Health Effects of Media on Children and Adolescents

As an individual who has conducted research into the influence of media violence and youth I am disturbed by the tone and citation bias evident in Strasburger et al., 2010. Not only is the debate on media violence effects not over, but research has been inconsistent, weak and fraught with methodological problems.

The notion that media violence effects can be compared to medical research has since been discredited as based on flawed statistics. It is truly unfortunate that such an "urban legend" is being repeated despite having been demonstrated as false...such a lofty claim should always have been subjected to much greater scrutiny than was the case here.

Ferguson, C. J. (2009). Is psychological research really as good as medical research? Effect size comparisons between psychology and medicine. Review of General Psychology, 13(2), 130-136.

Block, J., & Crain, B. (2007). Errors and omissions in "Media violence and the American public." American Psychologist, 62, 477-489.

The authors here engage in blatant citation bias, simply refusing to acknowledge a wide body of research that conflicts with their own views (these are just a few below).

Baldaro, B., Tuozzi, G., Codispoti, M., Montebarocci, O., Barbagli, F., Trombini, E., & Rossi, N. (2004). Aggressive and non-violent videogames: Short-term psychological and cardiovascular effects on habitual players. Stress and Health, 20, 203-208.

Barnett, J., Coulson, M., & Foreman, N. (2008, April). The WoW! factor: Reduced levels of anger after violent on-line play. Poster presented at the British Psychological Society Annual Meeting, Dublin, Ireland.

Colwell, J., & Kato, M. (2003). Investigation of the relationship between social isolation, self-esteem, aggression and computer game play in Japanese adolescents. Asian Journal of Social Psychology, 6, 149-158.

Ferguson. C. J., & Kilburn, J. (2009). The Public health risks of media violence: A meta-analytic review. Journal of Pediatrics,154(5), 759-763.

Ferguson, C. J. San Miguel, C., & Hartley, R. D. (2009). A multivariate analysis of youth violence and aggression: The influence of family, peers, depression and media violence. Journal of Pediatrics, 155(6), 904-908.

Ferguson, C. J., Rueda. S., Cruz, A., Ferguson, D., Fritz, S., Smith, S. (2008). Violent video games and aggression: Causal relationship or byproduct of family violence and intrinsic violence motivation? Criminal Justice and Behavior, 35, 311-332.

Ferguson, C. J., Cruz, A. M., Martinez, D., Rueda, S. M., Ferguson, D. E., & Negy, C. (in press). Personality, parental, and media influences on aggressive personality and violent crime in young adults. Journal of Aggression, Maltreatment and Trauma, 17,.

Ferguson, C. J. (2007). The good, the bad and the ugly: A meta- analytic review of positive and negative effects of violent video games. Psychiatric Quarterly, 78, 309-316.

Ferguson, C. J. (2007). Evidence for publication bias in video game violence effects literature: A meta-analytic review. Aggression and Violent Behavior, 12, 470-482.

Kutner, L., & Olson, C. (2008). Grand theft childhood: The surprising truth about violent video games and what parents can do. New York: Simon & Schuster.

Sherry J. (2007). Violent video games and aggression: Why can’t we find links? In R. Preiss, B. Gayle, N. Burrell, M. Allen, & J. Bryant, (Eds.) Mass Media Effects Research: Advances Through Meta- analysis (pp 231-248). Mahwah, NJ: L. Erlbaum.

Williams, D., & Skoric, M. (2005). Internet fantasy violence: A test of aggression in an online game. Communication Monographs, 72, 217- 233.

Unsworth, G., Devilly, G., & Ward, T. (2007). The effect of playing violent videogames on adolescents: Should parents be quaking in their boots? Psychology, Crime and Law, 13, 383-394.

The authors also misrepresent work that they do review. For instance in the Ybarra (2008) article, once the authors control for other variables, the influence of video game violence and television violence drops to non-significance (see figure 2 in that article).

