Measuring the Effects of Sexual Content in the Media: A Report to the Kaiser Family Foundation

This Report is available in Adobe Acrobat Format

Author: Drs. Aletha C. Huston, Ellen Wartella, and Edward Donnerstein

Executive Summary

The Kaiser Family Foundation has an ongoing interest in sexual health among young people and the potential contributions of mass media to sexual behavior. This report was prepared at the request of the Foundation to examine the methodological options for investigating the effects of sexual content in the media on children and adolescents. In preparing the report, we convened a Forum of twenty scholars with expertise in sexuality, sexual development, media analysis, and media effects to discuss these issues.

The purposes of this report are to review what we know about the relations of entertainment media to sexual development during childhood and adolescence, to consider methodological issues and challenges in studying this topic, and to propose some fruitful directions for future research.

There are many opinions about the effects of sexual content in the mass media, and they are often couched in political or religious overtones. This report is not intended to debate these opinions, rather, it is a review and discussion of social scientific methods which provide publicly shared, objective, empirical, and replicable information that can be used to build a cumulative body of knowledge of this area.

Although the effects of sexual content have received relatively little attention from researchers, there have been content analytic studies of the portrayals of sexuality in television and movies and there is evidence that sexual messages in entertainment media have been increasing.

Studies of sexual messages in movies and on television (prime-time, soaps, and music videos have been studied most heavily) have found that over the past twenty years, there has been an overall increase in the number of portrayals and the amount of talk about sex in these media and an increase in the explicitness of these portrayals. Furthermore, the television research shows a fairly consistent sexual message across TV genres: most portrayals of sex depict or imply heterosexual intercourse between unmarried adults, with little reference to STDs/AIDS, pregnancy, or use of contraception.

There are sound theoretical reasons to believe that television and other media can play an important role in educating children and adolescents about sexuality. Media portrayals surround children and adolescents, and young people are intensely interested in sexuality, romance, and relationships.

Yet, there are very, very few studies of the effects of sexual messages in the media on child and adolescent viewers. The few experimental studies show that television has the potential to change viewers’ attitudes and knowledge. Correlational designs provide weak evidence that television viewing is linked with sexual behavior and beliefs, but the measures of viewing are crude at best. There also is some evidence that such personal factors as interest in sexual content, level of understanding, perceived reality, and parental mediation modify the influence of sexual messages. Much more empirical work is needed to substantiate the claim that naturally occurring sexual content in the media actually does cause changes in attitudes, beliefs, and behaviors. Such changes need to be examined as a function of what individuals are watching, the messages they are receiving, how they are interpreting them, and other factors that influence a young person’s sexual personae.

Two approaches to sexual development are reviewed in this report. Healthy sex, or the role of sex in individual mental health and in healthy relationships, focuses on enabling people of all ages to develop the attitudes, values, and behaviors that promote healthy sexual functioning. In this approach, sex is considered good and essential to human functioning. The second orientation, sexual health, has a narrower focus based in public health concerns about the physical disease, mental health, and social problems that can arise from sexual behavior. The majority of the literature in this area is concerned with STDs, including HIV, and unwanted, early, or out-of-wedlock pregnancy, but sexual violence and coercion, including rape, and mental health problems (e.g., depression, low self-esteem, distorted body image) also are considered. The sexual health literature tends to focus on prevention through encouraging young people to abstain from or postpone sexual intercourse, especially with multiple partners, and by encouraging them to use “safer sex” practices when they do have intercourse.

Research designed to understand the influence of mass media on sexual health must be informed by an understanding of the developmental changes in sexuality during childhood and adolescence, as well as socioeconomic, cultural, family, and peer influences. At the very least many of these influences must be controlled in studying media effects. Perhaps more important, it is likely that the processes involved and outcomes of interest will differ for different groups of young people. If we are to completely understand the effects of sexual content in the media we need to consider a range of outcomes — cognitive, emotional, attitudinal, behavioral — either separately or in combination with one other. In addition, we need to be cognizant of vast individual differences in how viewers respond to sexual depictions.

