Council on Communications and Media. American Academy of Pediatrics. Policy statement--sexuality, contraception, and the media

Situational context of home-based sexual education in urban slums of Ibadan, Nigeria-evidence from a qualitative study

This study explores the influence of situational context on parent-adolescent communication about sexual and reproductive health (SRH) issues in the urban slums of Ibadan, Nigeria. A qualitative exploratory study was conducted in the Southeast and Northeast LGAs of Ibadan. Eight (8) vignette-based focus group discussions (FGDs) with parents and adolescents of both sexes were conducted in addition to four (4) key informant interviews (KIIs) with community and women's leaders. Interviews were tape-recorded, transcribed, and translated into English. Thematic analysis was adopted using ATLAS Ti 9 software. Findings portray SRH meanings and experiences, intergenerational cultural norms, and expectations for SRH, gender double standards in SRH discussion, streetwise SRH knowledge, and social media exposure as contexts that interfere with parent-adolescent communication on SRH issues. The findings show that despite understanding the need for SRH discussion, parents and adolescents lack effective communication on SRH issues due to the interference of unfiltered streetwise SRH knowledge and social media exposure. Also, SRH conversation between parents and adolescents promotes gender inequalities as different information is passed to adolescent girls and boys. Interventions that take into account situational occurrences must be geared towards enabling parents to give their adolescents early exposure to relevant, context-specific SRH knowledge.

Teen Pornography: An Emerging Mental Health Challenge

Exposure to pornography is not an uncommon and unusual phenomenon in the digital era, with teens being no exception. Exposure to pornography among teens may happen accidentally, out of curiosity, or intentionally to derive sexual excitement. Many individuals exposed to pornography may later develop pornography addiction. Most parents who are aware that their children view pornography are often worried about such behavior and sometimes seek help from mental health professionals. So, it can be certainly said that exposure to pornography among teens may cause significant distress in them and their parents. As pornography is a major source of sex education for a large number of teens, lots of myth and misguided information are harbored from watching pornography. This article focuses on the mental health aspects of pornography exposure among teens and the possible remedial measures.

Online Sexual Solicitation of Children and Adolescents in a High-Risk Population

INTRODUCTION

The Internet provides a powerful potential tool for sexual predators. Experiencing trauma, including sexual abuse, can increase child and adolescent risk of experiencing online sexual solicitation.

METHOD

A retrospective chart review was conducted for the detailed information of all children and adolescents aged 8-18 years presenting to the Child Advocacy Center of large, tertiary care, Midwestern U.S. pediatric hospital with concerns of sexual abuse.

RESULTS

Three-hundred twenty-five children and adolescents were seen in the Child Advocacy Center during the 9 months; 139 (42.8%) denied talking to anyone online that they had not met offline (face to face in real life), 88 (27.1%) reported talking to individuals online that they had not met offline but never talking about sex; 65 (20%) reported online sexual solicitation with individuals they had not met offline; and 33 (10.2%) reported highest-risk behaviors online involving meeting someone offline or having sex with someone offline whom they had met online.

DISCUSSION

The number of youth involved in online sexual solicitation illustrates that children who have been sexually abused are at increased risk for sexual solicitation. This study also suggests that young children are vulnerable to online sexual solicitation. Youth engaged in these concerning online behaviors with individuals of all ages.

Online Sexual Solicitation of Children and Adolescents

Technological advances have exploded in the new millennium. The Internet provides many opportunities to enrich the lives of youth by providing greater access to learning opportunities, valuable resources, and positive social interactions with peers. However, the Internet is a relatively new and unregulated entity that can also place children and adolescents at risk for a variety of negative and potentially dangerous exposures. One such risk is online sexual solicitations and interactions with older adolescents, peers, and adults. This continuing education article will explore online sexual solicitation of child and adolescents in terms of definition, epidemiology, predictors, consequences, and implications for practice.