The authors here seem quite content to publish misinformation that is spread to the general public. In the 2009 AAP statement on media violence (in which Strasburger played a large role in developing), the claim was made that 3500 studies of media violence have been published with only 18 not finding significant effects. This statement was originally made (to my knowledge) by the AAP in 2000 (Cook, 2000). It has since been thoroughly discredited (Freedman, 2002, Pinker, 2002, Ferguson, 2009). Meta-analyses of media violence, even those that broadly sample poorly validated outcome measures can only find about 200-300 studies, including unpublished studies. Ironically, even if this statement were true in 2000, it could not be true in 2009 (or 2010) unless absolutely no research had taken place over the intervening 10 years.

To be frank, the AAP should be embarassed to have published such poorly fact-checked work and disseminated this to a public generally lacking the means to fact-check such extraordinary claims. That the AAP has been willing to accept such claims, and such clearly biased reviews so uncritically is a dark day for social science.

Conflict of Interest:

None declared

To the Editor-

We are writing in response to both The American Academy of Pediatrics Council on Communications and Media’s(1) revised policy statement on media violence published in the November 2009 issue of Pediatrics and the Strasburger, et al article, March, 2010. The authors of each of these articles report that exposure to violence in media poses a significant health risk to children, asserting that media exposures contribute to aggressive behavior, desensitization to violence, depression, fear of being harmed, bullying, nightmares, and sleep disturbances. While we concur that media exposures may have long-term health risks, the authors contend that the strength of association between media violence exposures and negative outcomes are so significant that they are reportedly greater than the association between calcium intake and bone mass, lead ingestion and IQ, and lack of condom use and sexual transmission of HIV. Most disturbing, however, is the affirmation in the AAP media violence policy statement that “the debate should be over.”

While we fully agree with the cautionary tone of the articles, we argue to the contrary on the finality of the debate: there are too many factors yet to be studied or made apparent in the media and health risk equation. Three concerns provide the opportunity for continued discourse: 1) it is still unknown if exposure to media violence is a symptom or a cause of negative behaviors or a combination of the two;(2,3) 2) no distinction has been made between types of media and whether certain media may have a stronger associations than others;(4) and 3) there are scant data on the degree to which media plays a role in children’s health, especially in relation to other known risk factors.(5,6)

After reviewing the references included in the Council on Communications and Media’s policy revision, we agree that several of the cited studies demonstrate alarming results. What we find missing, however, is any true link to or even estimate of causality. For instance, Ybarra et al, referenced in both articles, found in their cross-sectional study of youths ages 10-15 years that self-reports of exposure to media violence had elevated odds of concurrent self-reporting of participation in violent acts.(7) While there are inherent flaws in self-report studies, taking the findings as causal is concerning, breaking a fundamental tenet of cross-sectional research. Their results beg the question; did the survey ask the correct question? Is the exposure to violent media a symptom rather than a cause? Perhaps it is the youth that are more likely to commit violent acts that also frequent violent media sites and utilize violent videogames more often. We cannot find a study that has addressed this aspect of the debate. Clearly more research is necessary.

Another area of research that requires better understanding is whether certain media types have more of an association with violence than others. The AAP policy statement makes a recommendation to reduce exposure to media, yet it cannot be that straightforward. First and foremost we need better evidence of causality including which types, if any, may be more influential than others. All media are not created equal. Comparison of the Star Wars movie series versus videogames such as Lego Star Wars: The Video Game™ helps demonstrate this point. Both contain violence, but the former is a passive, observational, style of media with “real” people, whereas the latter is active with cartoon characters. Are those differences significant? The answer is unknown, but further focused research will allow for educated decisions and more meaningful and targeted interventions.

Finally, the conviction of the Strasburger, et al article and the AAP policy statement unduly vilifies violence in media without consideration for other, likely stronger, factors. We believe far too much credit is given to media violence. In returning to the cited Ybarra et al study, the results reveal significantly higher odds ratio of participation in violent acts for other factors outside of violent media exposures.(7) For example, seeing or hearing people being shot, bombs going off, or street riots (odds ratio [OR]: 8.6; 95% confidence interval [CI]: 4.6-16.1) or having consumed greater than or equal to 5 alcoholic drinks in the last 30 days (odds ratio [OR]: 21.6; 95% confidence interval [CI]: 6.6-70.9) has a far more significant impact than that for exposure to media violence (odds ratio [OR]: 1.50; 95% confidence interval [CI]: 1.13–1.98). When deciding where to focus efforts to decrease negative or violent behaviors, is media violence truly significant enough to warrant such attention in relation to these and other factors? The answer to that question is not fully known, however when examining trends in total media exposure time for youths ages 8- to 18-years-old and serious violent crime rates perceived to be committed by juveniles over the last 10 years, the relationship is strikingly inverted with media exposure time increasing while violent crime rates decrease.(8,9)

