Pediatricians Should Educate Parents, Youths about Media's Effects

ARTICLE REPRINT • From the September 1999 AAP News, the official news magazine of the American Academy of Pediatrics

Concerns about the behaviors and fates of young people voiced in "Romeo and Juliet" are as relevant today as 500 years ago. Indeed, the parents of Columbine High School students were as shocked and uncomprehending as the Montagues and Capulets at the end of Shakespeare's drama of adolescent passion and destruction. The public's initial question of "How could this happen?" was swiftly followed by assignment of blame, much of it leveled at entertainment media: movies, television, music, video games and the Internet. It is human nature to assign blame, to look for fault. We want to know why - and we want something that we can fix. Hidden in the finger-pointing are lessons we would do well to learn as health professionals who care for the lives and well-being of children and adolescents.

Littleton was only one of a series of school shootings over the past two years. Each year more than 150,000 adolescents are arrested for violent crimes,^[1] more than 300,000 are assaulted seriously enough to need medical care,^[2] and 3,500 are murdered.^[3] Research by RH DuRant, et al. has shown that the strongest single correlate with violent behavior is previous exposure to violence, and an association between media exposure and subsequent violent behavior has been demonstrated in more than 1,000 studies. However, the etiology of violence is complex and multifactorial. Jolted into awareness of youth violence as a public health epidemic, we are now realizing how little we know about its causes.

Recognizing this, the U.S. Senate passed a bill May 20 allocating $25 million over the next five years to study the risk factors for youth violence and the processes by which children develop patterns of violent thought and behavior, including the roles played by peer pressure and social forces like the media.

Research has shown that when young people are exposed to media violence they develop fear of being victimized by a "mean world," learn aggressive attitudes and behaviors, and become desensitized to violence.^[4] Today, 99 percent of American homes have a television and 87 percent a VCR; watching videos is America's favorite leisure activity. Children average 28 hours of television a week, spending twice as much time each year with TV as they do in school. About three-quarters of all 12- to 19-year-olds spend an average of six hours per week watching music videos.^[5] Video games generate $10 billion in earnings a year. Fantasy violence is the favorite type of game played by children6 who average 90 minutes of video gaming per day.^[7]

Media function as a "superpeer," replacing the role once played by a social circle of friends and family, modeling and encouraging ways of thinking and behaving. It is no wonder young people are confused about the nature of interpersonal relationships, their own safety and the use of violence to resolve conflicts. They are saturated in a flood of sensation, from cathartic, no-repercussion shootings on television to the lyrical portrayal of violence in music videos to being rewarded for kills in graphic "first person shooter" video games.

As child health professionals, we must be aware of the ubiquitous and powerful presence of media in our patients' lives.

In this epidemic of school shootings, I have been struck by the stunned, haunted looks in the eyes of the young people accused of the killings. They appear to be in shock, surprised and devastated by what they have done. As an adolescent physician, I cannot help but see them as our patients. Adolescence represents a series of increasingly difficult developmental tasks. Starting from childhood's magical thinking and impulsive behavior that parents must contain, one must develop abstract thought and social controls to deal with adult realities. If this developmental process occurs in a violent environment, it can become distorted.

Lt. Col. David Grossman, an adjunct professor at Arkansas State University who also teaches the psychology of killing for the Army, said on "60 Minutes" April 25 that he sees fantasy violence video games as "murder simulators." They use desensitization and operant conditioning to teach kids to "associate pleasure with human death and suffering." He said he is not surprised that teens who spend hundreds of hours perfecting skills on video games are able to kill so effectively the first time they use a real gun. And we should not be surprised by teens' stunned disbelief at the carnage.

The media are not going away. Censorship is unwanted, unconstitutional and ultimately unsuccessful in a free society. However, as U.S. House of Representatives Speaker Dennis Hastert (R-Ill.) asserted, "Free expression does not necessarily have to lead to moral chaos. Let us join together in finding ways to help parents raise their children to be good, productive citizens."

We must approach the media and their effects as a reality of contemporary life. As clinicians, we need to recognize the potent effects of media on child health. We must ask about media use as part of the medical history. Children should not have televisions and video games in their own rooms (54 percent do).^[8] We should encourage parents to set limits on media use and to consume media with their children, discussing with them what they have seen and learned.

What will make the most significant and lasting difference is to help our young people become media literate. Former U.S. Commissioner of Education Ernest Boyer wrote, "It is no longer enough to simply read and write. Students must also become literate in the understanding of visual images." In order for children and adolescents to be protected from the media's effects, they must learn to "read" and understand media messages for what they are, rather than passively accepting them at face value. Media education teaches us to be selective, critical viewers who make informed choices and can evaluate and modulate media's effect on ourselves and on society.

Media Matters, the Academy's national media education program for pediatricians, parents and young people, targets the public health effects of media. The central themes of Media Matters are easy to learn, and kids enjoy learning them because they like being smarter than what is being sold to them. Renee Hobbs, professor of communications at Babson College, Wellesley, Mass., has developed five questions parents can use to evaluate the media their children consume:

1. Who is the author and what is the purpose of this message?
2. What techniques are used to attract the child's attention?
3. What lifestyles, values and points of view are represented?
4. How might different people interpret this message differently? (women? children? different racial or ethnic groups?)
5. What is omitted from this message?

Media are not inherently malignant. They are tools. Like a shovel, media are neutral. The shovel can be used to hit someone on the head or to till a field. Used correctly, the media can serve an important role in the development of emotional maturity and positive social behavior.

Violence and high passion have been staples of drama since long before Shakespeare. With appropriate understanding, media can illuminate the danger and inhumanity of violence without the child having to experience it directly. It is how we understand human violence and how we act upon that understanding that makes the difference. To quote from one of Shakespeare's bloodiest plays, "Julius Caesar," "The fault ... is not in our stars, but in ourselves."

The potential for violence does not arise from an outside force, it lies within each of us. Children have fewer checks on primal violent urges than adults. As parents and pediatricians, we hope to contain and rechannel those urges. Unprotected use of media can warp psychological development that allows awareness of human suffering to control violent desires. Knowing media and how they work will allow children to recognize and direct their effects, to use them wisely, and to learn of human suffering through ways that allow them to grow up healthy and safe.

To learn more about Media Matters, contact Jennifer Stone in the AAP Division of Public Education, (800) 433-9016, ext. 7870, JStone@aap.org.

References

1. Snyder HN, Sickmund D and Poe-Yamagata E. Juvenile Offenders and Victims: 1996 Update on Violence. National Center for Juvenile Justice.
2. Barancik JL. Am J Public Health. 1983;73:746-51.
3. Centers for Disease Control and Prevention, Atlanta, 1996. Homicide and Legal Intervention Deaths and Rates per 100,000, United States 1988-1994.
4. Gerbner G. Pediatric Annals. 1985;14:822-27.
5. Teenage Research Unlimited. Television Viewing Study. 1996.
6. Funk J and Buchman D. J Communication. 46(2), 19-32.
7. Elmer-Dewitt P. Time. Sept. 27, 1993, p. 71.
8. National Television Violence Study. 1996.

Dr. Rich is a member of the AAP Committee on Public Education and director of Video Intervention/Prevention Assessment at Children's Hospital, Boston/ Harvard Medical School.

Reprinted with permission. American Academy of Pediatrics, AAP News, September 1999 .