Barrier Protection Use by Adolescents During Sexual Activity

Rates of sexual activity, pregnancies, and births among adolescents have continued to decline during the past decade to historic lows. Despite these positive trends, many adolescents remain at risk for unintended pregnancy and sexually transmitted infections (STIs). This technical report discusses the new data and trends in adolescent sexual behavior and barrier protection use. Since 2017, STI rates have increased and use of barrier methods, specifically external condom use, has declined among adolescents and young adults. Interventions that increase availability of or accessibility to barrier methods are most efficacious when combined with additional individual, small-group, or community-level activities that include messages about safer sex. Continued research informs public health interventions for adolescents that increase the consistent and correct use of barrier methods and promote dual protection of barrier methods for STI prevention together with other effective methods of contraception.

Social media and children: what is the paediatrician's role?

Social media use has become an integral part of children's and adolescents' lives. It has become a novel way of interaction among people and influences people's social lives and public opinion as well as people's purchasing decisions and businesses. Any website or platform that allows social interaction is considered to be a social media site. Social media use among children in 25 European countries has been reported to be 38% among 9-12 year olds and 77% among those aged 13-16 years. All these children report having their own profile on at least one social network site. While social networking provides children and adolescents with many opportunities and benefits, it also carries many risks. Among the benefits are socialization and communication enhancement, improving learning skills, positive impact on education and getting health information. Potential risks of social media use include falsifying age and identity, cyberbullying, sexting, Facebook depression, gamification, glamourization, cyberostracism and sleep disturbances.Conclusion: Paediatricians play a vital role in promoting the physical, mental and social welfare of all children. There is a critical need for paediatricians to play an active role, guiding children and families appropriately through the impact of social networking, in order to become a real driver of children's development.

Do Policy Statements on Media Effects Faithfully Represent the Science?

Professional advocacy associations such as the American Psychological Association (APA) and American Academy of Pediatrics commonly release policy statements regarding science and behavior. Policymakers and the general public may assume that such statements reflect objective conclusions, but their actual fidelity in representing science remains largely untested. For example, in recent decades, policy statements related to media effects have been released with increasing regularity. However, they have often provoked criticisms that they do not adequately reflect the state of the science on media effects. The News Media, Public Education and Public Policy Committee (a standing committee of APA’s Division 46, the Media Psychology and Technology division) reviewed all publicly available policy statements on media effects produced by professional organizations and evaluated them using a standardized rubric. It was found that current policy statements tend to be more definitive than is warranted by the underlying science, and often ignore conflicting research results. These findings have broad implications for policy statements more generally, outside the field of media effects. In general, the committee suggests that professional organizations run the risk of misinforming the public when they release policy statements that do not acknowledge debates and inconsistencies in a field, or limitations of methodology. In formulating policy statements, advocacy organizations may wish to focus less on claiming consensus and more on acknowledging areas of agreement, areas of disagreement, and limitations.

Effects of Sexual Media Literacy Education for School Nurses in South Korea

This study aimed to examine the effects of a sexual education program (SEP) focused on sexual media literacy (SML) for school nurses. A quasi-experimental, pre-/posttest design was used to examine SML knowledge, awareness, reinterpretation skill, and self-efficacy. A total of 66 school nurses participated. The experimental group (n = 35) participated in an 18-hr SEP that focused on SML, while the control group (n = 31) did not. The experimental group showed significant improvement in knowledge (t = 6.47, d = 1.62, p < .001), awareness (t = 5.08, d = 1.19, p < .001), reinterpretation skill (t = 4.81, d = 2.28, p < .001), and self-efficacy (t = 8.29, d = 1.38, p < .001) as compared to the control group. The SEP developed in this study may be an effective educational intervention for school nurses.

Sexual Media and Childhood Well-being and Health

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.

