Media and Teen Sexual Behavior

1. Media and Teen Sexual Behavior Presenter: Date:

2. What We’re Going to Talk about Today What does the research tell us about media and teen sexual behavior? What are some examples of media interventions that have worked? What can you do in your communities?

3. By the end of the decade there will be… First of all, it’s important to get a sense of how much media teens are exposed to. It’s helpful to put a few numbers out there.First of all, it’s important to get a sense of how much media teens are exposed to. It’s helpful to put a few numbers out there.

4. Young people spend more of their waking hours (6-7 hours a day) engaged with some form of media than in any other activity. For children ages 6-17, the most frequent after-school activity is watching TV. Children who watch four or more hours of TV a day are less likely to read at grade level, spend adequate time on school work, play well with friends or have hobbies. Adolescents’ bedrooms have become mini-media centers, away from parental oversight. Young people spend more of their waking hours (6-7 hours a day) engaged with some form of media than in any other activity. For children ages 6-17, the most frequent after-school activity is watching TV. Children who watch four or more hours of TV a day are less likely to read at grade level, spend adequate time on school work, play well with friends or have hobbies. Adolescents’ bedrooms have become mini-media centers, away from parental oversight.

5. Generation Media 93% of teens between 12 and 17 use the Internet and 55% of those use social networking sites So I asked my 22-year old nephew whether all his friends had a myspace page….So, just what do the national numbers say about the proportion of teens that engage with these various media? just over half of teens (51%) go online daily. 75% of teens have access at school 70% go online at friend’s or relative’s house 50% have gone online at library 9% go online at community center or house of worship 93% have multiple access points 64% of online teens 12-17 (which equates to 59% of all teens) say they’ve engaged in at least one type of content creation So I asked my 22-year old nephew whether all his friends had a myspace page….So, just what do the national numbers say about the proportion of teens that engage with these various media? just over half of teens (51%) go online daily. 75% of teens have access at school 70% go online at friend’s or relative’s house 50% have gone online at library 9% go online at community center or house of worship 93% have multiple access points 64% of online teens 12-17 (which equates to 59% of all teens) say they’ve engaged in at least one type of content creation

6. Why Care? Concern about the influence of media on teen behavior Messages in the media might not be consistent with other messages. There are several behavioral theories which suggest that media content influence teens attitudes and behaviors. For example, the foundation of the Social Learning Theory proposes that when we see behavior that is rewarded in the media, we imitate and may eventually adopt that behavior as our own. Other theories have suggested that exposure to sexual content in the media may sensitize viewers to sexualized attitudes and behaviors. Another prominent theory is that as youth use media more and more, the media may act as a super-peer and overwhelm the information they are receiving from other peers, adults, etc. Also, there have been numerous studies linking violence in the media with violent attitudes and behavior. Thus, there has been a lot of research to determine not only the influence of the media on teen sexual attitudes and behaviors, but also how can we use the media to our advantage to positively influence large numbers of teens and young adults. Messages in the media might not be consistent with other messages. There are several behavioral theories which suggest that media content influence teens attitudes and behaviors. For example, the foundation of the Social Learning Theory proposes that when we see behavior that is rewarded in the media, we imitate and may eventually adopt that behavior as our own. Other theories have suggested that exposure to sexual content in the media may sensitize viewers to sexualized attitudes and behaviors. Another prominent theory is that as youth use media more and more, the media may act as a super-peer and overwhelm the information they are receiving from other peers, adults, etc. Also, there have been numerous studies linking violence in the media with violent attitudes and behavior. Thus, there has been a lot of research to determine not only the influence of the media on teen sexual attitudes and behaviors, but also how can we use the media to our advantage to positively influence large numbers of teens and young adults.