To further elucidate this point, we draw from the education literature. Henry Jenkins, an educational academician, is leery of the credit we place on media violence in the evolution of violent behaviors and questions how media could actually teach violence.(3) He points out that when deciphering how children learn, it never is as simple as teaching a group of students something and each learning perfectly. Students bring individual motivations, interpretations and past experiences into the learning equation. Believing a child could play a violent video game and subsequently learn to be violent grossly overestimates the learning process. As Jenkins eloquently states, “There is, in short, a huge difference between education and indoctrination.”(3) Putting this point into context for a primary care physician, asking if a patient plays violent videogames should then be a prompt, not an assumption, that he or she might be concurrently engaging in violent behaviors.

In summary, the debate is not over; we have only evaluated the tip of the iceberg. We wonder whether we have even asked the correct questions and urge critical rethinking on this issue rather than continued propagation of the same literature on media and violence. Additional comparative research and exploration needs to occur in order to understand this issue and, more importantly how it can be strategically prevented and addressed.

Best regards,

Nicole M. Paradise Black, M.D., F.A.A.P. Assistant Professor Department of Pediatrics, University of Florida College of Medicine Shands Children’s Hospital at University of Florida Gainesville, FL

Erik W. Black, Ph.D. Assistant Professor Department of Pediatrics, University of Florida College of Medicine School of Teaching and Learning, University of Florida College of Education Gainesville, FL

Lindsay A. Thompson, M.D., F.A.A.P. Assistant Professor Department of Pediatrics and Epidemiology and Health Policy, University of Florida College of Medicine Gainesville, FL

References

1. American Academy of Pediatrics Council on Communications and Media. Policy Statement: Media Violence. Pediatrics. 2009; 124(5):1495-1503.

2. Ferguson, CJ, Kilburn, J. The Public Health Risks of Media Violence: A Meta-Analytic Review. J Pediatr. 2009;154:759-63

3. Jenkins H. Make meaning not war: Rethinking the video game violence debate. Independent School. 2004; 63(4): 38-48.

4. Gentile DA, Saleem M, Anderson CA. Public Policy and the Effects of Media Violence on Children. Social Issue and Policy Review. 2007; 1:15-61

5. Ferguson CJ, Kilburn J. Much ado about nothing: The misestimation and overinterpretation of violent video game effects in Eastern and Western nations: Comment on Anderson et al. (2010). Psychol Bull. 2010; 136: 174-178

6. Block, JJ, Crain, BR. Omissions and errors in “Media Violence and the American Public.” Am Psychol. 2007; 62: 252

7. Ybarra ML, Dierner-West M, Markow D, Leaf PJ, Hamburger M, Boxer P. Linkages between Internet and other media violence with seriously violent behavior by youth. Pediatrics. 2008; 122 (5):929-937

8. Henry J. Kaiser Family Foundation. Generation M2: Media in the Lives of 8- to 18-Year-Olds. Menlo Park, CA; January 2010. http://www.kff.org/entmedia/upload/8010.pdf. Accessed May 4, 2010

9. Bureau of Justice Statistics, National Crime Victimization Survey, and Federal Bureau of Investigation Uniform Crime Reporting Program, Supplementary Homicide Reports. Serious Violent Crime by Perceived Age of Offender 1973-2007. Bureau of Justice Statistics, Washington, DC; May 4, 2010. http://bjs.ojp.usdoj.gov/content/glance/offage.cfm. Accessed May 4, 2010

Conflict of Interest:

None declared

Dear Dr. Strasburger,

Thank you for a comprehensive review of the topic.

I found your review informative and convincing. In fact I would like to ask for your permission to develop a power point presentation to bring it to local schools that allow me.