Sex, Love, and Risk-n-Responsibility: A Content Analysis of Entertainment Television

This study documents the extent of sexual content, including sexual health content, in scenes with and without expressions of love on network and cable television popular with emerging adults. Sexual talk and/or behavior was found in 20% of all television scenes coded across 53.5 hours of programming. A third of these scenes featured sex alongside expressions of love. An additional 10% of scenes suggested love but not sex. Coded as a separate category, 25% of analyzed scenes contained a passing joke or pun referencing sexual organs, making these non-specific comedic one-liners the predominant reference to sex in this sample. Beyond jokes, most of the sexual or loving talk in this sample consisted of expressing a romantic interest in someone; sex- and love-related behaviors largely consisted of kissing or flirting. Very few scenes specifically referenced sexual intercourse. Sexual health messages were also rare. The majority of scenes mentioning any health consequence (= 7% of analyzed scenes) concerned emotional heartache. One scene mentioned sexually-transmitted infections; 12 of the nearly 2,600 scenes coded mentioned condoms or contraceptives. It is thus a challenging proposition to build upon existing sexual depictions on television to promote safe sex practices within sexual and loving contexts.

Off-Road Vehicle Crash Risk during the Six Months after a Birthday

Background

Off-road vehicles are popular and thrilling for youth outside urban settings, yet sometimes result in a serious crash that requires emergency medical care. The relation between birthdays and the subsequent risk of an off-road vehicle crash is unknown.

Methods

We conducted a population-based before-and-after longitudinal analysis of youth who received emergency medical care in Ontario, Canada, due to an off-road vehicle crash between April 1, 2002, and March 31, 2014. We identified youth injured in an off-road vehicle crash through population-based health-care databases of individuals treated for medical emergencies. We included youth aged 19 years or younger, distinguishing juniors (age ≤ 15 years) from juveniles (age ≥ 16 years).

Results

A total 32,777 youths accounted for 35,202 emergencies due to off-road vehicle crashes within six months of their nearest birthday. Comparing the six months following a birthday to the six months prior to a birthday, crashes increased by about 2.7 events per 1000 juniors (18.3 vs 21.0, p < 0.0001). The difference equaled a 15% increase in relative risk (95% confidence interval 12 to 18). The increase extended for months following a birthday, was not observed for traffic crashes due to on-road vehicles, and was partially explained by a lack of helmet wearing. As expected, off-road crash risks did not change significantly following a birthday among juveniles (19.2 vs 19.8, p = 0.61).

Conclusions

Off-road vehicle crashes leading to emergency medical care increase following a birthday in youth below age 16 years. An awareness of this association might inform public health messages, gift-giving practices, age-related parental permissions, and prevention by primary care physicians.

Sexuality Education for Children and Adolescents

The purpose of this clinical report is to provide pediatricians updated research on evidence-based sexual and reproductive health education conducted since the original clinical report on the subject was published by the American Academy of Pediatrics in 2001. Sexuality education is defined as teaching about human sexuality, including intimate relationships, human sexual anatomy, sexual reproduction, sexually transmitted infections, sexual activity, sexual orientation, gender identity, abstinence, contraception, and reproductive rights and responsibilities. Developmentally appropriate and evidence-based education about human sexuality and sexual reproduction over time provided by pediatricians, schools, other professionals, and parents is important to help children and adolescents make informed, positive, and safe choices about healthy relationships, responsible sexual activity, and their reproductive health. Sexuality education has been shown to help to prevent and reduce the risks of adolescent pregnancy, HIV, and sexually transmitted infections for children and adolescents with and without chronic health conditions and disabilities in the United States.

The application of a feminist poststructural framework in nursing practice for addressing young women's sexual health

AIMS AND OBJECTIVES

Using a feminist poststructuralist framework, this paper examines the conflicting discourses of young women who experience power struggles with regard to their sexuality and sexual health practices. It aims to provide nurses with a pragmatic framework for exploring, interrogating and potentially transforming health care situations when caring for young women in a sexual health setting.

BACKGROUND

Sexuality and sexual health are important components of health and well-being. Young men and women are continually perpetuated with societal ideals of sexuality and sexual health practices. Young women specifically, receive societal and peer pressure to conform to certain sexual health practices that can lead to both positive and negative health outcomes. Nurses and other health care providers may care for young women in a public or acute care setting that are living with these conflicting sexual health discourses.

DESIGN

A review of the literature on young women's sexuality and sexual health was conducted and analysed using a feminist poststructuralist framework.

