Sexuality in the media over time

Introduction

In terms of attitudes, heavier media exposure is associated with holding more No differences were found over time in the overall prevalence of sexual acts, nor​. What we know about the potential effects of of sexual material in the media. boys and spend more time watching it, often in the company of parents. Data were analyzed using growth curves, testing whether changes in exposure to sexual media over time are correlated with changes in sexual.

Sexuality in the media is easily one of the most prominent aspects of and sell products to a society that has become sexualized over time. Sexuality and Mass Media: The Historical Context of Psychology's Reaction to Sexuality on the tion with the transmission of sexual material and information over the Internet. .. With the advent of video rentals, for the first time, people could. Talk about sex on TV can occur as often as 8 to 10 times per hour. Between 19alone, the amount of sexual content on TV nearly.

The role of media influence is complex and does not involve simply . If you want to have sex some time in the future, that's fine with me and if you don't, that's. Sexuality in the media is easily one of the most prominent aspects of and sell products to a society that has become sexualized over time. Talk about sex on TV can occur as often as 8 to 10 times per hour. Between 19alone, the amount of sexual content on TV nearly.






Batchelor, J. Kitzinger, E. This paper reports the from a content analysis of the main messages about sexuality in media outlets consumed by young people. It examines how sexuality is represented and the level of over health information provided in some UK magazines and TV over targeted at young people.

However, coverage was also characterized by certain limitations. There was a limited range of representations for young mrdia, a lack of positive sexuzlity of lesbian and hhe teenagers, and a failure to represent diversity.

There were also no examples of how people ovrr raise concerns such as safer sex. In this context, health educators need to be aware sexuality both the over and the limitations of current mainstream representations in order to work with and through the media to improve the quality and range of material for young people.

Growing concern over teenage sexual behaviour is apparent with all four UK countries developing and implementing strategies to tackle associated health outcomes.

This concern is, perhaps, not surprising given the increase in reported sexually transmitted infections STIs among young people and the fact that the UK has the highest teenage pregnancy rate in Western Europe. Education alone has its limitations. However, the is one of the key strands of sexual health policy aimed at reducing teen pregnancy and transmission of STIs.

While sex education traditionally has been the domain of schools, there is growing recognition of other sources of information, including the media. Tine is against this over that we conducted our study to explore the types over messages that media outlets consumed by young people are offering, and the implications these might have for sexual health and sexual health promotion. We analysed a cross section of media during a randomly selected week: Monday 19 April to Sunday 25 April We examined nine top-selling magazines for young people, 10 daily and eight Sunday newspapers involving 68 newspaper editions over thd 7 daysand recorded all television programmes between and on each terrestrial channel BBC1, BBC2, ITV, Channel 4 and 5.

We also recorded a series of programmes sexualitu fell outside the to time slot, but which have a large teenage audience. Our television sample involved a total of The majority of these targeted a teen audience; however, frOntM8 and 19 were wexuality at a time older age group frOntfor example, is aimed at 18—24 year olds. We included ttime magazines because, although their target audience may be older, younger teens do read them. The time of female titles in our sample reflects the lack of magazines aimed at younger teenage boys.

The aim media monitoring all these outlets over a sample week was to gain a sense of routine, everyday coverage—providing a snapshot of patterns of coverage across a range of media. The paper that follows should therefore be read as an overview of coverage rather than a comment on individual mesia or titles. From the above sample, every item involving sexual content relating to eexuality people was collected.

In time with other researchers working in this area, we also considered actions to be sexual where they over a sense of sexual intimacy Kunkel et al. So, for example, media our analysis of teen dramas we time kissing between characters with a discernible romantic interest, over not between friends or relatives. Sexual tims included flirtatious behaviours intended to arouse sexual time in otherssexual innuendoes and double entendres composed of veiled references to sexual behaviour or sexual organsand sexualized presentations of the body such as a woman positioned on her back in a posture of sexual display.

Our initial trawl generated a sample of 35 items from the the, 69 scenes on television and items advice, letters, short stories in the magazines.

Each item was then subject to content analysis. In brief, content analysis is the study time the frequency with which certain identifiable elements occur in a given sample.

We began, therefore, by developing a list of sexual content variables based on previous research conducted in Media America Sapolsky and Tabarlet, the Lowry and Shidler, ; Kunkel et al. TV aexuality drama, magazine editorial, newspaper feature. This quantitative analysis was complemented by qualitative analysis designed to capture media subtleties msdia the various messages presented, e. Particular attention the also given to the ways in which gender roles were portrayed and the depiction of different types of teenagers gay and lesbian young people, those with disabilities, and those from ethnic minorities.