There are several inherent ethical and practical problems in doing research on children’s and adolescents’ sexual knowledge, attitudes, and behavior. The broad outline of these issues can be subsumed under several general principles regarding the protection of human subjects, which have been articulated by the federal research directors. Specific concerns regarding how various institutional research boards (IRBs) interpret these general guidelines, and gaining parental consent when children and adolescents are the subjects in a study also pose barriers to research.

The report suggests that researchers can design and conduct important research within these national and local guidelines. We recommend research based on the following premises:

1. Research in this area should be conducted by interdisciplinary teams of investigators, with expertise in the area of sexual development and others with expertise in media research.
2. There is need for an accumulated body of systematic studies using a variety of methods with a variety of populations. Given the paucity of available studies and the need to develop a systematic research base, no one grand study will provide definitive answers.
3. Research on the effects of sexual media content should in general begin with small-scale studies and move to larger field and longitudinal studies. Small-scale studies (laboratory, survey, observational) can permit refinement of questions, measures and methods in a relatively low-cost and efficient way.
4. Research must take into account developmental, gender and ethnic differences. The functions and effects of sexual media content in sexual development may vary substantially for boys and girls, for different ethnic groups, and across different age groups.
5. There is a need for the development of valid and reliable measures of the use of media sexual content and of outcome measures of sexual knowledge, attitudes, and behaviors. One cannot generalize the validity or reliability of measures used with adult populations to children and adolescents particularly in this research domain.

In addition to the premises laid out above, the report provides some more specific recommendations about what kinds of studies should be conducted. We encourage researchers to think creatively about additional research design options.

There is little existing research literature that addresses the issue of children’s media use patterns. Any attempt to understand the influence of media on young people should begin with an assessment of both the amount and patterns of media use among children. Given the recent explosion in new media choices such as the Internet, computer games, and niche cable channels, it is imperative that we have an understanding of what media kids are using, and how and why they are using them.

Though many studies have looked at the amount and nature of sexual depictions on television, future content analyses should be more theoretically guided and contextually situated. Future research should include in its framework theories about sexuality, sexual development, and media effects. In addition, most content analyses have been limited to certain genres of television programming. Future content analyses should include cable programming, advertising, news, talk shows and new media.

In studying the effects of sexual media content on viewers, it is important to consider the various types of outcomes, including cognitive, emotional, attitudinal, and behavioral. In the early stages of conducting research on this topic, small experimental studies are likely to be more useful than correlational studies. Some of the proposed experimental techniques include manipulating outcomes of sexual media messages to measure immediate effects on children’s knowledge, schemas, attitudes and even behaviors.

A second phase of research could employ the field experiment technique, best used in cooperation with the media industry. The body of the report identifies two successful examples of field experiments, and recommendations for future field experiments on sexual content.

Once preliminary research is conducted on the effects of sexual content, an accelerated longitudinal design with overlapping cohorts would be the next recommended approach. This design would maximize the information obtainable in a five-year period, and would allow for follow-up in later years, were funding available.

Our final recommendation concerns the process for bootstrapping research in this entire area. As we have previously noted there is little systematic knowledge about the effects of sexual content. We certainly encourage research across many disciplines and funding agencies (both federal and private), but a central guiding framework is needed. We believe that an initiative akin to the Surgeon General’s 1970 study of Television and Social Behavior would be useful. A collaborative effort by the Kaiser Family Foundation, working with other foundations, could produce a coordinated research base collected in a major report that would provide a solid foundation for understanding the effects of sexual media content and could serve as a basis for future funding and research.

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Measuring the Effects of Sexual Content in the MediaReport

This chartbook provides a general guide to the more than $8 billion in federal funding allotted in 1998 for HIV/AIDS research, prevention, care and assistance and international programs. It serves to assist in identification of the types of programs supported, as well as recent spending trends.

You can find the latest version of the report here.

Note: This publication is no longer in circulation. However, a copy may still exist in the Foundation’s internal library that could reproduced. Please email order@kff.org if you would like to pursue this option.