METHODS

A review of the sexual health literature on young women was conducted. Issues identified from the review, as they relate to sexual discourse were power, language, subjectivity and agency. Nursing strategies to address these issues in practice were identified using a feminist poststructuralist framework.

DISCUSSION

The feminist poststructural framework highlights the conflicting discourses related to young women's sexuality and sexual health practices. This paper provides a pragmatic example of how to incorporate theory to improve nurses' understanding of an individual or group's health.

RELEVANCE TO CLINICAL PRACTICE

Examples of how a feminist poststructural framework can be used to enhance sexual health nursing practice are discussed, such as helping nurses to challenge the status quo and question the sexual health norms among young women.

Online communication predicts Belgian adolescents' initiation of romantic and sexual activity

Online communication is associated with offline romantic and sexual activity among college students. Yet, it is unknown whether online communication is associated with the initiation of romantic and sexual activity among adolescents. This two-wave panel study investigated whether chatting, visiting dating websites, and visiting erotic contact websites predicted adolescents' initiation of romantic and sexual activity. We analyzed two-wave panel data from 1163 Belgian adolescents who participated in the MORES Study. We investigated the longitudinal impact of online communication on the initiation of romantic relationships and sexual intercourse using logistic regression analyses. The odds ratios of initiating a romantic relationship among romantically inexperienced adolescents who frequently used chat rooms, dating websites, or erotic contact websites were two to three times larger than those of non-users. Among sexually inexperienced adolescents who frequently used chat rooms, dating websites, or erotic contact websites, the odds ratios of initiating sexual intercourse were two to five times larger than that among non-users, even after a number of other relevant factors were introduced.

CONCLUSION

This is the first study to demonstrate that online communication predicts the initiation of offline sexual and romantic activity as early as adolescence. Practitioners and parents need to consider the role of online communication in adolescents' developing sexuality.

WHAT IS KNOWN

• Adolescents increasingly communicate online with peers. • Online communication predicts romantic and sexual activity among college students. What is New: • Online communication predicts adolescents' offline romantic activity over time. • Online communication predicts adolescents' offline sexual activity over time.

Contextual influence of Taiwanese adolescents' sexual attitudes and behavioral intent

This study examined parental, peer, and media influences on Taiwanese adolescents' attitudes toward premarital sex and intent to engage in sexual behavior. Participants included a convenience sample of 186 adolescents aged 13-15 recruited from two middle schools in Taiwan. Parental influence was indicated by perceived parental disapproval toward premarital sex and perceived peer sexual behavior was used to measure peer influence. Media influence was measured by the adolescents' perception of whether the media promotes premarital sex. We conducted structural equation modeling to test a hypothesized model. The findings suggested that the perceived sexual behavior of peers had the strongest effect on Taiwanese adolescents' sexual attitudes and behavioral intent, while parental disapproval and media influence also significantly contributed to adolescents' sexual attitudes and intent to engage in sex. School nurses are in an ideal position to coordinate essential resources and implement evidence-based sexually transmitted infection and HIV/AIDS prevention interventions that address issues associated with the influence of parents, peers, and media.

The media as a critical determinant of the sexual and reproductive health of adolescents in Ibadan, Nigeria

PURPOSE

Findings on the influences of the media on the sexual health of adolescents in vulnerable communities in Ibadan are presented.

METHODS

Phase I of the WAVE study in Ibadan was conducted among participants purposively selected from disadvantaged communities in Ibadan North Local Government Area (LGA). Qualitative research methods (key informant interviews, in-depth interviews, community mapping and focus group discussions as well as photovoice sessions) were utilized.

RESULTS

A total of 132 key informants and adolescents (aged 15-19 years) participated. The key informants were teachers, youth workers, and religious leaders working with adolescents within the LGA. Respondents mentioned a number of media technologies (such as television, cellphones, computers, the Internet as well as online and hard copy novels) that adolescents are exposed to in contemporary times. They said these had positive and negative influences on them. Adolescents often looked up information on the Internet although it was mostly used as a means of meeting and communicating with friends. Respondents stated that the media had a strong influence on adolescents' sexual and reproductive health especially regarding dating, relationships, and sexual practices. It also exposed them to pornography and Internet fraud.