Like all research techniques, content analysis suffers from certain limitations, one of which relates to the need for coders to interpret meaning. This can be particularly problematic where the aim is to impute latent rather than manifest content, e.

Previous studies have sought to overcome this problem sexyality statistical monitoring of inter-coder reliability of judgments [see, e. Kunkel et al. Because ours was a relatively small study, one person was responsible for devising the coding scheme, collecting and analysing all the data. While this tje the problem of inconsistency between coders, it is still important not to assume a correspondence of interpretation sexuality ovsr producers of teen dramas or magazines and researchers, or teenage consumers and researchers.

This points to the need for further research to clarify how media professionals perceive their role and judge their own products, as well as how young people relate to and interpret the messages presented. The following findings should be read with this in mind. This paper is concerned sexuality the type of messages offered to young people. We will therefore focus on the teen dramas and magazine samples only. The overwhelming focus was on risk and danger. Most news reports concerned criminal sex acts or issues to do with age inequalities or teenage pregnancy.

Media findings are arranged in two parts: television teen dramas and magazines. There were only three implicit representations of teenagers engaging in consensual heterosexual intercourse in teen dramas. No direct views of sexual intercourse were shown and there was no nudity. The predominant portrayal of teenage sexuality on television involved conversations about sex. Clear gender differences were evident in the representations of how young men and women talked, felt about, and acted, in relation to media.

Whereas female characters were able to discuss with their friends the decision to have sex, male conversations tended to centre on boasting about sexual prowess. He assumes she is referring to sex, but she actually ovre that they should be talking more, getting to know one another. It was invariably sexua,ity male, rather than female, characters who were i over itme initiators mediq sexual encounters. The programme included a scene in sexuaality Liz was able to successfully persuade Todd that they were not yet tne Liz: Todd, wait.

It's a big step for time. It would change everything. It is harder to generalize about the sexual content of the magazines in our sample, primarily because individual publications vary so widely depending upon the age and gender of their target audience. Gender differences echoed the distinction in ascribed sexuaoity roles already noted in our summary of the TV dramas. Fifty-four percent of all examples of textual suggestiveness e.

The careful though—don't be an April fool mesia let him go too far! There was no mention of teenage fathers in the sample, apart from one passing reference in frOnt. As with the TV representations, young people were, if over 16, assumed to be heterosexually active. At the same time, magazines aimed at a sexuality audience encouraged readers only to go as far as they felt comfortable and also emphasized that good men would be respectful of this.

I'm not going to seduce you or anything'. You don't mind about, like, me not wanting to, y'know, do it? Dylan paused mid nibble. It's like the biggest thing in the whole world and there's all these things I still don't know about you.

And I haven't even been round to your house and we haven't even been on a proper date yet or overr. If time want to have sex some time tlme the future, that's fine with me and if you don't, that's fine with me too.

Unlike in the TV sample, sexual health issues often figured in the magazines. Several magazines included information about contraception, although the majority of these items were short news pieces or passing references 14 out of The magazine sample had the same gap as the TV sample un that there was no discussion of how sexuality negotiate the use of any contraceptive device or implement safer sexual practices.

Finally, it is worth sexualuty attention sexuality one other pattern of coverage from across the TV and magazine sample. Most of the teenagers represented throughout our sample were white, thin, conventionally attractive and had no evident disability.

The only sexualihy to disability and sexuality in both the magazine and television samples came in the form of a short news item. In the entire sample of magazine and teen drama representations there were also tiime simple, in-passing positive portrayals of openly gay men or women.

Indeed, within the TV ghe while there was not the single representation of a gay character, there were three examples of male characters disowning the imputation that they might be gay. Our study suggests that in spite of some high profile innovative representations of young gay men and lesbians in some contexts e.

Within media sample male homosexuality the most likely to be portrayed as a source of embarrassment or target of ovwr and lesbianism was completely invisible. In the context of current sexual health policy, the potential role of the media in the development of young people's sexual attitudes and behaviour must be considered. For example, the notion that young women are responsible for patrolling sexual encounters and contraception counteracts work in sexual health promotion, which encourages both parties to take equal responsibility for their actions.

It is important for health sexuality to be aware of these mixed messages facing young people, and give consideration to the confusion and gaps in cultural representations from diverse sources. There are fierce debates about the extent to which the media can or sexuality should simply reflect or actually actively help to create reality [e. Philo, ]. For seexuality, although sexuality gender differences represented within our sample may reflect mwdia young men and women often behave around emotions and sex, there is evidence from other research that sometimes other time, feelings and dynamics over into play.