7. Sexual Content in Popular Media Teen magazines Television Less than 10% of shows address any risk of sexual activity; during the 2001-2002 season 71% of programs contained sexual content Movies Sexual content in R-rated films has increased in the past 10 years Internet 75-83% of teens have access to the internet at home Teen magazines: Still very popular form of media. Between 1974 and 1994, the number of stories with sexual content and themes nearly doubled. Messages about boys in popular teen magazines such as Seventeen, YM, CosmoGirl, Elle Girl typically portray adolescent males as “boy toys”. Furthermore, magazines with a youth readership were 60% more likely to show couples engaged in sexual activity compared to general readership magazines. TV Content analysis of TV shows indicates that sexual content is increasing. Precursor behaviors, such as kissing and touching, were more prevalent than sexual intercourse, which was portrayed or implied in about 12% of all shows. Less than 10% of the shows that dealt with sexual intercourse addressed any sexual risks or responsibilities. During the 2001-2002 season, 71% of programs contained sexual content with an average of 6.1 sex-related scenes per hour. Movies Sexual content in R-rated films has increased in the past 10 years or so. Internet 75-83% of teens have access to the internet at home and 70% of them report having ever been exposed to internet pornographyTeen magazines: Still very popular form of media. Between 1974 and 1994, the number of stories with sexual content and themes nearly doubled. Messages about boys in popular teen magazines such as Seventeen, YM, CosmoGirl, Elle Girl typically portray adolescent males as “boy toys”. Furthermore, magazines with a youth readership were 60% more likely to show couples engaged in sexual activity compared to general readership magazines. TV Content analysis of TV shows indicates that sexual content is increasing. Precursor behaviors, such as kissing and touching, were more prevalent than sexual intercourse, which was portrayed or implied in about 12% of all shows. Less than 10% of the shows that dealt with sexual intercourse addressed any sexual risks or responsibilities. During the 2001-2002 season, 71% of programs contained sexual content with an average of 6.1 sex-related scenes per hour. Movies Sexual content in R-rated films has increased in the past 10 years or so. Internet 75-83% of teens have access to the internet at home and 70% of them report having ever been exposed to internet pornography

8. Media Exposure and Attitudes and Behavior Exposure to greater sexual content in the media is linked to increased likelihood of initiating sex, more sexual partners, and higher risk of pregnancy or STDs Media as a “superpeer” Teens learn what is “expected” behavior Normalizes sexual activity 45% of teens and adults believe that media can be used to help start a conversation between youth and their parents about sex

9. What Can/Should be Done? Educate parents ? About media, and sex Educate children/ teens ? Teach media literacy skills ? Help develop healthier sexual media “diets” Interventions ? PSAs ? Entertainment-Education ? Media Advocacy

10. Media Interventions Public Service Announcements: An approach using a short message (or messages) which are usually targeted to a specific audience and designed to increase knowledge and awareness, change attitudes, or encourage a specific behavior Entertainment Education (E-E): A strategy in which messages about socially desirable behavior (or risky behavior with relevant consequences) are embedded in entertaining media content. It is based on the principles of Social Cognitive Learning theory Social Marketing: An approach that applies commercial marketing strategies (including multiple promotion techniques, strategic placement and pricing of the product, and persuasive messages) to achieve behavioral change that benefits society.

11. International Interventions 25 mass media interventions from 19 countries Interventions were interested in changing: Knowledge Attitudes Behavior There have been many media intervention conducted abroad to address adolescent sexual health, particularly in developing countries. Because the media environments are usually less complex compared to the media environment in the U.S., these interventions have been evaluated and offer many valuable lessons learned for practitioners in the U.S. Most of the interventions included in this review were interested in changing either knowledge, attitudes, and/or behavior. A majority of the interventions did report some sort of behavioral change these outcomes included talking with others about sexual health, visiting a health care facility, or changing specific sexual behaviors such as decreasing number of partners, delaying sex, increasing condom use etc. There have been many media intervention conducted abroad to address adolescent sexual health, particularly in developing countries. Because the media environments are usually less complex compared to the media environment in the U.S., these interventions have been evaluated and offer many valuable lessons learned for practitioners in the U.S. Most of the interventions included in this review were interested in changing either knowledge, attitudes, and/or behavior. A majority of the interventions did report some sort of behavioral change these outcomes included talking with others about sexual health, visiting a health care facility, or changing specific sexual behaviors such as decreasing number of partners, delaying sex, increasing condom use etc.

