"What gets my goat about TV is that everybody has to be happy all the time. Rich and happy and thin. If you're not, there's something wrong with you. You need fastfast-fast relief. It can come from Bufferin, Binaca, or booze, but it's got to be fast. There's no problem that can't be solved in a 30-minute sitcom. Sex is the shortcut to love. Violence is the shortcut to problem solving. That's television: the instant gratification medium."
-Actor Jason Robards, TV Guide, May 4. 1985
In the Golden Age of Television during the 1950s ("Leave It to Beaver," "Dobie GiIIis," "Father Knows Best, " "The Donna Reed Show" ), television teenagers worried about skin blemishes, prom dates, after-school jobs, and catchers' mitts. Now, in the 1980s, they agonize about a friend's suicide, a teacher's sexual advances, a father's homosexuality, a girlfriend's pregnancy, or a classmate's heroin addiction. A chicken-and-egg dilemma has evolved - does television merely reflect society and its changes during the past 30 years (eg, increasing rates of teenage sexual activity and drug use) or is television directly responsible for some of those changes?
Though teenagers watch less TV than younger children (an average of 21 hours/week for teenage females and 23 hours/week for males),1 they still learn from what they watch and, because of their own evolving identities, may be even more susceptible to televised violence, sex, drug usage, or role stereotyping. That the extraordinary rises in teenage sexual activity and drug usage have coincided with the video explosion of the past 30 years is too provocative an occurrence to dismiss as sheer coincidence. Outside of the laboratory, cause-and-effect is difficult to prove; but there are data to support the following conclusions about television and teenagers:2
* The portrayal of teenagers on TV is distorted and over-emphasizes their sexuality and their crises.
* TV has become increasingly sexual, more by innuendo than by explicitness.
* Alcohol is a nearly ubiquitous drink on TV, yet the true effects of alcohol or alcoholism are rarely depicted.
* TV is over-populated with doctors, lawyers, and policemen and depicts very few blue-collar workers to a teenage audience that is struggling with their own future career plans.
* Obese characters are rarely depicted on television.
* Music Television (MTV) is particularly violent, sexual, and often demeaning to women.
ADOLESCENTS ON TV
TV adolescents are frequently portrayed "in crisis," and that crisis is usually drug or sex-related. During the 1980-1981 season, for example, half of the 15 films with adolescent themes trafficked in sex: a high-school boy's affair with his teacher ("Thin Ice") ; rape ("Diary of a Teenage Hitchhiker"); seduction ("The Babysitter"); and prostitution ("Off the Minnesota Strip"). In "Fallen Angel," a shy 12-year-old runs away from home, poses nude for photographs, takes drugs, and testifies in court against her corruptor, all within a 2hour format. Frequently, these movies are shown during "sweeps weeks," when ratings determine advertising revenues.3
SEXUAL BEHAVIORS PORTRAYED ON TELEVISION
BEVERAGES ON PRIME-TIME TELEVISION DRAMAS
Children and adolescents are often portrayed as wisecracking miniature adults (eg, Arnold on "Different Strokes," who is actually a teenager playing a child who is more mature than most adults) or wise and more rational than adults (eg, "Charles in Charge"). Only "Family Ties," "The Cosby Show," and ABCAfternoon Specials, have consistently shown teenagers and their parents as they really are. In one 1985 episode of "The Cosby Show," for example, son Theodore arrives home after purchasing a shirt, "an original Gordon Gartrell. " Cosby leams that the shirt cost $95 and is stunned. "I don't have a $95 shirt, and I've got a job!"/"Don't you want something better for your son?"/"Sure. You want to trade your room for that shirt?"/"But I told Christine I was getting a Gordon Gartrell. "/"Tell Christine you lied. "4 Occasionally, shows like "Facts of Life" or "Family Ties" try to Seal with themes like premarital sex, sex education, or cocaine use; but despite the conscientiousness of the writers and producers, it is impossible to deal with all the nuances of major teenage problems in a 23-minute sitcom.