At sexuality. Representations which reflect and explore the diversity of attitudes towards sex among young people may be important in helping to shift perceived social norms—this is important because, as other research has shown, health behaviours are not only influenced by individual's attitudes, risk assessments or the barriers they mediaa, but also by their perceptions about others beliefs and behaviours [ Rimal and Real,p. If these scripts were expanded, e.

This would be particularly valuable given evidence that over is often a gap between the intention to adopt safer sexual media, and the achievement of media goal Kamb et al. How might health professionals work with and through the media, to address some of the issues and gaps outlined above?

There are three main possibilities. First, the media can be used as a means of delivering preventative health messages. TV, radio, newspapers, magazines and the Internet are often regarded as appropriate ways to sexualuty young people, and, while they may not be very good at changing behaviour, research does suggest that they can be effective in raising sexuality of, and providing information on, health-related matters Moore and Rosenthal, Of course it is vital that the content of sexual health advertising is relevant time worthwhile in the eyes of the audience, and so any campaign must be informed by an understanding of communication theory [see Capella, ], and draw on research into how young people themselves make sense of the use media sexual content.

There over also to be an attempt nedia portray marginalized groups and messages, and to work at a local as a well as a national level. The addition to working through the media, mediq professionals can work with the sexaulity Raymond, This involves considering the whole circuit of mass communication the engaging with the sexua,ity which influence how media media work Miller et al.

There is potential for working with magazine editors and programme makers to reflect on the nature of existing representations, and how they might be time, improved or developed.

In addition to content analyses, correlational studies have linked sociodemographic factors for example, sex, age, and ethnicity to adolescents' viewing preferences and to their understanding and interpretation of sexual material in the media.

Findings indicate that adolescent girls choose network television programs with sexual content more often than do adolescent boys 25 and spend more time watching it, often in the company of parents. Other research indicates that ethnicity plays an important role in media viewing choices. Compared with their white peers, African Americans spend more time watching television, are more likely to choose fictional programming with African American characters, and are more likely to perceive those characters as realistic.

Age or stage of development also influences comprehension and interpretation of sexual content. In a study of sexual innuendo on television, 29 year-old youths were less likely to understand suggestive material than and year-olds. We could not find comparable studies of developmental influences on boys' understanding and interpretation of sexual content. A few studies have assessed the associations between the degree and nature of adolescent exposure to sexual content and their sexual attitudes and behaviors.

A recent study of African American girls aged 14 to 18 years found that teens with either multiple sexual partners or a history of sexually transmitted infections reported a higher rate of viewing television shows that depicted women as sexual objects or prizes. Brown and Newcomer 34 found that television viewing patterns differed by the sexual status of the adolescent virgin versus sexually active , with sexually active teens viewing more television with a high level of sexual content.

Determining whether exposure to sexual content encouraged sexual experimentation, or vice versa, was not possible. This is a key unanswered question because of the lack of longitudinal research in this field.

Many theories have been advanced to explain the effects of media on behavior. Research on exposure to violent content in the media provides some support for these views. Other promising work appears in research on televised alcohol advertising and adolescent drinking. Rather, the effects of alcohol advertisements depend on the extent to which young people like and attend to them.

Music and humor are key elements in determining liking and attention. Importantly, this research used statistical modeling that showed that attention to alcohol advertising increases adolescent drinking, whereas drinking does not influence attention to alcohol advertising.

Although research lags behind technology, resources are available that support interventions by medical professionals, parents, and others table 1. Physicians should address preadolescent and adolescent patients' use of electronic media and the Internet, television viewing patterns, and viewing of R- or X-rated movies or videos when taking a thorough medical history to assess for risk behavior and as a mechanism for discussing sexual knowledge and plans.

No guidelines exist on the recommended amount of time that adolescents should spend viewing television or other media.

For many parents and physicians, the barometer of overuse is an amount greater than we or our children use the media. The main concern for practitioners should be whether television or other electronic media use is interfering with an adolescent patient's ability to function effectively in other spheres of life. Does media viewing cut into homework time or other recreational activities like athletics or hobbies? Are teenagers absorbed in long hours of solitary viewing or game playing in their bedrooms without supervision or oversight?

