Sexual content is highly prevalent in traditional media, and portrayals rarely depict the responsibilities and risks (eg, condom use, pregnancy) associated with sexual activity. Exposure to such content is linked with shifts in attitudes about sex and gender, earlier progression to sexual activity, pregnancy, and sexually transmitted infection among adolescents. However, little information is available about moderators and mediators of these effects. We also know little about digital media, their sex-related content, and their potential influence on youth. Data from a few studies of older youth indicate that sexual displays on social media sites are related to problematic beliefs and behaviors among those who post this content and among viewers. Online pornography appears to be more problematic for youth than off-line sources. Given the vast and increasing amount of time youth spend online and their developmental openness to influence, more research attention to digital sexual media is needed. Those who undertake this work should identify potential negative consequences of use and opportunities to improve adolescent sexual health through digital media. Studies of on- and off-line media in which researchers examine younger media audiences, identify processes explaining sexual media effects on behavior, and moderators of effects are needed. Such studies could be used to inform interventions to reduce negative outcomes and increase positive media effects. Policy makers should stimulate the development of such interventions, including tools to help parents identify and manage negative media influences on their children’s sexual well-being and development and dissemination of innovative media literacy programs related to sexual health.
Sexual socialization is part of adolescent development, and the emergence of sexual interest and activity is normative during this period. But sex can involve significant risks. Negative outcomes are more likely with earlier sexual debut. High rates of teen-aged pregnancy and sexually transmitted infections suggest that many youth initiate intercourse before they are prepared for the responsibilities involved.
Many things contribute to developing sexual attitudes, beliefs, and behavior, including early sexual debut. One is media.
Traditional Media and Sexual Behavior, Attitudes, and Outcomes
Television, movies, music, and magazines contain a great deal of sexual content and little discussion of emotions, responsibilities, or risks associated with sexual activity (eg, pregnancy, sexually transmitted infections, birth control, and condom use). Sex is portrayed in both word and deed, with characters discussing sex they have had or want to have, myriad jokes and innuendo, advice from magazines about techniques to “drive your partner wild,” and scenes portraying activities from “making out” to intercourse. In 2005, more than two-thirds of television programs contained sexual content, but portrayals of safer sex were rare.1
A variety of evidence links exposure to sex in traditional media with shifts in sexual attitudes, behavior, and outcomes. In 21 studies, researchers used longitudinal data to find a potential cause-and-effect relationship between exposure to sexual content and earlier sexual intercourse.2 The best and most compelling from a public health perspective are 3 longitudinal surveys of adolescents in which researchers found that youth whose media diets contained greater amounts of sexual content when initially surveyed were more likely to initiate intercourse by follow-up (1–2 years later).3,–5 These relationships held after accounting for a dozen other factors that are associated with both media habits and sexual behavior, such as religiosity and parents’ monitoring of their children’s activities and whereabouts. In 1 of these studies, researchers found associations between exposure to sexual content and later pregnancy.6 These findings suggest not only that media promote sexual activity but also that the activity promoted is riskier.
Many researchers have also documented associations between sexual media exposure and sexual attitudes and beliefs. In a comprehensive review of 32 studies, Ward7 concluded that sexual media consumption is associated with greater acceptance of casual sex and perceptions that sex is more frequent or prevalent. In another study,8 researchers found that a media diet high in sexual content predicted adolescents’ safe sex self-efficacy, sex-related outcome expectancies, and perceived peer norms. Conversely, it appears that sexual media can promote healthy sexual beliefs and attitudes. Youth who reported seeing a television episode discussing condom efficacy changed their beliefs about whether condoms usually prevent pregnancy.9 In an additional study, researchers randomly assigned college students to view television episodes that included portrayals of guilt or regret over sexual activity or similar episodes without these consequences. Viewers of the negative consequences reported more negative views of premarital sex.10 Researchers conducting interventions have capitalized on such effects as a method of improving sexual behavior related to public health.