12. Example: PSA Campaign Carnival Campaign PSA campaign via TV, radio, and print conducted in Brazil during the month of Carnival In 86 cities and 22 states throughout the country Goal: Increase condom use with a particular focus on girls TV was most effective medium Young women who saw the PSAs were more likely to support norms that favored condom use than those not exposed to the PSAs Approximately one-month public service announcement (PSA) campaign via television, radio, and print during Carnival in Brazil carried out in 86 cities and 22 states. Exposure:• Television was the most efficient medium in reaching the desired audience, with 81% of whom? reporting exposure Effects:• The more the young women saw campaign messages on television or billboards, the more they supported the norm that favors the participation of women in the purchase of condoms. • Television announcements helped to generate discussions about AIDS in the social environments of the young women.• Only about ¼ of respondents either discussed the TV ad or heard someone discuss the ads. Kelly Key (a famous singe) was used as a role model to empower young women to not be ashamed to purchase condoms and demand that their boyfriend use them. She was a controversial choice, but the Ministry of Health supported their decision due to her popularity with the intended audience of young women. Approximately one-month public service announcement (PSA) campaign via television, radio, and print during Carnival in Brazil carried out in 86 cities and 22 states. Exposure:• Television was the most efficient medium in reaching the desired audience, with 81% of whom? reporting exposure Effects:• The more the young women saw campaign messages on television or billboards, the more they supported the norm that favors the participation of women in the purchase of condoms. • Television announcements helped to generate discussions about AIDS in the social environments of the young women.• Only about ¼ of respondents either discussed the TV ad or heard someone discuss the ads. Kelly Key (a famous singe) was used as a role model to empower young women to not be ashamed to purchase condoms and demand that their boyfriend use them. She was a controversial choice, but the Ministry of Health supported their decision due to her popularity with the intended audience of young women.

13. Example: PSA and E-E Campaign Staying Alive Campaign Global campaign conducted in partnership with MTV Incorporates traditional PSA with E-E and internet component geared its global Staying Alive campaign to address the global impact of HIV/AIDS and promote prevention for youth ages 16 to 25. MTV broadcast the campaign worldwide over its 37 channels (the number of channels has since grown to 41) and made the entire campaign available rights-free to any third-party broadcaster who signed an agreement with MTV. As a result, approximately 800 million households worldwide had access to the campaign.14, 20 The evaluation studies included data from Senegal, Brazil, and Nepal. The three primary objectives of the campaign were to: promote favorable HIV-prevention attitudes, knowledge, and skills; to elevate the level of personal concern about HIV/AIDS among young people, including concerns about the damaging impact of HIV-related stigma and discrimination; and to empower young people to take concrete action for themselves and their communities with regard to HIV/AIDS. A series of six public service announcements aired on MTV; A campaign Web site linked to MTV.com with links to information and resources; An hour–long documentary aired on MTV entitled “StayingAlive 4" which offered narratives of young people living with HIV/AIDS in different regions of the world; and Concerts held in Seattle,Washington, and Johannesburg, South Africa which were aired on MTV on December 1, 2002, World AIDS Day. The concert comprised of approximately 60% content related to HIV/AIDS and 40% music. Positive impacts of the Staying Alive campaign were found in all three evaluation countries. For example, there was a positive association for all three sites between exposure to the campaign and HIV prevention beliefs. This association remained even after controlling for other factors such as gender, education, and previous sexual behavior. In addition, in all three sites, communication about HIV with more types of people was higher among people exposed to the campaign compared to those without exposure. geared its global Staying Alive campaign to address the global impact of HIV/AIDS and promote prevention for youth ages 16 to 25. MTV broadcast the campaign worldwide over its 37 channels (the number of channels has since grown to 41) and made the entire campaign available rights-free to any third-party broadcaster who signed an agreement with MTV. As a result, approximately 800 million households worldwide had access to the campaign.14, 20 The evaluation studies included data from Senegal, Brazil, and Nepal. The three primary objectives of the campaign were to: promote favorable HIV-prevention attitudes, knowledge, and skills; to elevate the level of personal concern about HIV/AIDS among young people, including concerns about the damaging impact of HIV-related stigma and discrimination; and to empower young people to take concrete action for themselves and their communities with regard to HIV/AIDS. A series of six public service announcements aired on MTV; A campaign Web site linked to MTV.com with links to information and resources; An hour–long documentary aired on MTV entitled “StayingAlive 4" which offered narratives of young people living with HIV/AIDS in different regions of the world; and Concerts held in Seattle,Washington, and Johannesburg, South Africa which were aired on MTV on December 1, 2002, World AIDS Day. The concert comprised of approximately 60% content related to HIV/AIDS and 40% music. Positive impacts of the Staying Alive campaign were found in all three evaluation countries. For example, there was a positive association for all three sites between exposure to the campaign and HIV prevention beliefs. This association remained even after controlling for other factors such as gender, education, and previous sexual behavior. In addition, in all three sites, communication about HIV with more types of people was higher among people exposed to the campaign compared to those without exposure.