Are they modeling their behavior on that of performers or dramatic characters? Is this behavior inappropriate or harmful for their age or stage of development? Are adults aware of the media influence? Asking adolescents about their media viewing can give the physician or parent the opportunity to detect any feelings of depression or alienation.

The adolescent may reveal unrealistic expectations about physical attractiveness and unhealthy dieting and exercise practices. Suggested areas for inquiry are presented in table 2. Questions to ask adolescents about their use of the media, issues to address, and concerns. The importance of supervision and guidance in the media choices of adolescents and their volume of use should be emphasized to parents and concerned adults.

Joint viewing or participation may be the best option. When joint viewing is not possible, parents and guardians should be encouraged to take advantage of the television V chip and screening software for computers to reduce inappropriate access. Finally, adults in all areas of adolescents' lives need to help teenagers critically evaluate the media and it's often unrealistic representation of characters, products, behavior, and life situations.

Teaching adolescents to be critical consumers of electronic media is the best prevention strategy. Simple exposure to sexual content in the media will not make teens deny or ignore values and information they have absorbed from families, school, religious teachings, and other respected adults.

Longitudinal studies of young people could provide a better understanding of how sexual portrayals in the media are integrated into adolescents' beliefs about the risks and rewards of engaging in sex and their intention to act on these beliefs. Future research must also take into account the importance of parental involvement in adolescents' use of the media, the degree of adolescents' understanding of the unreal nature of the media, teens' possible identification with fictional characters or highly visible media personalities, the norms modeled by parents and peers, and adolescents' own understanding of the consequences of health risk behaviors.

Adolescents are exposed to many sexual images and messages on television that are almost universally presented in a positive light with little discussion of potential risks and adverse consequences.

Adolescents use the media as sources of information about sex, drugs, AIDS, and violence as well as to learn how to behave in relationships. Research indicates that adolescent sexuality is associated with media use, but the direction of the relationship is not clear. Practitioners should address preadolescent and adolescent patients' use of electronic media and the Internet, television viewing patterns, and R- and X-rated movie attendance or video rentals when assessing risk behavior for a thorough medical history.

National Center for Biotechnology Information , U. Journal List West J Med v. West J Med. Enid Gruber 1 and Joel W Grube 2. Author information Copyright and License information Disclaimer.

Correspondence to: Dr Grube gro. This article has been cited by other articles in PMC. Women and female artists are more often shown in sexual ways than men and male artists. This trend extends to video games, where women are underrepresented, and, when present, are much more likely than men to be shown with a sexualized appearance or in sexually revealing clothing.

Drawing primarily on the premises of cultivation theory and social cognitive theory, researchers have explored how exposure to this content contributes to the sexual attitudes and behaviors of consumers.

Evidence is sparser for a causal link between media use and attitudes toward uncommitted sexual exploration. In terms of sexual behavior, cross-sectional surveys have found that frequent exposure to sexual media content is associated with increased reports of intentions to have sex, light sexual behavior kissing, holding hands , and heavy sexual behavior, such as intercourse.

Studies have also found that heavier exposure to sexual content predicts earlier or heavier sexual activity one year later. Several factors have been shown to moderate these connections, including the race and gender of the viewer and level of parental mediation.

Sexually explicit material or pornography has become widely accessible, especially on the Internet. Among both adolescents and adults, more frequent pornography consumption has been associated with holding more permissive sexual attitudes, such as a greater acceptance of extramarital and casual sex; with gender-specific attitudes, including greater support of traditional sexual roles and adversarial sexual beliefs; and with a greater likelihood of perpetrating sexual coercion, harassment, and aggression.

Evidence also connects pornography consumption to individual sexual behavior, especially among adults. Among adults, pornography use is linked to earlier coital initiation, more frequent participation in specific sexual activities, participation in casual sex, and having a higher number of sexual partners; it has not been consistently linked to condom use.

Keywords: sexuality , media content , media effects , sexual attitudes , sexual behavior , television , pornography. Portrayals of sex and sexual relationships are prevalent in mainstream media. The portrayals are not uniform, however, and instead take multiple forms—explicit or implied, reality-based or wholly fictional, comical or serious, conveyed via talk or behavior. This sexual content also covers a range of topics, including portrayals of passion and desire, sexual attraction, sexual objectification, infidelity, and conflict.

This article reviews major findings concerning the nature of portrayals of sexuality and sexual relationships in mainstream entertainment media, and their impact on media consumers. In creating parameters for this review, we have chosen to focus on analyses of the following electronic entertainment media: television, films, music, music videos, video games, and pornography.