Traditional Media, Gendered Sexual Scripts, and Sexual Objectification
Traditional media also appear to influence youths’ “sexual scripts,” or shared societal-level beliefs about how people should act in sexual situations. These scripts are important in themselves and may also influence sexual health, pleasure, risk-taking, and dysfunction. Within North American media, the dominant sexual script expects men to pursue sexual relationships, prioritize sex and pleasure over emotion, treat women as sexual objects, and reject homosexual feelings or “feminine” behavior. Women are expected to set sexual limits, act sexually passive, use their bodies and looks to attract men, prioritize emotion and commitments over sex, and minimize their own desire.11 More frequent exposure to traditional media is associated with support of these notions and misogynistic attitudes toward women.7
Sexually objectifying portrayals of women appear in 52% of magazine advertisements, 59% of music videos, and 32% of the music lyrics of male artists.7 More than 100 studies have revealed links between young people’s exposure to objectifying content and their objectification of women or self-objectification.7 Those exposed to objectifying portrayals are more tolerant of or in agreement with sexual harassment, adversarial sexual beliefs, rape myths, child sex abuse myths, and interpersonal violence than participants without this exposure and experience greater body dissatisfaction, appearance anxiety, and disordered eating beliefs.7
Twenty-seven percent of Teen-rated video games contain sexual themes.12 Exposure to this content is linked to increased odds of ever having had sex, sexual assault, and attempted or completed rape among youth 14 to 21.13
Women are underrepresented in video games, and when present, they are much more likely than men to be shown with a sexualized appearance or in sexually revealing clothing.7 Persons exposed to sexualized women in video games express greater acceptance of rape myths and tolerance of sexual harassment than others.7 Playing a video game as a sexualized female character appears to result in lower self-efficacy and less favorable attitudes toward women’s cognitive capabilities.14
Social Media: A New Source of Sexual and Relationship Content
Compared with traditional sexual media, we know little about social media, their sex-related content, and how they might influence youth.2 Facebook remains the most commonly used social media platform in the United States, with 71% of adolescents ages 13 to 17 using the site.15 Since 2012, use of social media by young people has been marked by an increasing diversification of platforms visited, with more adolescents assembling an archipelago of different sites and applications that they frequent, including Facebook, Instagram, Snapchat, Twitter, and others, which makes researching the impact of social networking sites that much more difficult.16
Researchers are just beginning to explore whether some of the above-noted research revealing a relationship between exposure to sexual media and progression in sexual activity generalizes to adolescents’ use of sexual social media. One study revealed that sex-related self-disclosure on social media was associated with off-line sexual risk behaviors (including casual sex).17 Recent longitudinal research with Dutch adolescents revealed that being exposed to sexy self-presentations on social media and sharing one’s own sexy images or materials were both positively related to adolescents’ beliefs that it was important to be “sexually outgoing” (flirty, wild, seductive, and giving the impression that one is sexually available).18 The authors of the same study established that exposure to sexy-self presentations indirectly related to a willingness to engage in casual sexual behaviors because it increased youth’s positive sense of peers who engaged in such behavior.18
Social media use also appears to be related to self-objectification, body shame, and decreased sexual assertiveness.7 One study suggests that social media influence teenagers involved in dysfunctional or violent romantic relationships by “redefining the boundaries between dating partners.” Social media were used for monitoring or controlling a partner, being verbally aggressive with a partner, limiting access to oneself, and for reconnecting after a violent episode or breakup.19
Although most of the researchers studying sexual media have focused on the negative effects of media use, the unique ability of social media to reach large numbers of adolescents with information to improve sexual health has not been lost on organizations with this goal. The authors of a recent study found that 10% of teenagers get a lot of health information from social media and 23% get at least some from social media; 18% have researched sexually transmitted diseases online.20
Sexting involves the exchange of sexual content (text or images) via cellular phones or the Internet. Rates of sexting among youth vary across study methodologies, sample characteristics, and definitions of the term.21 In nationally representative samples of youth, the rate of sending sexual images of oneself is 5% to 7%.22,23 Approximately 7% to 15% have received a sext.22,24 Sexting may be an emerging aspect of natural adolescent sexual exploration and experimentation.23 It is often part of an existing or developing romantic relationship. Sexting is also associated with some risks. It is sometimes pressured or coerced.25 Sexts are sometimes passed to a third party as a method of bullying or revenge.26 Youth senders of sexts are sometimes prosecuted under child pornography laws.26 Finally, sexting is correlated with a constellation of adolescent risk behaviors, including sexual activity, sexual risk taking, and substance use,23 suggesting a need for risk-reduction intervention with sexting youth.