SEX AND DRUGS
At a formative stage of their sexuality, teenagers view sexual relationships on TV that are rapid, frequent, casual, usually occur outside of marriage, and convey status. American TV is rife with sexual suggestiveness (Table 1), particularly soap operas, which are very popular with teenagers and pre- teenagers. One study documented a sexual reference or act every 9 minutes during daytime soap operas, with unmarried partners involved 3 times as often as married partners. "General Hospital," which has the highest ratings among teenage audiences, is also the sexiest of the soaps (16 sexual behaviors or references per hour).5
Likewise, alcohol is the most frequently consumed beverage on TV (Table 2), is used most often as a social lubricant or to resolve a crisis, and the true consequences of over-indulgence are ignored.6 Although in real-life, one-third of American adults do not drink and another third drinks only occasionally, on television alcohol comprises 62% of all beverage use. There are nearly nine alcohol references or acts per primetime hour, and 95% of sitcoms and 100% of dramas involve alcohol in some way.7
In 1983, the Hollywood Caucus of Producers, Writers, and Directors urged their industry to avoid:8 1) gratuitous alcohol use (eg, pouring a drink used as a transition to the next scene, 2) glamorizing drinking, 3) showing excessive drinking without consequences or miraculous recoveries from alcoholism and, 4) depicting alcohol use in a macho context. The success of these guidelines awaits documentation, but the television industry has displayed sensitivity to at least one health issue - cigarettes. In a 196Ì episode of "Dr. Kildare," both Dr. Kildare and his mentor, Dr. Gillespie, smoked; whereas in IO hours of two 1971 to 1977 hospital dramas, "Medical Center" and "Marcus Welby, MD," not a single cigarette was seen. In the 1980s, only 2% of series stars and 16% of main characters smoke,9
Television advertising has long used sex to sell products ranging from cars and shampoo to feminine hygiene deodorant. Given the opportunity to advertise contraceptives in a straightforward and responsible way, however, the industry has thus far refused. A recent 30-second ad by the American College of Obstetrics and Gynecology was rejected by all three major networks.10 In it, three young women are discussing their futures: one wants to be President; one wants to go to college; the third, obviously pregnant, admits that she had wanted to start a family, "but not this soon." An announcer urges viewers to call a tollfree number for more information about contraception because "unintended pregnancies have greater medical risks than any contraceptives." (In fact, there is not a single case report in the medical literature to date of a teenage girl dying from complications of taking birth control pills.11) Ads for the Today spermicidal sponge and the Encare vaginal suppository have also been rejected by the networks, although local stations have shown them without any public outcry. The Center for Population Options has recently formed a national task force comprising civic, medical, and religious groups to pressure the networks into accepting contraceptive advertising. As one pediatrician notes: "It is possible that the appearance of one or two condom advertisements on Monday night football programs would do more to lower teenage pregnancy rates than five years' worth of federally funded adolescent health programs."12
Beer and wine producers spend $900 million a year creating broadcast commercials that will encourage people to drink more. This, despite more than 20,000 deaths annually from drunken driving and nearly IO million Americans who are already alcoholics. Children see nearly 1,000 ads for alcoholic beverages a year according to one study.13 In addition, several studies have shown that media are prime sources of information for teenagers about drugs and alcohol." Since 1960, there has been a 50% per-capita increase in alcohol consumption in the US. Nearly 100% of high school seniors have experimented with alcohol, and 39% report taking five or more drinks in a row at least once in the two weeks prior to being surveyed. l4 Teenagers are hardly immune to many of the messages implied in these ads: 1) it is normal and "adult" to drink, 2) adults who drink have more fun, athletic and business success, are sexier, and have more friends, 3) beer drinkers are macho, 4) drinking is an appropriate reward for a job well done. In 1985, Project SMART (Stop Marketing Alcohol on Radio and Television) failed to obtain Congressional approval of a bill banning all broadcast advertising of alcoholic beverages (Center for Science in the Public Interest, 1501 Sixteenth Street, N. W., Washington, D.C. 20036). A similar movement in Sweden in the mid-1970s sueceeded, and per-capita consumption declined 20%. Since Congress banned cigarette ads in the US in 1971, per-capita consumption of cigarettes has dropped 25% and the number of new teenage smokers has declined.
Clearly, the American public cannot have it both ways: if sex is used to sell products and if alcoholic beverages are promoted indiscriminately, then teenage sexual activity and drug abuse will continue to be problems into the 1990s and beyond.