New National Surveys of Parents and Children on TV Ratings System:

Half of Parents Use the New TV Ratings,But Many Say Changes Could Make Them More Helpful

Parents Also Need To Know More About How the System Works

Embargoed for release until 9:00 a.m. ET, Wednesday, May 27, 1998

The Report is available in Adobe Acrobat Format

The Chart Pack is available in Adobe Acrobat Format

Contacts:Tina Hoff/Kaiser Family Foundation (415) 854-9400, orMatt James/Kaiser Family Foundation (415) 854-9400

Washington, DC – As the first television season using the new ratings system draws to a close, half of all parents with children ages 2-17 (54%) say they are using the new ratings to help guide their children’s viewing, and 45% say they have stopped at least one of their children from watching a particular show because of its rating, according to two new surveys of parents and children by the Kaiser Family Foundation. But more than eight out of ten parents who use the ratings say there are improvements that would make the ratings more helpful, and many do not have a good understanding of how the current system works.

The survey also finds that parental concerns about television content are rising. The number of parents of children ages 2-17 who say they are concerned “a great deal” that their children are being exposed to too much sexual content on TV increased from 43% in an October 1996 Kaiser Family Foundation survey to 67% in April, 1998, when this survey was conducted. The number expressing the same concern about violent content increased from 39% to 62% over the same period.

The TV ratings system was designed to help address concerns about television content by giving parents assistance in monitoring what their children watch. Nearly all of the parents who have ever used the ratings say they have found them “useful” (42% “very” and 51% “somewhat”). A smaller percentage of parents who use the system say the ratings have been “successful” in keeping children from being exposed to inappropriate material (13% “very” and 51% “somewhat”).

“Parents say they are more concerned than ever about the impact of TV on their kids,” said Drew Altman, President of the Kaiser Family Foundation. “The good news for the ratings system is that many parents are using the ratings and find them helpful; but they do not always understand the system, and there are changes they’d like to see made.”

One out of five parents say (18%) they have not heard about the ratings system. Twenty-seven percent of parents say they have heard of the ratings system but “never” or “hardly ever” use it. The most common reason given by these parents for not using the ratings is that they would rather decide for themselves what is appropriate or not for their children to watch (31% say this is the leading reason).

Many Children Also Use Ratings.

In a companion survey of children, a third (36%) of 10-17 year olds report that at least once, one of their parents has stopped them from watching a show because of its rating. The survey also revealed that just over a third (36%) of all children say they themselves have decided not to watch a particular show because of the rating it received. But children have mixed reasons for tuning out: forty percent say it is because their parents wouldn’t want them to watch the show, while 26% say it is because they think the show is meant for younger kids.

Parents Say Changes Could Make Ratings More Useful.

Most parents who use the ratings (73%) say they learn a show’s rating from seeing the symbol on-screen at the beginning of the show, but many (67%) say even when they are looking for the rating they miss seeing it. More than eight out of ten parents who use the ratings say they favor having the rating appear on screen more often (84%) or announced out loud at the beginning of the show (82%), but most do not favor having the rating stay on screen throughout the entire show (42% support, 57% oppose).

Many Parents Need More Information About Ratings.

The survey indicated that many parents could use more information about how the ratings system works, including what kinds of shows are rated, who rates programming, and what the different rating symbols mean. Even among those parents who are aware of the ratings system,

• Less than half know that children’s shows (49%), talk shows (40%) and soap operas (23%) are rated.
• About half (54%) know what at least six of the eleven rating symbols mean, while 46% know five or fewer.
• Thirty-one percent know that the television industry rates programs itself, while 32% believe that an independent review board does the rating. Nine percent think the government rates shows, and 27% say they don’t know who does the rating.

Parents Say Ratings Accurately Depict TV Content.

Seventy-one percent of parents who use the ratings say they provide “reasonably accurate” information about TV shows, although half (50%) say they have on occasion disagreed with how a particular show was rated. Only 12% of parents who use the ratings say they know who to complain to in such a situation.

Parents would use a v-chip.

Nearly two-thirds of all parents (65%) say that if they had a v-chip in their home, they would use it to block certain programming. But most parents say they are either “not too likely” (24%) or “not at all likely” (45%) to go out and buy a TV with a v-chip (or a set-top box) in the next year or two.