Online Pornography: A Special Case
New technologies have expanded adolescents’ access to pornography. Online pornography differs from the pornography of the past in some critically important ways.27 Online content is always “on” and is portable, allowing access at any time and in any place. It can be interactive and more engaging, so there is potentially increased learning and exposure time. Extreme forms of violent or sexual content are more prevalent on the Internet than in other popular media.27 Participation is private and anonymous, which allows children and adolescents to search for materials they could not search for in traditional media. Finally, online media exposure is much more difficult for parents to monitor than media exposure in traditional venues. National and international studies reveal that exposure to online pornography is common among boys and not uncommon among girls. Within the United States, 42% of 10 to 17 year olds have seen pornography online, with 27% saying they intentionally viewed such materials.27 An examination of 15 to 18 year olds found 54% of boys and 17% of girls admitted to intentional viewing.27
Studies in which researchers look at younger media audiences, focus on the processes that might explain sexual media effects on behavior, and look at social media are needed.
Researchers should identify reliable moderators of effects that might be used to design or target interventions, including characteristics of youth such as developmental stage, race, and characteristics of sexual content. All media users will not approach sexual media content with the same cognitive capabilities or interest as others. Developmental factors should be taken into account and tested as effect-moderators as we assess the extent to which media use and content affects children’s and adolescents’ sexual beliefs and behaviors. We know that young children (<7–8 years old) have trouble distinguishing between what is happening on the screen and what could happen in real life. Taking cognitive processing capabilities into account will be important as we understand more about what and how children learn about sexuality from the media. Similarly, physical, socioemotional, and cognitive maturity can affect both the salience and processing of sexual media content,28 as can developing sexual self-concepts. Incomplete brain development pushes adolescents to engage in risky behaviors and may affect the extent to which sexual media content is sought and acted on.
Minority youth may be less affected by some media portrayals.29 More study of racial and ethnic differences may help identify methods to promote resilience to negative media influences across all youth.
Media influences on sexual development and health can be positive, and more research is needed to identify (1) ways to draw youth to (and get youth to create) positive content and (2) aspects of portrayals that most reduce risk or enhance health and well-being.
It is important that the authors of future studies balance concerns over ecological validity with concerns over causal inference, either by using a variety of methods (eg, both laboratory experiments and cross-sectional surveys) or by using designs that include this balance inherently (eg, natural experiments, quasi-experimental studies of momentary responses to exposure, or longitudinal surveys of representative samples).
Clinicians and Providers
Clinicians should follow the recommendations in the American Academy of Pediatrics policy statement on sexuality, contraception, and the media.30
Policy makers should do the following:
educate parents about the power of sexual media;
provide tools to help parents recognize problematic sexual content, empower them to limit their children’s exposure to and creation of such content, and help them discuss its potential influence with their children;
facilitate partnerships between media producers or platforms and media researchers or health experts to limit problematic portrayals and increase healthy messages about sex and sexuality;
promote the development of innovative, evidence-based interventions that take media literacy beyond the classroom; and
stimulate research in which newer forms of sexual media, including social media and their influence on adolescents’ health and well-being, are examined.
Policy Makers and Educators
Policy makers and educators should do the following:
invest in the continuing development and dissemination of media literacy curricula and
make the discussion of sexual media and its influence an integral part of health and sex education in schools.
Drs Collins and Strasburger provided an outline for the manuscript, drafted sections of the manuscript, and assembled, reviewed, and revised the manuscript; Drs Brown, Donnerstein, Lenhart, and Ward drafted sections of the manuscript and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted.
The analysis, conclusions, and recommendations contained in each article are solely a product of the individual workgroup and are not the policy or opinions of, nor do they represent an endorsement by Children and Screens: Institute of Digital Media and Child Development or the American Academy of Pediatrics.
FUNDING: This special supplement, “Children, Adolescents, and Screens: What We Know and What We Need to Learn,” was made possible through the financial support of Children and Screens: Institute of Digital Media and Child Development.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.