By the time the average American child reaches adulthood, he or she will view more than 30,000 electronic "stories" on TV. According to Gerbner, TV has created a new "cultural mythology."15 His studies show that heavy TV viewers consistently view the real world according to the way it is portrayed on TV, not the way it really is. Teenagers are particularly susceptible to such "mythology" as they try out new behaviors and test new aspects of their identities. Adolescents consistently view a TV world that is white, middle class, violent, and male. Blacks - despite Cosby and Benson - usually play subservient roles; and blue-collar workers, who comprise 60% of the real labor force, only hold 6% to 10% of TV jobs. As anchorman Howard Beale screams in Paddy Cheyevsky's "Network":
"You people sit there, night after night. You're beginning to believe this illusion we're spinning here. You're beginning to think the tube is reality and your own lives are unreal. This is mass madness!"
Does television have to provide a perfect representation of real life? No - movies do not, books and magazines do not. However, in all other entertainment forms, the entertainee makes an educated choice. With television, the set is turned on an average of 7 hours per day, and the viewer tends to watch habitually, whatever is presented. It is the only medium that brings to people things they would otherwise not choose. l6 A frequent analogy is that television is like a big supermarket. If a shopper chooses all "junk" food, is it the fault of the store owners, the managers, or the check-out clerks? Unfortunately, the analogy is not an accurate one: television sets are ensconced in nearly every American household as a virtual member of the family, and the choices are extremely limited. The argument that network executives are merely giving the American public what it wants - ie, a heavy diet of sex and violence - was laid to rest by the astounding success during the 1984-1985 season of "The Cosby Show," which contains little of either. Cosby has clearly demonstrated that the public will watch wholesome, entertaining television that has solid family values and contains nothing objectionable. The predictable rush to imitate him may revolutionize American television in the next decade.
TABLE 3 BODY TYPES ON TELEVISION
Several other aspects of TV viewing are problematic for teenagers. Concerns about TV violence and violent or aggressive behavior among children and adolescents have been discussed in detail elsewhere in this issue. ' 7 Several studies suggest that heavy TV viewing may be associated with poor reading skills,18 and that youngsters in grades six through nine with lower IQs watch more television than those with higher IQs.19 Socially isolated and depressed teenagers are also known to be heavy TV viewers.20 Again, cause-andeffect is difficult to prove here; but TV may be serving as a substitute peer group or a substitute tranquilizer in some isolated or disturbed adolescents.
With the incidence of anorexia nervosa cited as high as 1 in 200 middle class females,21 TV nutrition is being studied closely. Dietz, using National Health Survey data, found that hours spent watching TV proved a strong predictor of adolescent obesity, with the prevalence increasing 2% for each additional hour of television viewed.22 One survey of prime-time programs found that TV characters are usually happy while in the presence of food, rarely dine alone, and often snack on sweets. However, food is never explicitly used to satisfy hunger; rather, it serves to bribe others or for social introductions. Furthermore, TV has an obsession with thinness: 88% of all characters are thin or average in body build (Table 3), and obesity is depicted as a problem associated almost entirely with middle or old age. The author suggests that television presents conflicting messages: poor nutritional habits, guaranteed to make us fat, and a poor image of obese and overweight people, guaranteed to scare us into thinness.23 One small solution to TV's obsession with thinness was the British Broadcasting Corporation's (BBC) ban, issued in 1985, on telecasting beauty contests, calling them "an anachronism in this day and age of equality and verging on the offensive."24
MUSIC TELEVISION (MTV)
Ever since Little Richard bawled "Good Golly, Miss Molly!" and Elvis Presley gyrated his pelvis while singing "Heartbreak Hotel," parents have objected to rock lyrics. Whatever effects rock music have on teenage behavior must be multiplied several-fold by being able to see the lyrics dramatized visually on MTV. Some videos contain explicit scenes of violence, drug use, rape, sexual explicitness, or degradation of women. Young adults watch MTV an average of an hour per day during the week and IVi hours on weekends.25 In one study, heavy MTV viewing correlated with increased sex anxieties and conflicts with parents.26 One easy solution would be omitting MTV from the basic cable package that all subscribers receive, regardless of whether they want it or not. Another is to offer a "parental lock" to block MTV from home sets.27 A third is for parents and Congress to pressure the record industry to "stop pornographic rock" or put warning labels on objectionable albums.28 Of the three solutions, the first seems the easiest and the best conceived, both constitutionally and psychologically.
