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Children, Adolescents, and the Media: Issues and Solutions

1999; American Academy of Pediatrics; Volume: 103; Issue: 1 Linguagem: Inglês

10.1542/peds.103.1.129

1098-4275

Victor C. Strasburger, Edward Donnerstein,

Impact of Technology on Adolescents

I believe television is going to be the test of the modern world, and that in this new opportunity to see beyond the range of our vision we shall discover either a new and unbearable disturbance of the general peace or a saving radiance in the sky. We shall stand or fall by television. —Author E. B. White1Television and other media represent one of the most important and underrecognized influences on children and adolescents' health and behavior in the 1990s. Their impact should be eliciting serious concern, not just from parents and educators but from physicians, public health advocates, and politicians as well (Fig 1). Although objections to various programming and advertising practices can exist on common sense, philosophical, aesthetic, humanistic, or public health grounds without strict scientific data,2 increasing numbers of studies document that a serious problem exists.By time criteria alone, television represents the predominant medium. Young people average 16 to 17 hours of viewing weekly, beginning as early as age 2.3 When video game and videocassette usage are added, some teenagers may spend as many as 35 to 55 hours in front of the television set.4 More families own a television set than a telephone.5However, other media are important as well. Adolescents can spend nearly equal amounts of time listening to the radio, although music is used frequently as an accompaniment to other activities.4,6 More than half of all 15- to 16-year-olds had seen the majority of the most popular, recent R-rated movies in one study.7 In a separate study, 92% of males and 84% of females had seen or read Playboy or Playgirl by age 15.8Finally, playing video games has become a favorite pastime of children and adolescents and now represents a $7 billion per year industry.9 One survey of nearly 400 seventh- and eighth-grade students found that teens average 2 to 4 hours per week playing such games.10 Although not much data are available about young people's use of new technology such as the Internet, there is every reason to believe that "surfing the Net" will prove popular as well. Indeed, in one recent national survey 89% of teenagers reported using a computer, 61% "surfed the Net," and 14% reported seeing something that they did not want their parents to know about.11 By 1996, nearly five million youths had used the Internet or an on-line service from school or home.12Media exert a significant displacement effect—2 to 3 hours per day spent watching television or playing video games means less physical activity, reading, and interaction with friends—but such data do not speak to cause-and-effect concerns. Likewise, content analyses can only demonstrate what the average child or adolescent will view. Even so, such analyses are disturbing when they reveal what the average American child or teenager is exposed to annually.Young people view an estimated 10 000 acts of violence each year.13 Most recently, the National Television Violence Study examined nearly 10 000 hours of television programming throughout 3 years and found that 61% contains violence, with children's programming being the most violent (Fig 2).14–16 In addition, 26% of violent interactions involved the use of guns.16 During the 3 years of the study, none of the key indicators of violence in the media changed, despite widespread public concern.14–16 A recent comprehensive analysis of rock music videos of all genres demonstrated that 22.4% of all Music Television videos portrayed overt violence, 20% of all rap videos contained violence, and weapon carrying was depicted in 25% of all Music Television videos.17 Attractive role models are the aggressors in more than 80% of violent music videos.18Each year, teenagers view nearly 15 000 sexual references, innuendoes, and jokes, of which <170 will deal with abstinence, birth control, sexually transmitted diseases, or pregnancy.19The so-called family hour of prime time television (8 to 9pm) contains more than 8 sexual incidents per hour, more than four times as much as in 1976.20 Nearly one-third of family hour shows contain sexual references, and the incidence of vulgar language is increasing dramatically as well.21 The Internet offers unparalleled access to hard-core pornography with just a few keystrokes.22A recent content analysis found that alcohol, tobacco, or illicit drugs are present in 70% of prime time network dramatic programs, 38 out of 40 top-grossing movies, and half of all music videos.23 In another recent study, one-fourth of all Music Television videos contained alcohol or tobacco use.24Several studies document that smoking is making a comeback in Hollywood movies: a 1994 study of the 62 top-grossing films from 1960 to 1990 found that levels of smoking remained constant despite decreases in real-life and that lead characters were far more likely to smoke on screen (65%) than their real-life counterparts with similar demographic characteristics.25,26 Similarly, an American Lung Association study of 133 movies released in 1994 to 1995 found that 77% depicted tobacco use.27In addition to programming, young people view ∼20 000 commercials each year, of which nearly 2000 are for beer and wine.28For every "just say no" or "know when to say when" public service announcement, teens will view 25 to 50 beer and wine advertisements.29 Alcohol and tobacco advertisers are becoming an increasing commercial presence on the Internet as well, with more than 35 alcoholic beverages represented, homepages devoted to smoking, a Budweiser on-line radio network, interactive games, free giveaways, brand spokescharacters, and specially designed chat rooms.12 Altogether, tobacco manufacturers