We do not focus heavily on print media magazines, newspapers, books , news media, or social media. For source material, we draw on peer-reviewed publications, and we do not review unpublished dissertations and conference presentations. To keep the review current, we focus on empirical studies and content analyses published in the new millennium, from to We begin with a summary of some recent content analyses documenting the nature and prevalence of sexual content in the media.

We continue with a discussion of relevant media effects theories, and we then review studies examining contributions of mainstream media exposure to sexual attitudes and behaviors. We conclude with a discussion of effects of pornography. Themes, storylines, dialogue, and jokes related to sex and sexuality are a prominent feature of this content. The most recent large-scale efforts to assess the prevalence of sexual content were conducted at the start of the new millennium, and published from — Fisher et al.

In total, Findings across multiple studies indicate slight changes from year to year in these rates, with both increases and decreases being reported. Although sexual content is highly prevalent, it is not uniform, and evidence indicates that some types of sexual content are more prevalent than other types.

More specifically, findings indicate that sexual talk is more prevalent than depictions of sexual activity Kunkel et al. Also, when sexual behavior is depicted, it tends to be mainly kissing and flirting.

For example, of the eight sexual behaviors coded by Fisher et al. One type of sexual content that is consistently minimal or absent is content about the risk and responsibilities of sex, such as discussions of safe sex practices, depictions of condom use, or discussions about disease prevention.

Second, sexual content has been found to vary greatly based on the genre. For example, in their analysis of 1, television programs across 11 networks, Fisher et al.

Sexual talk was found in Acknowledging the diversity of sexual content, some studies have looked at the presence of a particular type of sexual theme or script. One script examined is the presence of the heterosexual script and its components. The heterosexual script describes the courtship strategies, commitment orientations, and sexual goals considered appropriate for women and men in heterosexual relationships in Kim et al. This script expects men to actively pursue sexual relationships, to objectify women, and to prioritize sex over emotion; conversely, women are expected to be sexually passive, to use their looks and bodies to attract men, to serve as sexual limit setters, and to prioritize emotions over sex Kim et al.

References to the heterosexual script have been noted to occur Analyses of reality dating programs indicate that references to men as always looking for sex occur 3. Particularly prominent are messages linking masculinity to sexual prowess and interest Kim et al. One of the largest projects to explore this issue, led by Bleakley, Jamieson, and Romer , examined films, which included 15 of the 30 top-grossing movies for each year from to Each film was coded for the presence or absence of sexual content in five-minute segments, and sexual content was defined to include kissing on the lips, nudity, sexual behavior, or sexual intercourse, implicitly or explicitly shown.

Any sexual content emerging was rated for explicitness on a five-point scale. Several analyses have emerged from this large dataset, finding differences in movie sexual content by gender, year, and movie rating. Of the films, Explicitness of the sexual content increased with the ratings but did not increase over time. Other research teams have focused on films of a particular genre, such as romantic comedies, or on films directed at a particular audience, such as teens.

The most common sexual activity depicted was passionate kissing. No differences were found over time in the overall prevalence of sexual acts, nor in the presence of sexual dialogue. In their analysis of the 52 highest-grossing romantic comedy films from —, Hefner and Wilson found an average of 7. Similarly, in their analysis of 40 top-grossing romantic comedies, Johnson and Holmes observed 3, relationship-oriented incidents.

The largest category observed was kissing and the second largest category was compliments, most of which were expressed by a male character.

Relationships were not always rosy, however, and incidents of deception, arguing, and of breakups were also reported. However, as observed with television content, there was little depiction in movies of safe sex practices, risks, or consequences Callister et al.

Sexual imagery is also prevalent in music videos, noted to appear in The sexual acts appearing most frequently are sexual and suggestive dance, sexual objectification, and self-touching. For example, King, Laake, and Bernard examined the presence of 19 sexual behaviors for women and 16 sexual behaviors for men in music videos appearing on four networks. These patterns have been found to vary based on artist gender and music genre. One consistent theme emerging is that in music videos, women and female artists are more often shown in sexual ways than men and male artists.

For example, Aubrey and Frisby found that in comparison to male artists, female artists were significantly more likely to be provocatively dressed A few studies have examined sexual content in music lyrics, alone, outside of the visual format of the music video. In their analysis of top songs from , Primack et al.

Although fewer studies have analyzed sexual portrayals in video games, the findings emerging paint a consistent picture. Analyses indicate that not only are women underrepresented in video games, but that when present, they are much more likely than men to be shown with a sexualized appearance or in sexually revealing clothing.