CONCLUSIONS

The study highlighted the important role the media plays in the sexual health of adolescents in Ibadan. Intervention programmes need to make use of this medium to reach out to more adolescents and measures should be instituted to prevent adolescents from misusing the media.

Sexual media exposure, sexual behavior, and sexual violence victimization in adolescence

BACKGROUND

Emerging research suggests sexual media affects sexual behavior, but most studies are based on regional samples and few include measures of newer mediums. Furthermore, little is known about how sexual media relates to sexual violence victimization.

METHODS

Data are from 1058 youth 14 to 21 years of age in the national, online Growing up with Media study.

RESULTS

Forty-seven percent reported that many or almost all/all of at least one type of media they consumed depicted sexual situations. Exposure to sexual media in television and movies, and music was greater than online and in games. All other things equal, more frequent exposure to sexual media was related to ever having had sex, coercive sex victimization, and attempted/completed rape but not risky sexual behavior.

CONCLUSIONS

Longer standing mediums such as television and movies appear to be associated with greater amounts of sexual media consumption than newer ones, such as the Internet. A nuanced view of how sexual media content may and may not be affecting today's youth is needed.

Healthy sex and sexual health: new directions for studying outcomes of sexual health

Sexual behavior is an important aspect of adolescent development with implications for well-being. These chapters highlight important perspectives on studying sexual health from a normative, developmental perspective, such as viewing a range of sexual behaviors as life events; considering potentially positive physical health, mental health, social health, and identity outcomes; examining both intraindividual and interindividual differences in outcomes; recognizing the romantic relationship context of sexual behavior; and understanding how sexual media may impact sexual health outcomes. We suggest new directions for studying sexual health outcomes, such as studying behaviors beyond vaginal sex and condom use, new methodologies such as latent class analysis, sophisticated longitudinal designs, and collection and analysis of dyadic data. We recommend research on populations underrepresented in sexual health research such as late adolescents who do not attend traditional universities and adolescents from ethnic/racial minorities. Finally, we consider future directions for sexuality education and prevention efforts.

Condom Use by Adolescents

Rates of sexual activity, pregnancies, and births among adolescents have continued to decline during the past decade to historic lows. Despite these positive trends, many adolescents remain at risk for unintended pregnancy and sexually transmitted infections (STIs). This policy statement has been developed to assist the pediatrician in understanding and supporting the use of condoms by their patients to prevent unintended pregnancies and STIs and address barriers to their use. When used consistently and correctly, male latex condoms reduce the risk of pregnancy and many STIs, including HIV. Since the last policy statement published 12 years ago, there is an increased evidence base supporting the protection provided by condoms against STIs. Rates of acquisition of STIs/HIV among adolescents remain unacceptably high. Interventions that increase availability or accessibility to condoms are most efficacious when combined with additional individual, small-group, or community-level activities that include messages about safer sex. Continued research is needed to inform public health interventions for adolescents that increase the consistent and correct use of condoms and promote dual protection of condoms for STI prevention with other effective methods of contraception.

Children, Adolescents, and the Media

Media, from television to the "new media" (including cell phones, iPads, and social media), are a dominant force in children's lives. Although television is still the predominant medium for children and adolescents, new technologies are increasingly popular. The American Academy of Pediatrics continues to be concerned by evidence about the potential harmful effects of media messages and images; however, important positive and prosocial effects of media use should also be recognized. Pediatricians are encouraged to take a media history and ask 2 media questions at every well-child visit: How much recreational screen time does your child or teenager consume daily? Is there a television set or Internet-connected device in the child's bedroom? Parents are encouraged to establish a family home use plan for all media. Media influences on children and teenagers should be recognized by schools, policymakers, product advertisers, and entertainment producers.

School daze: why are teachers and schools missing the boat on media?

Most American schools are 50 years behind in incorporating new technology into the classroom and using media wisely. Some experts estimate that 65% of today's grade-school students may end up doing jobs that have not even been invented yet. Abundant evidence now exists that children and teens learn preferentially from the media, yet the media are often frowned on as too distracting for students or too distant from the basic 3 Rs. American schools are failing in their fundamental responsibility to students. Educators need to learn how to use media and new technology wisely.