spend $6 billion per year, and alcohol manufacturers $2 billion per year in all media, trying to entice young people into "just saying yes."30,31Data like these are alarming, but are the media actually responsible for episodes of child aggression, teen homicides, and increased rates of teenage drug use and sexual activity?32Or, as the entertainment industry maintains, do the media merely mirror an increasingly violent, drug-oriented, and sexualized society? A close examination of the available data are essential.The research is voluminous and very clear on the relationship between media violence and real-life aggression: a cause-and-effect relationship exists.33–38 Such research involves detailed cross-sectional studies,39–43 naturalistic studies,44,45 longitudinal studies,46–50 and several meta-analyses.51–54 Two government reports, the 1972 Surgeon General's Report55 and the 1982 National Institute of Mental Health56 report affirmed this conclusion after examining all available data. The latter stated unequivocally:56After 10 more years of research, the consensus among most of the research community is that violence on television does lead to aggressive behavior by children and teenagers who watch the programs. This conclusion is based on laboratory experiments and on field studies. Not all children become aggressive, of course, but the correlations between violence and aggression are positive. In magnitude, television violence is as strongly correlated with aggressive behavior as any other behavioral variable that has been measured (authors' italics). The research question has moved from asking whether or not there is an effect to seeking explanations for the effect.Taken together, the research data are persuasive that high levels of television viewing are causally related to aggressive behavior and the acceptance of aggressive attitudes.57 The correlations found are stable throughout time, place, and demographics.13,34 Added to this is the now-sizable body of research demonstrating that the more adolescents are exposed to violence or are victims of violence in their homes or communities, the more likely they are to use violence or carry weapons themselves.58–61 Clearly, the witnessing of violence is an important determinant of violent behavior; and media violence represents the witnessing of violence vicariously, on the television or movie screen.As long ago as the 1960s, laboratory experiments by Bandura et al62 established that young children are liable to imitate what they see on the television screen, particularly if the behavior is performed by an attractive role model and is either rewarded or goes unpunished (Bandura's social learning theory). Several longitudinal correlational studies have tracked children or adults for a period of up to 30 years and found that viewing media violence at young ages (8 years and younger) is a significant risk factor for adolescent or adult aggressive behavior or even criminal violence.43,4548–50,63 Researchers have concluded that children learn their attitudes about violence at a very young age and, once learned, the attitudes tend to be life-long.64American media are also rife with portrayals of justified violence (eg, the "good guy" beating up the "bad guy"), which research shows is the single strongest positive reinforcer for young people.30,65 Not only can media violence facilitate aggressive or antisocial behavior, it may also desensitize viewers to future violence and can also increase viewers' perception that they are living in a mean and dangerous world.36,66 The problem is that the entertainment industry does not want to admit the connection any more than the tobacco industry will acknowledge the cause-and-effect relationship between cigarette smoking and lung cancer.63Media violence is not the sole cause of violence in society. Poverty, racism, inadequate parenting, the dissolution of the American family, individual psychologic differences all may have far more impact. Studies have found that child abuse, sexual abuse, witnessing domestic violence, or witnessing community violence may all play a key role in determining who will become violent.58–6167–70But the use of violence to achieve goals or to settle conflicts is, in fact, learned behavior. Such learning occurs in social groups such as the family, peer groups, and gangs. Television and other media may function as a super peer in this respect.32How much do media contribute to real-life violence? When 22 separate estimates of effect size were collated from various surveys, the size of the effect for media violence was estimated to be 5% to 15%.30,35 Given all the factors contributing to violence, to be able to isolate media violence as one factor is significant.Homicide and suicide are the second and third leading causes of death among adolescents, and guns contribute significantly to both.71 What links adolescent homicides to American media is the glamorization of guns, which represent 26% of all violent interactions on television (Table 1).16,36 Although there are no specific data linking viewing gunplay in the media with actual gun-related offenses in real life, the connection seems logical, at least to one television critic:72On average, a violent crime is committed (in the US) every 17 seconds. The entertainment industry alone cannot be blamed for this, any more than guns alone, and not the people who pull their triggers, can be blamed for gun-related deaths; however the connections are inescapable. If there were fewer guns, fewer people would be shot to death; if there were fewer violent images, fewer people might be moved to seek violent solutions.Unfortunately, the data are not nearly as clear for determining what relationship exists between early sexual activity and a heavy diet of sexualized content.73,74 Although there are more than 1000 studies linking media violence to real-life violence, there are only 5 studies demonstrating any connection between