Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of all Children Policy Statement—Sexuality, Contraception, and the Media THE COUNCIL ON COMMUNICATIONS AND MEDIA abstract KEY WORDS From a health viewpoint, early sexual activity among US adolescents is sexual activity, adolescents, media, television a potential problem because of the risk of pregnancy and sexually ABBREVIATIONS STI—sexually transmitted infection transmitted infections. New evidence points to the media adolescents TV—television use frequently (television, music, movies, magazines, and the Internet) This document is copyrighted and is property of the American as important factors in the initiation of sexual intercourse. There is a Academy of Pediatrics and its Board of Directors. All authors major disconnect between what mainstream media portray—casual have filed conflict of interest statements with the American sex and sexuality with no consequences—and what children and teen- Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American agers need—straightforward information about human sexuality and Academy of Pediatrics has neither solicited nor accepted any the need for contraception when having sex. Television, film, music, commercial involvement in the development of the content of and the Internet are all becoming increasingly sexually explicit, yet this publication. information on abstinence, sexual responsibility, and birth control re- mains rare. It is unwise to promote “abstinence-only” sex education when it has been shown to be ineffective and when the media have become such an important source of information about “nonabsti- nence.” Recommendations are presented to help pediatricians ad- dress this important issue. Pediatrics 2010;126:576–582 INTRODUCTION Early sexual activity among teenagers can be problematic. According to the 2009 Youth Risk Behavior Survey, 46% of all high school seniors www.pediatrics.org/cgi/doi/10.1542/peds.2010-1544 have had sexual intercourse, and 14% have had 4 partners or more.1 doi:10.1542/peds.2010-1544 Although pregnancy rates have generally been decreasing since 1991, All policy statements from the American Academy of Pediatrics the United States still has the highest teen pregnancy rate in the West- automatically expire 5 years after publication unless reaffirmed,revised, or retired at or before that time. ern world,2 and for the first time in 15 years, the birth rate increased PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). 3% from 2005 to 2006.3 Early intercourse also increases the risk of Copyright © 2010 by the American Academy of Pediatrics contracting a sexually transmitted infection (STI), including HIV, and adolescents have one of the highest STI rates of any age group.4 Al- though 15- to 24-year-olds account for only one-quarter of the sexually active population in the United States, they contract nearly half of all new STIs every year.4 A recent study by the Centers for Disease Control and Prevention revealed that 1 in 4 teenagers has had an STI.5 Ten percent of young women who had first had sex in their teenage years reported that their first time was involuntary, and the younger they were, the more likely that was the case.6 WHAT CHILDREN AND TEENAGERS LEARN FROM THE MEDIA American children and teenagers spend more than 7 hours/day with a variety of different media.7 Those media are filled with sexual mes- sages and images, many of which are unrealistic.2 On television (TV), which remains the predominant medium in terms of time spent for all young people, more than 75% of prime-time programs contain sexual 576 FROM THE AMERICAN ACADEMY OF PEDIATRICS Downloaded from www.aappublications.org/news by guest on September 24, 2021 FROM THE AMERICAN ACADEMY OF PEDIATRICS content, yet only 14% of sexual inci- per issue to sexual topics.19 Cover- erectile dysfunction drugs are ubiq- dents mention any risks or responsi- age of sex as a health issue in mag- uitous. In the first 10 months of bilities of sexual activity.8,9 Talk about azines is more common than on TV, 2004, the makers of these drugs sex on TV can occur as often as 8 to 10 but the overarching focus seems to spent nearly $350 million on adver- times per hour.10 Between 1997 and be on deciding when to lose one’s tising.32 At the same time, advertise- 2001 alone, the amount of sexual con- virginity.12,20 ments for birth control products tent on TV nearly doubled.9 ● The Internet has become an abun- are rare.2 So-called reality TV has also entered dant source of both sexual informa- Because so many sex education pro- the picture. In 1997, there were only 3 tion and pornography that cannot grams have recently been focused on reality dating shows; by 2004, there