Children, adolescents, and the media: health effects

The media can be a powerful teacher of children and adolescents and have a profound impact on their health. The media are not the leading cause of any major health problem in the United States, but they do contribute to a variety of pediatric and adolescent health problems. Given that children and teens spend >7 hours a day with media, one would think that adult society would recognize its impact on young people's attitudes and behaviors. Too little has been done to protect children and adolescents from harmful media effects and to maximize the powerfully prosocial aspects of modern media.

Internet bullying

There is substantial literature on the impact of the mass media on children's and adolescents' health and development. The question of what role new technology plays in the media's influence is now a subject of both review and discussion, particularly regarding health risks and intervention. This article takes a brief look at online usage and the theoretical mechanisms that might make Internet access more problematic in terms of risks, compared with more traditional media such as television and film. One of these risks, known today as cyberbullying or Internet harassment, is scrutinized in detail.

Media's contribution to sexual knowledge, attitudes, and behaviors for adolescents and young adults in three Asian cities

PURPOSE

Evidence in western countries indicates that the media have associations with adolescents' and young people's sexual behavior that may be as important as family, school, and peers. In this new study of Asian adolescents and young adults in the three cities of Hanoi, Shanghai, and Taipei, the associations between exposure to sexual content in the media and adolescents' and young adults' sex-related knowledge, attitudes, and behaviors are explored in societies with traditional Confucian culture, but at different stages in the process of modernization.

METHODS

The data are from a questionnaire-based cross-sectional study conducted from 2006 to 2007, where a sample of 17,016 adolescents and young adults aged 15-24 years from Shanghai, Hanoi, and Taipei completed face-to-face interviews coupled with computer-assisted self-interviews for sensitive questions. For the objectives of this article, analysis was restricted to the 16,554 unmarried respondents. Exposure to sexual content in the mass media (including the Internet and traditional media), pornographic videos, and a preference for western/Asian movies/videos were the main media influence measures. Sex-related knowledge, premarital sexual permissiveness (PSP), and sex-related behaviors were the main outcome measures. The impact of each of four contexts including family, peer, school, and media on sex-related knowledge, attitudes, and behaviors were assessed using multiple linear regression stratified by gender and city, controlling for age, urban/rural residence, education, and economic status. The change in adjusted R(2) from the multiple linear regression analysis was adopted to indicate the contribution of family, peer, school, and media variables to respondents' sex-related knowledge, attitudes, and behaviors.

RESULTS

The contextual factors, including family, peer, school, and media, explained 30%-50% of the variance in sex-related knowledge, 8%-22% of the variance in PSP, and 32%-41% of the variance in sex-related behaviors. Media variables explained 13%-24% of the variance in sexual knowledge, 3%-13% in PSP, and 3%-13% in sex-related behaviors, which was comparable with that of family, peer, and school variables. These associations differed by city and gender.

CONCLUSIONS

Access to and use of mass media and the messages they present are influential factors on sex-related knowledge, attitudes, and behaviors of unmarried Asian adolescents and young adults, and should be considered in future research and intervention programs attempting to improve reproductive health outcomes.

Television viewing and its impact on childhood behaviors

Despite the emergence of new media technologies, television remains the most widely used screen media format. Unfortunately, concerns have arisen about its effects on the health and well-being of children and adolescents. This article reviews television usage trends and television's impact on sleep, attention, and interpersonal relationships. American Academy of Pediatrics recommendations on television use are also discussed. Many studies on television viewing have cross-sectional designs, and longitudinal research is limited. However, research to date suggests that excessive television viewing is associated with negative effects on sleep, attention, and interpersonal relationships. As use of different media formats escalates, research across multiple specialties (including child psychiatry) will need to incorporate evaluation of media use into its assessments. More research and education are needed on the appropriate use of media in youth. Information on the health effects of television may also increase awareness of potential issues with less well-studied media formats.