media with high sexual content and changes in teenagers' sexual behavior or attitudes:Thus, for sexual activity, inferences must be drawn from the violence literature (ie, if children and teenagers can learn aggressive behavior, why shouldn't they be able to learn sexual behavior as well?).79 In addition, the United States continues to have the highest teenage pregnancy rate in the Western world, despite the fact that American teenagers are not having sexual intercourse in greater numbers than their Western peers.80,81 This is an important finding that points to the absence of a societal expectation that even with early sexual initiation, birth control is a necessity. If, as data suggest, the media represent an important and effective source of sexual information for teenagers (Table 2),32,74 the high United States pregnancy rate could be resulting from several interrelated factors: a lack of easy access to birth control, a lack of information about birth control in sex education classes, a glut of inappropriate sexual messages in the media, and an absence of appropriate messages in the media about abstinence and the use of birth control.82Studies indicate that the $8 billion of advertising that tobacco and alcohol manufacturers pitch every year to the American public has a significant impact on adolescents' beliefs and attitudes about smoking and drinking and may influence their actual consumption as well. Correlational studies indicate a small but positive (+0.15 to +0.20) relationship between ad exposure and consumption.83In addition, advertising exposure seems to influence initial drinking episodes which, in turn, contribute to excessive drinking and abuse.83 As long as 20 years ago, the National Science Foundation commissioned a report on the effects of advertising on children, which concluded:84It is clear from the available evidence that television does influence children. Research has demonstrated that children attend to and learn from commercials, and that advertising is at least moderately successful in creating positive attitudes toward and the desire for products advertised … . Younger viewers … appear to be the most vulnerable … .Numerous recent studies document that children and adolescents who are exposed to greater amounts of tobacco or alcohol advertising are more likely either to use or intend to use such products.2985–90 This makes intuitive sense as well, because $8 billion a year is a lot of money to commit to advertising if it does not influence people to consume your product. Such advertising is extremely effective, especially in reaching younger audiences (Table 3).91The evidence is strongest regarding cigarette advertising and promotions.85,92 In one well-publicized study, children as young as 6 years old were as likely to recognize Old Joe as the Mouseketeer logo for the Disney Channel and to associate him directly with cigarette smoking.93 In addition, there is a positive correlation between advertising expenditures and brand consumption (Table 4).85,94 Revenues for cigarette advertising have also been shown to influence the editorial content of print media,95 and cigarette brands popular with teens are more likely to advertise in magazines with high youth readerships.96 A 1997 study found that one-third of teens owned cigarette promotional items, and these teens were four times more likely to be smokers.97 Most importantly, a recent longitudinal study found that an estimated one-third of all adolescent smoking could be causally related to tobacco promotional activities.98For alcohol, the correlations so far have been only moderate.83The preponderance of the evidence indicates that alcohol advertising stimulates favorable predispositions, higher consumption, and greater problem drinking by young people. Nevertheless, the evidence clearly does not support the interpretation that advertising exerts a powerful, uniform, direct influence; it seems that advertising is a contributing factor that increases drinking and related problems to a modest degree rather than a major determinant.As one leading researcher recently noted concerning media violence, "The scientific debate is over."99 What remains is what, if anything, the entertainment industry will do in response to these public health concerns and determining if such negative effects can be successfully mitigated with media education approaches.It is entirely possible that all other potential effects will follow the same pattern and strength of these known correlations but, considerable new data are needed regarding the media's impact on teenagers' sexual behavior in particular. Does sexual content influence sexual activity, use of contraception, sexual orientation? The answers will remain unknown until longitudinal correlational studies can be performed. Furthermore, some recent research indicates that there may be considerable variation in how different teenagers view the same program, depending on their ethnicity, family background, and other characteristics.100 Such findings may have special relevance for sexual portrayals and their impact on teenagers.Other much-needed research includes: ongoing content analyses of violence, sex, and drug use in television programming, movies, and rock music videos; a longitudinal study of the effect of violent video and computer games on children's attitudes and behavior; a longitudinal study of the impact of rock music on adolescents' affective states and suicidal behavior; and studies of how children and teenagers use the Internet.In addition, although the relationship between advertising and consumption is now well established, what is unknown is how to counteract the unhealthy aspects of advertising portrayals. At present, counteradvertising does not seem able to reach the density that mainstream advertising has, thus making it less useful as a solution.30 Might teenagers be susceptible to antidrug messages embedded creatively in mainstream programming?101Will