be regulated.21,22 Online pornogra- abstinence only, the media have argu- were more than 30.11 Some shows, phy is now a $1 billion industry.12 In ably become one of the leading sex ed- such as Temptation Island, bring par- a national sample of 1500 10- to 17- ucators in the United States today.2 Ad- ticipants together for the sole purpose year-olds, nearly half of the Internet olescents frequently cite the media as of seeing who “hooks up.” A study of users had been exposed to online a source of sexual information.2 For ex- college students revealed that viewing pornography in the previous year.23 ample, in a national survey the media such shows correlated with beliefs in a In addition, unwanted sexual solici- rivaled parents and schools as a double standard—that men are sex tations and harassment are not un- source of information about birth con- driven and that men and women are common,24 although they may not be trol.33 The media are powerful sources sexual adversaries.11 It is interesting to as frequent as parents fear.25 for behavioral “scripts” concerning note that the less sexually experienced ● Social networking Web sites and sexual situations, especially for inex- students were more likely than sexu- home pages enable teenagers to perienced teenagers.2,34 Yet, parents ally experienced students to be watch- present themselves publicly, some- and legislators fail to understand that ing reality shows, which suggests the times in sexually suggestive although they may favor abstinence- importance of such programs for sex- ways.12,26 One study of 233 teen only sex education (despite the lack of ual socialization.12,13 home pages revealed that nearly any evidence of its effectiveness),35 the In addition to TV, other media provide 10% mentioned sex, and girls were 3 media are decidedly not abstinence frequent messages about sexual times more likely to do so than only. In fact, the United States has 27 behavior. boys. A recent study of 500 publicly some of the most sexually suggestive available MySpace profiles revealed media in the world.2 American media ● Music continues to be a major that nearly one-quarter of them ref- make sex seem like a harmless sport source of sexual suggestiveness. In erenced sexual behaviors.28 Also, a in which everyone engages, and re- 1 study, 40% of lyric lines contained national survey of nearly 1300 teen- sults of considerable research have in- sexual material, and only 6% con- agers and young adults revealed dicated that the media can have a ma- tained healthy sexual messages.14 that 20% reported having sent or jor effect on young people’s attitudes An analysis of the 279 most popular posted nude pictures or videos of and behaviors.12–18 In fact, the media songs in 2005 revealed that 37% themselves (“sexting”).29 may function as a “superpeer” in con- contained sexual references and ● Advertisements often use sex to sell. vincing adolescents that sexual activity that degrading sexual references Women are as likely to be shown in is a normative behavior for young teen- were common.15 suggestive clothing (30%), partially agers.2,36,37 In a survey of 2100 11- to ● Virtually every R-rated teen movie clad (13%), or nude (6%) as they are 17-year-old girls, only the 11-year-olds since the 1980s has contained at to be fully clothed.30 As one expert reported that they did not feel pres- least 1 nude scene and, often, sev- noted, “When sexual jokes are used sure from the media to begin having eral instances of sexual intercourse to sell everything from rice to roach- sex.38 (eg, the American Pie movie se- killer, from cars to carpets, it’s hard ries).16 Teen movies also contain to remember that sex can unite two IMPACT OF SEXUAL CONTENT ON distorted views of romance and nor- souls, can inspire awe. Individually, ADOLESCENT BEHAVIOR mal adolescent sexuality.16–18 these ads are harmless enough, Numerous studies have delineated the ● Teen magazines are popular with sometimes even funny, but the cu- media’s powerful influence on adoles- preadolescent and adolescent girls mulative effect is to degrade and de- cents’ sexual attitudes, values, and be- and devote an average of 2.5 pages value sex.”31 Advertisements for liefs.2,39–42 Unlike the media violence re- PEDIATRICS Volume 126, Number 3, September 2010 577 Downloaded from www.aappublications.org/news by guest on September 24, 2021 search literature, in which some 2000 rather than later,63 and sexually ex- that adolescents do not always listen studies exist, there have been only a plicit media may be particularly to their elders.2 In 2007, both CBS and handful of studies on the effects of sex- important.41,64 FOX refused a condom advertisement ual content on actual behavior.