An average child in the United States between the ages of 8 and 18 spends six hours and 43 minutes every day watching, reading, listening to and playing with various media.

Assessing the impact of that much media exposure on children's health was the focus of an Oct. 5, 2001, conference co-sponsored by Children’s Hospital Boston and the Harvard School of Public Health.

"Media are perhaps the most powerful single force in the world today and have a profound effect on the physical and mental health of young people," said Michael Rich, M.D., M.P.H., assistant professor of pediatrics at Harvard Medical School and conference co-leader. "It's time we pay attention to this as a serious public health issue."

The amount of time that children spend with the media each day is "astonishing," he said, citing a 1999 study by the Kaiser Family Foundation which measured the time young people spend with television, computers, movies, videos, video games, books, magazines, newspapers, radios, CD's and tapes.

In addition, surveys show that children and adolescents list popular media as a prime source of information on health, sexual behavior, interpersonal relationships and substance use, said Dr. Rich, an adolescent medicine physician at Children's Hospital Boston.

The connection between kids and the media raises the question of what the media is teaching young people. Because parents don't regularly look at or listen to entertainment aimed at young people, they often lose sight of — and are shocked by — the constant flood of graphic, unhealthy images kids see in the media on a daily basis, Dr. Rich said.

Research studies he cited at the conference show that entertainment media portray a high number of risky health behaviors:

• Sixty-one percent of all programming portrayed violence, and children's programs were the most violent.
• Young people view an estimated 200,000 acts of violence, including 18,000 murders, by the age of 18.
• Tobacco, alcohol, and other drug use are portrayed as normal behavior in 70 percent of prime-time TV, in 38 of 40 top-grossing movies, and in 50 percent of music videos.
• Teens view nearly 15,000 sexual references every year. Of these, less than 170 discuss abstinence, contraception, sexually transmitted diseases or pregnancy.

How does all of that affect the behavior of children? It desensitizes, Dr. Rich said, leading to an "unthinking, unquestioning acceptance of both the content of what we're seeing and the relationships between the various types of content."

"We have significantly large, measurable health outcomes that are attributable to media exposure, which — while not the sole cause of violence or obesity or substance abuse — is one on which we can intervene," he said.

In more than 3,500 studies over 50-plus years, all but 18 showed a relationship between increased exposure to the media and increased violence, Dr. Rich said. "The correlation between exposure to media violence and subsequent aggressive behavior is stronger than other relationships that clinicians accept as fact, like the links between calcium and bone density, lead ingestion and lower IQ, or between passive smoke and lung cancer."

"We're not taking the violence relationship seriously yet," he said.

Exposure to media may be partly responsible for changing the nature of the risks facing our children, Dr. Rich said. "What we are seeing is that unlike 100 years ago, when infectious disease was the major cause of childhood morbidity and mortality, we are now fighting problems that result from health-risk behaviors that are learned and adopted by kids for one reason or another.

"The media are not the only reason young people learn and adopt unsafe sex. However, if they're steeped in an environment in which everyone in a soap opera falls in bed with everyone else, never talks about or shows contraception, never talks about sexually transmitted disease — if they're steeped with essentially irresponsible or thoughtless sexual activity, they are more likely to engage in sexual acts in these ways," he said.

Young people don't have to take media messages at face value. Instead, they can learn the skills that will allow them to be critical thinkers.

Media literacy — the ability to question, analyze and evaluate media messages — has emerged as a powerful tool for helping youth understand the world of media.

Leaders from the Youth Voice Collaborative, a program based at the Boston YWCA that teaches and uses media literacy, recommend five questions to ask while watching television or other media:

• Who made this message, and what were the producer’s goals or motives?
• What lifestyles, values, and points of view are represented in this message?
• How might other people interpret this message differently?
• What techniques were used to attract my attention, to affect my emotions?
• What is omitted from this message? Why was it left out?

Examples from the symposium of using media in positive ways to benefit children:

• The Flashpoint Program, a Massachusetts media literacy and life skills program for youth ages 13 to 17. The first part teaches, through viewing and discussing actual commercial and educational films, how to make more responsible choices on issues of violence, substance abuse and prejudice. Using the same educational techniques, the second part of the curriculum provides an in-depth focus on civil rights and prejudice. It's available free from the office of Essex County, Mass., District Attorney Kevin M. Burke, Museum Place, 2 E. India Square, Salem, Mass., 01970.
• Planet Health, for middle schools, is taught within math, science, language arts, social studies and physical education classes. Goals are to reduce obesity by cutting down on television viewing time, improving diet and increasing physical activity. It can be ordered, for a fee, from Human Kinetics, at www.humankinetics.com.
• January 2002 begins a new tradition, National Mentoring Month — an annual, concentrated burst of national and local media activity combined with extensive community outreach. The goals of National Mentoring Month include raising awareness of mentoring and recruiting individuals to mentor — especially in programs that have a waiting list of young people.
• Media Matters, a project of the American Academy of Pediatrics, teaches pediatricians, parents and children about the influence of media on children’s health behaviors. An advocate for media education, the academy (http://www.aap.org) has policy statements and brochures to help parents and pediatricians with the negative effects of media on children.

Used with permission of the copyright owner. All rights reserved. This article is not intended to provide advice on personal medical matters or to substitute for consultation with a physician.