the proposed settlement with the tobacco industry, which includes a ban on cartoon characters in advertisements, have an impact on young children? Further studies are needed.A vast body of literature now exists that attests to the power of the media to influence children's and adolescents' beliefs and, potentially, their behavior as well. Currently, American media contribute more to adverse health outcomes than to positive or prosocial ones, but it does not have to remain this way. Many solutions are available, ranging from controlling the way children view media (parent's role) to more effective office counseling and public health activism (physician's role) to regulating the media (governmental role) to improving the product itself (entertainment industry's role).Industry spokespeople frequently claim that if parents do not like what their children see, there is an off button on the television set or the computer. Parents counter that if the programs the media produced were healthier, they would not have to worry about their impact. In fact, both groups are right: parents do need to exercise better control over which media their children use; but the entertainment industry also needs to take responsibility for the health repercussions of what they produce.Most parents do not control the media their children or adolescents are exposed to with any consistency or regularity. Not only do parents frequently underreport the number of hours that their offspring view,33 but also they underreport the problematic shows that they view (Fig 3).102 In addition, one-fourth of preschoolers, more than one-third of grade-schoolers, and more than half of high-school youth have television sets in their bedrooms (Fig 4).102 Two 1997 surveys, involving a total of nearly 1500 parents, found that less than half of parents report "always watching" television with their children.102,103 Coviewing is thought to be an effective mechanism for mediating untoward effects of television viewing: an adult, watching a program with a child and discussing it with him or her, serves simultaneously as a values filter and a media educator (Table 5).30,104 However, one recent survey found that 44% of children or teenagers watch something different (usually Music Television) when they are alone than when viewing with their parents.105Despite these data, parents are apparently very concerned about the influence of television, more than all other media.102,106 Given the sheer quantity of hours that children spend in front of the television set, these concerns seem justified. However, other media that seem less significant quantitatively may be extremely important qualitatively: "What television suggests, movies and videos do," as one researcher notes.107According to recommendations issued by the American Academy of Pediatrics, based on a review of all available data to date, parents should:108Given the deleterious public health effects of media on youth, it is imperative that health professionals appreciate this relatively new cultural influence on their young patients, educate parents, and advocate for improved, healthier media. Physicians who treat children or adolescents should learn to take a media history (Table 6),1 especially when seeing patients with a history of aggressive behavior or school difficulties.32Educating parents can be accomplished using media education materials from a variety of organizations (Table 7). In addition, physicians can serve as role models by using television sets and videocassette recorders in their waiting rooms for educational programming only. Finally, physicians are important community resources for schools (media education programs), local television stations, and parents (Parent Teacher Associations). They can also advocate for improved media by writing to national networks, Hollywood studios, the United States Congress, and the Federal Communications Commission. They could also be instrumental in pressuring the television industry to begin broadcasting birth control advertising and urging the entertainment industry to restrict their depictions of violence and sexuality to responsible portrayals.One role of health professionals that remains controversial is advocating for greater numbers of public service announcements to offset the deluge of tobacco and alcohol ads that young people currently see. Commercial broadcasting expends the most amount of money per minute (up to $400 000) to produce commercials. Therefore, it is difficult to compete not only in density but also in production values.109 Viewing of public service announcements can make an audience more aware of a problem, make the problem seem important, and offer further information.110 Such effects are intensified when other interventions are occurring simultaneously (eg, antismoking public service announcements and restrictions on smoking in public places).111,112 One aggressive antismoking campaign in Vermont demonstrated a 35% lower smoking rate after 4 years when radio and television ads were combined with a standard school-based program.113 However, sometimes public service announcements are used by the very industries they are targeting to deflect criticism (eg, "Know when to say when").Both parents and health professionals need to begin engaging vigorously in media advocacy—"the strategic use of mass media for advancing a social or public policy initiative."114 According to Wallack,115 current debates must be reframed to refocus public attention on health issues, not individuals' weaknesses. For example, tobacco manufacturers have long deflected attention by framing the debate about smoking as an issue of individual freedom. Similarly, the National Rifle Association has confused the issue of handgun control by claiming that the Constitution guarantees everyone's right to own a handgun, despite the fact that no Federal court has ever overturned a gun control law as a violation of the Second Amendment.116–118 