Using Media to Maintain Sexual Health: A Focus on Adolescent Girls
Using Media to Maintain Sexual Health: A Focus on Adolescent Girls Jane D. Brown, PhD Sarah N. Keller, MS School of Journalism & Mass Communication, UNC-Chapel Hill Overview Adolescents Sexual health Special risk for teen girls Media Sexual content Effects on sexual identity & behavior Potential to promote sexual health Lessons learned: How to use media to promote sexual health? Defining the problem: Adolescent sexual health 73% of boys and 56% girls have sexual intercourse by age 18 Estimated 4 in 10 get pregnant by age 20 2/3 all STD cases acquired by age 25 75% teen pregnancies unintended AGI, 1994. McCauley A,. Meeting the needs of young people. Popul Rpts 1995; series J, no.41. Eng TR, Butler WT. Institute of Medicine. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington: National Academy Press, 1996. Use of contraceptives 72% sexually active girls ages 15-17 use contraception Fewer than half (44%) of girls who use contraception use condoms Girls, on average, delay 1 year after first sex before contracepting Estimated four in 10 get pregnant by age 20 AGI, 1994. McCauley A,. Meeting the needs of young people. Popul Rpts 1995; series J, no.41. STD rates Youth under 25 have one-half world’s HIV infections 12 million STD cases a year in U.S. 3 million in teens Girls age 15-19 have highest rates of gonorrhea in U.S.; chlamydia rates growing Eng TR, Butler WT. Institute of Medicine. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington: National Academy Press, 1996. STD knowledge 42% U.S. teenagers can’t name an STD other than HIV Only 3% know of chlamydia -- the fastest growing STD in U.S. Fewer than half (44%) of sexually active women talk to partners about HIV-- only 27% discuss other STDs American Social Health Association. Gallup Study: Teenagers Know More than Adults about STDs. Research Triangle Park, NC: 1996. Glamour, et al. Survey of Women about their Knowledge, Attitudes, and Practices Regarding their Reproductive Health. Menlo Park, CA: Kaiser Family Foundation, 1997. Media’s potential as an educator Media can be powerful Media are not being used to their full potential In Western Europe, 3/4 of population learns about STDs from TV, books or magazines In U.S., 1/4 learn about STDs from media ASHA, 1996. TV videos in Nigeria related to increased family planning 30 25 20 15 %using family planning 10 5 0 TV/radio Contraceptive use by Nigerian women in 1993 who had seen music videos and TV dramas to promote family planning in 1989-92 none Westoff C, Rodriguez G, Bankole A. Family Planning and Mass Media Effects. Chapel Hill: The Evaluation Project, 1996. PSAs promote condoms in Portland, Oregon 1992-94 Teens who used condoms in last month increased from 32% to 40% Teens who used condoms with casual partners rose from 72% to 90% Teens who planned to discuss condoms with next partners rose from 53% to 80% Blair J. PSI/Project ACTION: Improving Teen Risk Reduction. Washington: Population Services International, 1995. Define Target Audience, Focus Message & Choose Media Start with audience Define who they are: media use personal identity - what they care about risk level Gear message to fit Choose appropriate media Selecting target audience: Teen girls Girls twice as likely as boys to get STDs. Asymptomatic infections harder to diagnose Long-term complications more serious Young women have special risk: thinner cervical mucus multiple partners Less negotiating power in relationships CDC. HIV/AIDS Surveillance Report 1994; 5:1-36. Germain A, Wasserheit J, eds. Reproductive Tract Infections: Global Impact and Priorities for Women’s Reproductive Health. New York: Plenum Press, 1992. Formative research: Media use TV: 2 hours, 43 minutes per day Music: 3 - 4 hours per day Movies: First R-rated film at age 12.5 Magazines: Girls ages 11-13 start with Seventeen, move to Glamour Internet: Girls constitute 40% of CD-Rom Myst users American Psychological Association, 1993. Media diets vary by race & gender Not all teenagers tune into the same kind of media Girls prefer softer music and soap operas Boys prefer action flicks and harder, louder music African-Americans and children from single-parent households watch more TV Steele JR, Brown JD. Adolescent