You are pointing at an urgent problem of enormous proportions, possibly one of the biggest threats to the minds, souls and bodies of our youth.

I think that your article calls for a massive education campaign for parents, children, and professionals in the health and education areas. And a campaign to hold the entertainment industry and government accountable.

There is no need for further research to know that in most cases and for most children, the media is harmful, and that parents are ill prepared to play the role of critical consumers.

I doubt that your article will receive the press coverage that it deserves, and would like to call onto health care providers and educators to write to their local newspaper about it. I will.

Sincerely,

Francisco Enriquez.

Conflict of Interest:

None declared

Dear Editor:

As a school based occupational therapist, mother, and graduate student in the post-professional masters in occupational therapy program at Utica College, I found the article, Health Effects of Media on Children and Adolescents (Strasburger, Jordan, Donnerstein, 2010) to be alarming. While I possessed basic knowledge on the topic prior to reading the article, I found the statistics to be staggering and concerning, to say the least.

Clearly the data suggests that the average child in this country has been negatively impacted and predisposed to a plethora of problems by experiencing too much media exposure, raising the concern of occupational dysfunction in our children, in my opinion.

While the article offers suggestions for healthcare professionals to discuss prevention of excessive media exposure with parents, I feel it is equally important to discuss alternatives to excessive media usage. I also believe there are additional concerns that were not discussed within the content of the article.

With so much media exposure, I am concerned that today’s children do not learn how to play! I am concerned about development of their creativity and critical thinking skills, even something as simple as turn taking skills and learning how to compromise with a peer, cannot be addressed by limiting television/media exposure alone. I also have serious concerns about the long term effects of excessive media exposure on the visual system of today’s youth. While research indicates a correlation between aggression and violence in children and excessive media exposure, I am also curious about any correlation between childhood depression and excessive media usage and specifically if one is the cause of the other.

Research indicates children learn best with a multi-sensory approach to learning, which is lacking from excessive media exposure. While many young children I work with know how to operate their parent’s cell phone, fewer children have the ability to cut with a scissors well, nor are they learning pre-writing and writing skills or how to tie their shoes. Instead, well meaning parents are often sitting their child in front of a computer screen for academic activities and games, seemingly with less time spent on creative skill building activities, even activities as simple as drawing, painting, or board games. Children need many rich sensory experiences for development.

Occupational therapists possess a unique set of skills that can assist with making better life choices that promote a healthier lifestyle through meaningful occupation. In 2008, the American Occupational Therapy Association published the document Framework: Domain and Process, 2nd edition, (AOTA, 2008). This document was developed to articulate occupational therapy’s contribution to promoting the health and participation of people, organizations, and populations through engagement in occupation (AOTA, 2008). It is the role of the occupational therapist to promote overall health and well being (AOTA, 2008). It is my opinion that occupational therapists have much to offer to the discussion of reducing the negative effects of excessive media usage in children and adolescents by encouraging the importance and significance of participation in meaningful occupations.

Areas of occupation include activities of daily living (ADL), work, play, rest and sleep, education, and leisure to name a few. The performance skills needed to participate in meaningful occupations include motor and praxis skills, sensory-perceptual skills, emotional regulation skills, cognitive skills and communication and social skills (AOTA, 2008). Considering the average 8-10 year old watches television 3 hours and 41 minutes per day, (Strasburger et. al 2010) it is unlikely that children and adolescents are able to develop the appropriate performance skills needed for life occupations.

As a parent, I am thankful that I read this article, to prevent excessive media exposure with our own children. As an occupational therapist, I intend to educate the parents I work with and plan to encourage them to not only prevent excessive media exposure but also the importance of engaging their children in meaningful occupations as well.

Respectfully Submitted,

Mary Michelle Birkemeier-Brown Occupational Therapist 4/2/2010

References:

American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and process (2nd ed). American Journal of Occupational Therapy, 62, 625-683. Strasburger, V., Jordan, A., & Donnerstein, E.. Health effects of media on children and adolescents. Pediatrics 2010; 125 (4), April 2010. Retrieved on: 3/14/10 from www.pediatrics.org

Conflict of Interest:

None declared