Simply reclassifying guns as a consumer product would have a profound public health effect, especially because the sale and manufacture of guns is currently subject to less stringent regulations than the sale and manufacture of teddy bears.118,119 Successful reframing involves exposing unethical industry practices rather than trying to improve individuals' behaviors by urging them to be healthier.115The United States is one of the few Western nations that lacks a comprehensive, school-based media education program. Recently, Australia mandated media education for nearly every student from kindergarten through grade 12; Ontario, Canada has mandated media education for middle and high school students; and England, Scotland, and South Africa all have far more formal training programs than the United States.104 A number of advocacy groups (Table 7) have devised and tested curricula that can be used in a variety of settings, but school officials often resent having to commit more time and financial resources to what they view as extracurricular programs. Viewed in the context of protecting children and adolescents against crucial public health problems such as early sexual intercourse, interpersonal violence, and drug involvement, however, such programs take on a new urgency.More research is needed regarding the efficacy of media education programs. Nevertheless, several curricula have been field-tested, indicating that such programs can accomplish exactly what they set out to do.120–126 One curriculum, in particular, worked to change attitudes about television violence among first and third graders as well as decreasing their own levels of aggressive behavior as rated by their peers.127 Another recent curriculum has been shown to decrease third-graders' intention to drink alcohol.128 Computer and video games could also be used for prosocial learning.129Although the United States was the first nation in the world to have television, it is unique in lacking any clear public policy regarding it.34,130 American television was established and regulated according to the Communications Act, passed by Congress in 1934. The preamble to that act states that the public owns the airwaves, which are leased to the networks to produce programmingin the public's best interests (authors' italics). Because of the industry's reluctance to regulate itself, especially regarding violent content and production of educational programming for children, Congress and the Federal Communications Commission have taken an increasingly aggressive role during the past decade. The 1990 Children's Television Act required local broadcasters to produce some educational and informational programming for children. Unfortunately, broadcasters tried to cite programs like "The Jetsons" as educational, teaching children "what life will be like in the 21st century."131Irritated by the industry's lack of compliance with the Children's Television Act and by continued high levels of media violence,132 legislators passed the Telecommunications Act of 1996, which put teeth into the 1990 Children's Television Act by requiring ratings for programs and mandating that, beginning in September, 1997, broadcasters must air 3 hours of core educational programming per week.133 The Act also mandated that all television sets manufactured beginning in 1998 contain a v-chip that could be programmed by parents to filter out objectionable media violence. However, which ratings system or systems will be programmable onto the v-chip remains a contentious issue, one that perhaps the Federal Communications Commission will ultimately have to decide.After discussions with public advocacy groups, the television industry developed a complicated set of ratings that parallel current Motion Picture Association of America movie ratings.134Several problems exist with this proposed system: first, several studies show that parents prefer a more specific, content-based ratings system, not simple categories.135,136 Second, the current categories are not specific enough regarding content, and the contextual impact of violent or sexual references is completely ignored. For example, certain content becomes lost to the highest rating: a TV-M program with an "S" for sexual content may contain violence at a TV-14 level, but is not given a "V" for violent content. Third, parents may be tempted to place inappropriate faith in the rating "FV" for fantasy violence, even although research shows that this represents some of the most potentially detrimental programming for young children.15,16,137 Finally, studies document that older children and young teenagers are drawn toward the more adult ratings.138Despite the Federal government's traditional reluctance to regulate the entertainment industry because of First Amendment concerns, several potential solutions are available that would make television and other media healthier for children and adolescents.The United States is unique in the industrialized world in spending only $1.09 per capita for public broadcasting; the United Kingdom spends $38.56, Canada $32.15, and Japan $17.71.104,130 With increased revenues, the Corporation for Public Broadcasting could develop its own commercial-free series of stations gearing high-quality, education programming toward individual age-groups (2 to 5 years, 5 to 9 years, 9 to 13 years, and 13 to 17 years). An annual tax on television sets (as is done in Britain) could be used to raise these revenues.30,37 If the future home will receive 300 to 500 different channels, shouldn't at least 5% to 10% of them be reserved for noncommercial, educational programming for young people?This might also include funding for school-based media education programs. In particular, a systematic program of research is urgently needed whose goal would be the development of formal, easily administered educational programs about media sex, drugs, and violence.139It has now been 15 years since the