The new ratings, which combine both age-based ratings and content descriptors, were implemented in October 1997 as the result of an agreement among advocacy groups, policymakers and representatives of the television industry. NBC and BET have declined to use the content descriptors. The ratings are designed to work in conjunction with the v-chip device, which will allow parents to block shows with certain ratings from their homes. The v-chip is expected to be available in some new TV sets and in set-top boxes within a year; all new sets will be required to have a v-chip within a year and a half. Following are the rating categories:

TVY: All children. This program is designed to be appropriate for all children.

TVY7: Directed to older children. This program is designed for children age 7 and above.

TVG: General audience. Most parents would find this program suitable for all ages.

TVPG: Parental Guidance Suggested. This program contains material that parents may find unsuitable for younger children.

TV14: Parents Strongly Cautioned. This program contains some material that many parents would find unsuitable for children under 14 years of age.

TVMA: Mature Audience Only. This program is specifically designed to be viewed by adults and therefore may be unsuitable for children under 17.

V: Violent content.

S: Sexual content.

L: Language.

D: Suggestive dialogue.

FV: Fantasy violence.

Methodology

Parents, Children, and the Television Ratings System reports on the results of two national random sample surveys designed by the Kaiser Family Foundation and Princeton Survey Research Associates (PSRA), and conducted by PSRA by telephone between April 2-26, 1998. 1,358 parents of children ages 2-17 and 446 children ages 10-17 were interviewed. The margin of error for the survey of parents is plus or minus 3%, and for the survey of children is plus or minus 5%.

The Kaiser Family Foundation, based in Menlo Park, California, is an independent national health care philanthropy and not associated with Kaiser Permanente or Kaiser Industries. These surveys were conducted as a part of the Foundation’s Program on the Entertainment Media & Public Health, which was established to examine the impact of entertainment media in society, and to work with the entertainment industry, researchers and policymakers on important public health issues.

Copies of the summary of findings and questionnaires for the surveys reported on in this release are available by calling the Kaiser Family Foundation=s publication request line at 1-800-656-4533 (Ask for #1398).

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New National Surveys of Parents and Children on TV Ratings System:Press Release

The Southern Africa Grantmakers’ Affinity Group of the Council on Foundations and the U.S. Congressional Black Caucus cordially invite you to participate in a high-level conference under the co-chairmanship of Ambassador Andrew Young, Representative Maxine Waters, the Hon. Sir Ketumile Masire and the Hon. Nic

This policy brief provides an overview of the low-income, uninsured population. Based on an analysis of the March 1998 Current Population Survey, the report discusses the demographic characteristics of this vulnerable population. It also presents information detailing health insurance coverage for low-income children and adults, as well as trends in insurance coverage over the past decade. It concludes with a discussion of recent coverage expansions and policy changes that have affected low-income Americans. The policy brief also includes a set of detailed appendix tables that provide health insurance coverage information by socioeconomic characteristics.

• Policy Brief

Leading Health Care Consumer Protection Proposals Would Result In Modest Premium Increases for HMOS

New Cost Analysis of Consumer Protections:Major Provisions of President’s Consumer Bill of Rights and PARCA Estimated to Raise Premiums by Less Than 1%

Embargoed for release until: 9:00 a.m., EDT, Wednesday, April 22, 1998

For further information contact:Chris Ferris (202) 347-5270or Matt James (650) 854-9400

Washington, DC – A new independent cost analysis finds that the premium increases likely to result from two leading health care consumer protections proposals currently before Congress are modest. The study, prepared by Coopers & Lybrand for the Kaiser Family Foundation, finds that major provisions of the Consumer Bill of Rights and Responsibilities (CBRR) endorsed by the President are estimated to result in an annual premium increase of 0.61% for a typical HMO policy, adding approximately $31 per year to the cost of an average family insurance policy.

Major provisions of a similar proposal in the Congress, the Patient Access to Responsible Care Act (PARCA), would increase HMO premiums by 0.77%, adding an extra $40 to a family policy per year. The estimated premium increases under PARCA do not include the provision in the legislation that would allow health care consumers to sue their health plan directly; the researchers were unable to attach a dollar figure to this measure because of the high level of uncertainty regarding its potential impact.