14. Example Staying Alive Campaign (continued) Reached approximately 800 million households Evaluated in Senegal, Brazil, and Nepal In all 3 sites: There was a positive association between exposure to the campaign and HIV prevention beliefs Communication about HIV was higher among those exposed to the campaign versus those who were not geared its global Staying Alive campaign to address the global impact of HIV/AIDS and promote prevention for youth ages 16 to 25. MTV broadcast the campaign worldwide over its 37 channels (the number of channels has since grown to 41) and made the entire campaign available rights-free to any third-party broadcaster who signed an agreement with MTV. As a result, approximately 800 million households worldwide had access to the campaign.14, 20 The evaluation studies included data from Senegal, Brazil, and Nepal. The three primary objectives of the campaign were to: promote favorable HIV-prevention attitudes, knowledge, and skills; to elevate the level of personal concern about HIV/AIDS among young people, including concerns about the damaging impact of HIV-related stigma and discrimination; and to empower young people to take concrete action for themselves and their communities with regard to HIV/AIDS. A series of six public service announcements aired on MTV; A campaign Web site linked to MTV.com with links to information and resources; An hour–long documentary aired on MTV entitled “StayingAlive 4" which offered narratives of young people living with HIV/AIDS in different regions of the world; and Concerts held in Seattle,Washington, and Johannesburg, South Africa which were aired on MTV on December 1, 2002, World AIDS Day. The concert comprised of approximately 60% content related to HIV/AIDS and 40% music. Positive impacts of the Staying Alive campaign were found in all three evaluation countries. For example, there was a positive association for all three sites between exposure to the campaign and HIV prevention beliefs. This association remained even after controlling for other factors such as gender, education, and previous sexual behavior. In addition, in all three sites, communication about HIV with more types of people was higher among people exposed to the campaign compared to those without exposure. geared its global Staying Alive campaign to address the global impact of HIV/AIDS and promote prevention for youth ages 16 to 25. MTV broadcast the campaign worldwide over its 37 channels (the number of channels has since grown to 41) and made the entire campaign available rights-free to any third-party broadcaster who signed an agreement with MTV. As a result, approximately 800 million households worldwide had access to the campaign.14, 20 The evaluation studies included data from Senegal, Brazil, and Nepal. The three primary objectives of the campaign were to: promote favorable HIV-prevention attitudes, knowledge, and skills; to elevate the level of personal concern about HIV/AIDS among young people, including concerns about the damaging impact of HIV-related stigma and discrimination; and to empower young people to take concrete action for themselves and their communities with regard to HIV/AIDS. A series of six public service announcements aired on MTV; A campaign Web site linked to MTV.com with links to information and resources; An hour–long documentary aired on MTV entitled “StayingAlive 4" which offered narratives of young people living with HIV/AIDS in different regions of the world; and Concerts held in Seattle,Washington, and Johannesburg, South Africa which were aired on MTV on December 1, 2002, World AIDS Day. The concert comprised of approximately 60% content related to HIV/AIDS and 40% music. Positive impacts of the Staying Alive campaign were found in all three evaluation countries. For example, there was a positive association for all three sites between exposure to the campaign and HIV prevention beliefs. This association remained even after controlling for other factors such as gender, education, and previous sexual behavior. In addition, in all three sites, communication about HIV with more types of people was higher among people exposed to the campaign compared to those without exposure.