last, official government compilation of all available research to that time.56 Such reports highlight current knowledge, expose areas that warrant further investigation, and serve as valuable ammunition in the public health campaign to improve media for young people.As United States Supreme Court Justice Tom Clark once said, there is no war between the Constitution and common sense.140Compelling public health interests exist in protecting at least children and adolescents against the advertising of cigarettes and alcoholic beverages. Because such advertising represents commercial speech rather than free speech, it is not automatically protected under the First Amendment.141,142 The Federal Trade Commission is already empowered to ban advertising that is unfair or deceptive, and both tobacco and alcohol advertising arguably fit that description.28 But restricting advertising may be more feasible constitutionally than an outright ban.143 Current proposed Federal Drug Administration rules would restrict tobacco advertising seen by children or teenagers to black-and-white text only.144 New proposed legislation by Senator McCain (R-AZ) would completely eliminate tobacco advertising directed at children and, more importantly, would eliminate promotional events and advertising,145 which in the past decade has constituted more than half of the $6 billion that tobacco companies annually spend on advertising.29 One significant drawback to a broadcast ban on alcohol advertising might be the elimination of effective counteradvertising.146,147 Two alternatives exist: either require equal amounts of public service announcements that would extoll the dangers of alcohol148 or mandate that advertisements be restricted to so-called tombstone ads (ie, ads that show the product only but do not depict the qualities that the drinker might acquire). Such restrictions have been endorsed previously by the Federal Drug Administration, the Surgeon General, the American Academy of Pediatrics, and the American Medical Association.28,149,150 Because it is unlikely that the density or effectiveness of public service announcements will ever reach the levels of regular commercial advertising, limiting alcohol manufacturers to tombstone ads seems far more prudent.Although deregulation, not increased regulation, seems to be the current trend in Washington, children and adolescents deserve special protection from the Government. Although broadcasters complain that 3 hours of educational programming per week is burdensome, such an amount seems totally inadequate given their free use of public airwaves. All television networks and stations should be mandated to air at least 1 hour per day of educational programming for children. The United States is unique among nations in not having any such regularly scheduled programming.Likewise, young people deserve and will need special protections while using the Internet.151 Development of special blocking services, proscriptive entrances to certain Web sites, and other solutions will have to be developed to shield young people from pornography, dangerous chat rooms, and other explicit material on the Internet.152 A recent White House summit (July, 1997) has begun this process with cooperation from technology industries and Internet providers.Although the entertainment industry currently sees little problem with the quality of their product, the research literature and most parents would disagree. American media are the most graphically violent and sexually suggestive in the world. At present, networks, studios, and software companies have little incentive to create more educational and healthier programming. Indeed, the industry is quick to point to such exemplary works as "Shindler's List" as being prohumanitarian or "The Cosby Show" as showing strong family values, but then denies that any programming can have negative effects.153Unlike adults, children view television and movies as depicting the real world, with real adults interacting, and unfortunately it is a world that is rife with happy violence, unprotected and casual sex, drinking, smoking, stereotypes, and a variety of other, unhealthy images and behaviors.154One frequently heard excuse from the industry is that it is merely giving people what they want. Yet, there is significant evidence to the contrary. Gerbner132 compared Nielsen ratings of two samples containing more than 100 programs each—one of violent programs, the other of programs without violence. The nonviolent programs had a higher overall rating and market share. Similarly, a movie industry study found that PG-rated movies were three times more likely to gross $100 million than R-rated films.155 And public opinion polls document that as many as 80% of adults believe that entertainment violence is harmful to society.30What is needed is a virtual sea-change in attitude, from one of crass commercialism to one of respectful paternalism for the unique psychology and needs of young people. The American public is quick to criticize teenagers for their early sexual activity, drug-taking, or violent behavior; yet these youngsters are learning important behavioral cues from the media that surround them.Ratings, v-chips, school-based media-literacy programs, even increased parental scrutiny can only accomplish so much. There is no substitute for an immediate and significant decrease in the easy violence (especially when guns are included), the casual unprotected sex, and the frequent smoking and drinking currently being beamed at American children and adolescents (Table 8).30,37,156 Expecting the entertainment industry to acknowledge their responsibility to the public health may be naive, but the stone wall is beginning to crumble. Children and teenagers comprise a captive audience for entertainment producers, but they also represent the next and only source of adults in American society. As such, they deserve far better than what they are being exposed to now.