The cost of individual consumer protection provisions in both bills range from 12 cents per person per year to assure access to specialists in the CBRR to $6.96 per person per year to require a point of service option in PARCA.

The study estimated the effect of the consumer protection provisions on HMOs, which are the types of plans most likely to be affected. The study finds that other types of health insurance plans – such as Preferred Provider Organizations or Fee for Service plans – would be less affected by the consumer protection provisions, so the average premium increases across all types of health insurance would be lower than the figures found in the study.

The average cost of an HMO policy for a family is approximately $5,160 per year, according to the study. The report uses the HMO policy as the prototype for estimating the effects of the proposals on health insurance premiums. Premium costs are usually shared by employer and employee.

The report, Estimated Cost Effect of Provisions of Consumer Protection Proposals by the President’s Advisory Commission and the Patient Access to Responsible Care Act, is among the first to provide an independent analysis of PARCA. It comes on the heels of similar preliminary estimates of CBRR costs prepared by the Congressional Budget Office in March.

“This study suggests that most of the consumer protection provisions in the bills currently before Congress will have modest price tags,” said Drew Altman, President of the Kaiser Family Foundation. “There should be plenty of room to find common ground as the legislative process moves forward.”

A Comparison of the Two Proposals

Last year, the President appointed a commission – the Advisory Commission on Consumer Protection and Quality in the Health Care Industry – to make recommendations for ways to improve the quality of health care services. The commission issued its report, the Consumer Bill of Rights and Responsibilities, last November. The President endorsed its recommendations earlier this year and required through executive order the application of many of the provisions to all federal health programs.

The Patient Access to Responsible Care Act sponsored by Representative Norwood (H.R. 1415) and the companion bill sponsored by Senator D’Amato (S.644) contain many provisions similar to the CBRR.

“The consumer protection proposals that we examined largely reflect changes that are already underway in the health care market,” said Sandra Hunt of Coopers & Lybrand, the study’s lead author. “We estimate a modest change in HMO costs resulting from these proposals.”

The study sponsored by the Kaiser Family Foundation finds some variation in the costs of the specific measures included in the proposals:

• Information Disclosure: Both proposals contain provisions requiring information disclosure, which would require quality and satisfaction data to be made available to consumers. The CBRR recommends greater information reporting than PARCA. Because they are more extensive, the CBRR information disclosure requirements are estimated to cost six dollars per person per year; the PARCA provisions would cost about $1.20.
• Emergency Services Access: Both also propose specific levels of access to emergency services, requiring the use of a “prudent layperson” standard for access to these services. This standard generally means that an individual who reasonably believes that emergency treatment is necessary must be provided coverage for the initial treatment costs of emergency care. The study estimates that the emergency care provisions in each of the proposals would increase premiums by about $1.20 per person annually.
• Access to Specialists: The CBRR and PARCA include standards for access to specialist services, with the CBRR having more specific standards applying to gynecologists, certified nurse midwives and other routine and preventive services for women. In part because many health plans already allow access to specialists in a way similar to what the proposals call for, this provision would likely raise premiums nominally (by about 24 cents per person each year). Expanded access to women’s health services under CBRR, taken alone, would add about 12 cents per year.
• Third Party Appeals: The two proposals include provisions to allow health care consumers to ask for an independent third party review of health plan service requests and utilization decisions. This appeals process is designed to ensure that health plan consumers have a fair and impartial decision-making process to determine the medical necessity of covered services. The estimated cost of this provision is $1.20 per person annually under each of the proposals.
• Point of Service Option: Unlike the CBRR, PARCA would require that all network-model health maintenance organizations (HMOs) offer a Point of Service (POS) option to members. This would allow health plan members to chose health care providers that are not in the network by paying higher cost sharing for those services. This option would add an estimated $6.96 per person to annual premiums.
• Liability and Malpractice: PARCA also includes an amendment to federal law to permit patients to sue health plans in cases of personal injury or wrongful death. However, the cost implications of this provision are uncertain, and Coopers & Lybrand did not estimate the potential cost because of the high level of uncertainty regarding its potential impact.