room culture: Studying media in the context of everyday life. J Adolesc Hth 1995; 24(5). Media diets vary by personal identity, too Even within race & class categories, teenagers’ media use vary dramatically Teens define themselves by their identities Girls’ sense of selves may be particularly transitory & vulnerable to media influence Pipher M. Reviving Ophelia. New York: Ballantine Books, 1994. Thompson S. Going All the Way. New York: Hill and Wang, 1995. All teens get a lot of “sex”… TV: 8 sexual messages per hour on prime-time Movies: More explicit than TV Music: 3/4 lyrics about love and sex Magazines: Seventeen, Young Miss, Glamour & Cosmopolitan Internet: ? Sex on TV TV family hour 8-9 pm: 3/4 network programming contain sexual content only 9% of scenes mention responsibilities, risks, protection or consequences Advocates for Youth. Talking with TV. Washington: Advocates for Youth, 1996. Dale K, et al. Sexual Messages on Family Hour TV: Content and Context. Santa Barbara: Children Now, Kaiser Family Foundation, 1996. Sex on TV (cont’d) Sexual interactions on family hour TV shows has steadily increased over the past two decades 9 8 7 6 5 4 3 2 1 0 sexual interactions (talking or behavior) per hour 1976 1986 1996 Sex education on TV? Condoms, STDs & pregnancy are mentioned in fewer than 1 in 10 sex-related scenes on family hour TV 9 8 7 6 % sex-related scenes showing risks or responsibilities 5 4 3 2 1 0 1976 1986 1996 What effect? Studies are few Sex on TV increases perception that peers are having sex Teens unlikely to learn safe sex from TV Aggressive sex on TV increases acceptance of rape & sexual abuse Advocates for Youth, 1996. ASHA, 1996. What effect? (cont’d) TV violence studies show that violent programming teaches: behavior modeling (cool people are violent) social norms (guns are powerful) desensitization (killing people isn’t so bad) Same effects may occur with sex on TV: behavior modeling (stars have risky sex) social norms (premarital sex is OK) desensitization (violent sex won’t really hurt) When Oprah Winfrey recommends a book, it sells! Deep End of the Ocean, Jaquelyn Mitchard Song of Soloman, Toni Morrison The Book of Ruth, Jane Hamilton Thigpen DE. Winfrey’s winners. Time Magazine, Dec. 2, 1996 before after Hamilton The 900 800 700 600 500 400 300 200 100 0 Morrison Thousands of books in print before & after selection by Oprah Mitchard Lessons learned Define target audience Find out who they are: Media use Personal identity Risk level Focus message Choose media Use media channel & message style that audience uses Speak to relationship identity & sexual scripts Gear health messages to reach different categories of risk Gearing messages to fit Speaking to teen identities may be key to influencing behavior Identity -- a person’s self-perception & tastes in fashion, music & friends -- may determine sexual practice Project ACTION Social marketing to promote teenage condom use in Portland, Oregon by Population Services International 1992-94 Community mobilization Condom vending machines Peer skill-building workshops Motivational media campaign Evaluation research Project ACTION: Tailoring the message Target audience: At-risk teens ages 12-21 Focus groups subdivided into boys, girls & African-Americans Different PSAs designed to match sexual scripts of each subgroup PSA for girls: romantic flowers PSA for boys: pretty girls PSA for African-Americans: passionate glance Applying TV violence lessons to safe sex campaigns PSAs can be more effective Segment audience Show negative, realistic consequences Present alternatives to unwanted behavior Illustrate behaviors that lead to safe sex Use non-celebrity adolescent voices Avoid lengthy sponsor announcements Microsoft ClipArt Gallery UC-Santa Barbara, 1997. Other lessons learned Cues to action Give constructive suggestions to improve behavior Link to services: Tell where to go for condoms, STD counseling, treatment or more information Blair J, 1995. Community mobilization Use media to set agenda Involve youth & opinion leaders Foster support for new behavior Work with different sectors Active audience Teens don’t accept media messages wholesale Media use depends on identity Identity shaped partly by media Cyclical process Brown, 1995. Pipher, 1994.