobile Phones. Pew Internet & American Life Project, April 20, 2010. Available at: http://pewinternet.org/w/media//Files/Reports/2010/PIP-Teens-and-Mobile- 2010-with-topline.pdf.)
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