Estimated Annual Costs Per Person and Percent Increase in Premium

Provision CBRR PARCA Per Person Percent of Premium Per Person Percent of Premium

Information Disclosure $6.00 0.40% $1.20 0.08%

Emergency Service Access $1.20 0.11% $1.20 0.11%

Access to Specialists $0.12 0.01% $0.24 0.02%

Access to Women’s Services $0.12 0.01% Not part of PARCA

Third Party Appeals $1.20 0.08% $1.20 0.08%

Point of Service Option Not part of CBRR $6.96 0.48%

Total $8.64 0.61% $10.80 0.77% Note: In some cases the figures cited here are annualized from monthly estimates included in the study.

Other Consumer Protection Proposals:

Since the Kaiser Family Foundation commissioned the report, two other consumer protection measures have been proposed on Capitol Hill, one sponsored by Representative Dingell and Senator Daschle (H.R. 3605/S. 1890), and the other by Senators Jeffords and Lieberman (S. 1712).

More information on the four consumer protection proposals can be found on the Internet:

CBRRPARCADingell/DaschleJeffords/Lieberman

Methodology

The report, Estimated Cost Effects of Provisions of Consumer Protection Proposals by the President’s Advisory Commission and the Patient and Access to Care Act, is based on a Coopers & Lybrand analysis of actuarial data, prior research, and interviews with key health plan, association, and industry leaders. Actuarial data were used in those portions of the analysis where certain practices are already in place. Information regarding the level of change in practices that would be required to comply with the proposed standards was obtained from experts in the field and from a review of literature. The estimated premium increases under PARCA do not include the provision in the legislation that would allow health care consumers to sue their health plan directly, since the researchers were unable to attach a dollar figure to this measure because of the high level of uncertainty regarding its potential impact. The estimates also do not include the effects of provisions in PARCA prohibiting health plans from discriminating against certain providers and providing health professionals with a variety of due process rights.

* * *The Kaiser Family Foundation, based in Menlo Park, California, is an independent national health care philanthropy and is not associated with Kaiser Permanente or Kaiser Industries.

Additional copies of this report are available by calling Kaiser Family Foundation’s publication request line at 1-800-656-4533 (Ask for document #1391). This press release is also available on the Kaiser Family Foundation website at http://www.kff.org.

* * *

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Leading Health Care Consumer Protection Proposals Would Result In Modest Premium Increases for HMOSPress Release

• Report:

Health News Index March/April, 1998

The March/April 1998 edition of the Kaiser Family Foundation/Harvard Health News Index includes questions about major health issues covered in the news, including questions about Cancer and Social Security. The survey is based on a national random sample of 1,201 Americans conducted April 17-27, 1998 which measures public knowledge of health stories covered by news media during the previous month. The Health News Index is designed to help the news media and people in the health field gain a better understanding of which health stories in the news Americans are following and what they understand about those health issues. Every two months, Kaiser/Harvard issues a new index report.

Kaiser Family Foundation/Harvard University School of Public Health: Update on Americans’ Views and Experiences in Managed Care

The Kaiser Family Foundation/Harvard University School of Public Health: Update on Americans’ Views and Experiences in Managed Care is based on findings from the April 1998 Kaiser Harvard News Interest Index. The survey was designed and analyzed by researchers at the Kaiser Family Foundation and Harvard University. Nationwide interviews were conducted by telephone with 1,201 adults, 18 years or older, between Arpil 17-April 27, 1998.

• Topline/Survey: Kaiser Harvard News Interest Index April 1998

A joint Kaiser Family Foundation/YM Magazine survey of teens, ages 13-18, on what kinds of sexual situations they face today, how they “negotiate” dating, sex, and intimacy, and what kind f information teens need. The findings from this survey are also reported on in the May issue of YM in a special section of the magazine that provides teens with a guide to sexual decision-making, including whether it is the right choice, contraceptive information, and the risks and consequences of sexually transmitted diseases. The survey was conducted by Princeton Survey Research Associates.

News Release (.pdf)

Report (.pdf)

Toplines (.pdf)