For centuries, physicians have fought disease. Now pediatricians face a new morbidity: childhood accidents and violence (homicide and suicide) are the leading causes of death after 1 year of age, and sexual activity and drug use among teenagers are sources of major morbidity. This new morbidity requires a new breed of pediatrician, one that is more sensitive to cultural influences on children and adolescents, willing to do counseling with families about psychological issues, and perhaps even do "soft" (ie, non-"bench") research. As data are gathered, perhaps every television set will one day bear the label: "Caution: Too much or inappropriate viewing may be hazardous to your health. "
1. Nielsen Report on Television, A.C. N i eisen Company, Northbrook. IL, 1935.
2. Holroyd HJ: CKildten. adolescents, and television- Am J Dis Child 1985; 139:549-550.
3. Bedell S: A critical look at TV's distorted image of adolescents. TV Guide, July 4, 1981.
4. Gardner JE: Does your teenager need a $95 shirt - or just want one? TV Guide, May 4, 1985.
5. Lowry DT, Love G, Kitby M: Sex on the soap operas: Patterns of intimacv. Journal of Communication 1981; 31:90-96.
6. Lowery SA: Soap and booze in the afternoon: An analysis of the portrayal of alcohol use in daytime serials. J Stud Alcoho 1980; 41:829-838.
7. Breed W. DeR)C JR: Drinking and smoking on television: 1950-1982. J Public Health Policy 1984; 31:257-270.
8. Caucus for Producers, Writers, and Directors; We've done some thinking. Lot Angeles, 1983.
9. Breed W, Defoe JR: Cigarette smoking on television: 1950-1982. N Engi J Med 1983; 309:617.
10. Foltz K: TV, sex and prevention. Newsweek, September 9, 1985.
11. Strasburger VC: Sex, drugs, rock 'n' roll: Are solutions possible! Pediatrics 1985; 76(suppl):704-712.
12. Bergman AB: Condoms for sexually active adolescents. Am J Dis Child 1980; 134:247-249.
13. Jacobsen MF, Collins R: There's too much harm to let beer, wine ads continue. Los Angeles Times, March 10, 1985.
14. Johnston LD, O'Malley PM, Bachman JG: Use of licit and illicit drugs by America's high school students 1975-1984. Washington, DC, National Institute on Drug Abuse, No. (ADM) 85-1394, 1985.
15. Gerbner G: Health, medicine, and violence on TV. Tram Siud Coll Physician Phila 1984; 6:33-40.
16. Meynwitz J: Where have the children gone? Neusueefc Augiut 30, 1982.
17. Singer D: Does violent television produce aggressive children. Pediatr Am 1985; 14(12):804-813.
18. Morgan M: Television and reading: Does more equal better! Journal of Communication 1980; 30:159-165.
19. Fosaielli P: Television and children: A review. Developmental and Behavioral Pediatrics 1984; 5:30-37.
20. Murray J: Television and Youth: 25 Yersn of Research and Controversy Boys Town, Nebraska, The Boys Town Center for the Study of Youth Development. 1980.
21. Hofmann A: Adolescent Medicine. Menlo Park, CA, Addison Wesley, 1983.
22. Dien WH Jr. Gortmaktr SLi Do we arten our children at the television set? Obesity and television viewing in children and adolescents. Pediatric 1985; 75:807-312.
23. Kaufman L; Prime-rime nutrition, journal of Communication 1980; 30:37-46.
24. BBC bans beauty contest. Rwode magazine, June 30, 1985.
25. Singer DG: Alcohol, television, and teenagers. Pediatrics 1985; 76(suppl): 668-674.
26. Hellerstein L: MTV and Late-Adolescent Sexual Anxieties and Parental Conflict, thesis. University of Massachusetts, Amherst, 1985.
27. Moms win battle for MTV lock out device, Associated Press, July 19, 1985.
28. Stroud K: Stop pornographic rock. Newsweek, May 6, 1985.
SEXUAL BEHAVIORS PORTRAYED ON TELEVISION
BEVERAGES ON PRIME-TIME TELEVISION DRAMAS
TABLE 3 BODY TYPES ON TELEVISION