15. Interventions in the U.S. Fewer interventions in the U.S. have been rigorously evaluated 20 interventions more than half used new media technologies

16. Example: PSA Campaign Two-City Safer Sex Campaign Lexington, KY and Knoxville, TN PSAs Targeted high sensation-seeking/impulsive decision making young adults Evaluation Results: 13% increase in safer sex acts Results were short terms Continued 5 months after the campaign ended

17. Example: E-E The Bold and the Beautiful Entertainment education campaign followed by PSAs Focused on HIV Results: Generated total of 1,426 calls to the CDC’s national HIV/AIDS hotline during the soap opera time slot The first PSA generated a total of 1,426 calls to the CDC’s national HIV/AIDS hotline during the soap opera time slot, compared to 88 calls the previous day and 108 calls the day following the episode. Ten days later when the PSA was shown again, the call volume spiked even higher to 1,840 calls originating during and shortly after the episode. In comparison, there were 94 calls the day before and 234 calls the day after the HIV episode. Exposure: A post-test survey, funded by KFF, found that, among teens who had viewed the episode, two-thirds (65%) remembered that the specific storyline depicted an unplanned pregnancy caused by condom failure. The first PSA generated a total of 1,426 calls to the CDC’s national HIV/AIDS hotline during the soap opera time slot, compared to 88 calls the previous day and 108 calls the day following the episode. Ten days later when the PSA was shown again, the call volume spiked even higher to 1,840 calls originating during and shortly after the episode. In comparison, there were 94 calls the day before and 234 calls the day after the HIV episode. Exposure: A post-test survey, funded by KFF, found that, among teens who had viewed the episode, two-thirds (65%) remembered that the specific storyline depicted an unplanned pregnancy caused by condom failure.

18. New Media Technologies Focus on interacting with youth directly Through website, cell phones, etc. Not well evaluated, although promising

19. Example: New Media Technologies SexInfo Uses text messaging in combination with traditional PSAs Conducted in San Francisco, CA Targeted high-risk, urban youth Provides information on pregnancy testing, STD/HIV testing, referrals 4500 callers used the service during the first 25 weeks; 2500 calls led to referrals and requests for more information Methods: Health department conducted surveys in 2006 of a convenience sample of 322 patients aged 12-24 at clinics to which SexInfo users were most commonly referred. Effects: Consistent positive associations were found between demographic risk factors for STDs and campaign awareness. Overall, 11% of respondents reported awareness of the campaign. Preliminary data show that 4500 callers used the service during the first 25 weeks, 2500 of which led to referrals and requests for more information. Methods: Health department conducted surveys in 2006 of a convenience sample of 322 patients aged 12-24 at clinics to which SexInfo users were most commonly referred. Effects: Consistent positive associations were found between demographic risk factors for STDs and campaign awareness. Overall, 11% of respondents reported awareness of the campaign. Preliminary data show that 4500 callers used the service during the first 25 weeks, 2500 of which led to referrals and requests for more information.

20. Stay Teen Continued Website National Day Quiz A major part of our stay teen campaign was the development of a website geared toward teens. The website allows for some personal expression and also includes interactive stuff…we recently had a contest called “What’s your relationship reality” which encouraged teens to submit short video clips that defined that question. A major part of our stay teen campaign was the development of a website geared toward teens. The website allows for some personal expression and also includes interactive stuff…we recently had a contest called “What’s your relationship reality” which encouraged teens to submit short video clips that defined that question.

21. Stay Teen and User Generated Content All Stay Teen ads are filmed by teens Stay Teen contest developed in partnership with MySpace.com Offers teens a chance to create and share their own Stay Teen videos

22. Recommendations Use theory Know and involve the target audience Use multiple media channels as well as interpersonal communication Strive for long term exposure and sustainability Focus on the environment as well as individuals Evaluate your efforts

23. For more information Managing the Media Monster: The Influence of Media (From Television to Text Messages) on Teen Sexual Behavior and Attitudes Available at: http://www.thenationalcampaign.org/resources/monster/default.aspx www.thenationalcampaign.org