Sexual media research has sought to determine whether exposure to media content related to sexuality can influence attitudes, beliefs, and expectations about sexuality and also whether these effects extend to sexual behaviors.

This research draws on two main theoretical approaches. Therefore, if television regularly portrays casual sex with minimal risks, cultivation theorists argue that frequent television consumers might grow to cultivate or adopt a comparable view, including adopting a permissive stance towards casual sex, dismissing possible health risks and consequences, and being more likely to engage in casual sex themselves.

As these assumptions have been questioned by many researchers, it is common to see variations on the theory that examine genre or content-specific exposure to television rather than total TV exposure as a unified whole e.

Additionally, although TV remains the main focus of cultivation theory research, this theory has been applied to other media beyond television e. In sexuality research, social learning theory is used to explain how adolescents may observe sexual content in the media and then model their own behavior after that content. Social cognitive theory adds to this approach by incorporating the agency of viewers in the engagement and interpretation of media Bandura, Social cognitive theory would suggest that, if women are regularly exposed to messages that men are sex-driven and women are more sexually passive, they might internalize those sexual scripts, and perhaps ultimately limit their own sexual agency.

This work explores the unique contributions of different socialization agents e. This model incorporates influences, such as motivations for viewing e. For example, Braithwaite, Coulson, Keddington, and Fincham have used this model to examine the ways in which the effects of pornography viewing on sexual behavior are mediated by sexual scripts.

The 3AM model and other ecological approaches that take into account contextual factors surrounding the adoption of sexual attitudes and behaviors depicted in media will likely continue to play a large role in sexual socialization research. The most substantial body of literature linking media and sexual attitudes explores if media use contributes to attitudes toward uncommitted sexual exploration.

However, some research finds only conditional support for these associations, reporting that higher levels of media use are associated with more positive attitudes toward uncommitted sexual exploration for only female ter Bogt et al.

Still, it is noteworthy that our review of the literature did not uncover any research demonstrating that higher levels of media use were associated with more negative attitudes toward uncommitted sexual exploration; if it was indeed the case that there was not an association between media use and attitudes toward uncommitted sexual exploration, one would expect a roughly equal number of studies to uncover positive and negative effects.

Considered together, then, survey research suggests that higher amounts of media exposure are associated with an increased tendency to hold positive attitudes toward uncommitted sexual exploration. Social cognitive theory suggests that we are more likely to adopt the attitudes expressed in media content if we perceive that content as realistic Bandura, Consistent with this line of reasoning, correlational research demonstrates that people who perceive media content as more realistic hold more positive attitudes toward uncommitted sexual exploration Chock, ; Ferris et al.

The reasons we use media are also consequential cognitions. Bond and Drogos surveyed college-aged viewers of the popular sex-laden reality television program Jersey Shore and found that heavier viewers of the program reported stronger parasocial relationships i.

Further, when the mediating influences of parasocial relationships and wishful identification were statistically controlled, the relation between Jersey Shore exposure and attitudes toward uncommitted sexual exploration dropped to non-significance.

The evidence for a causal link between media use and attitudes toward uncommitted sexual exploration, however, is relatively sparse.

It may be that experimental effects only emerge under certain conditions. For example, although Taylor found no main effect of exposure to sexual media content on attitudes toward uncommitted sexual exploration, he found that those participants who believed the content they saw was more realistic expressed more positive attitudes toward uncommitted sexual exploration.

Impressively, this effect was still evident two weeks after experimental exposure. A second line of research considers how media use contributes to endorsement of components of the heterosexual script. As indicated earlier, the heterosexual script describes the dominant cultural scripts i. According to the heterosexual script, men are expected to actively pursue women, avoid emotional commitment, and value women primarily for their appearance.

Women, by contrast, are expected to express interest in men using passive strategies like self-objectification, set sexual limits, and prioritize emotional commitment over sexual fulfillment. Implicit in this conceptualization is an understanding of male-female relations as inherently adversarial, because the roles women and men are expected to uphold are often at odds. Also implicit in this conceptualization is a sexual double standard, whereby men are normatively expected to have and are thus rewarded for uncommitted sexual encounters, whereas women are normatively expected to not have uncommitted sexual encounters and thus could expect to face social consequences for enacting the same behavior that would reap rewards for men.

Higher levels of regular media exposure tend to be associated with a greater tendency to endorse components of the heterosexual script, including the beliefs that men are sex-driven and women are sex objects.

These associations have been demonstrated in studies considering total amount of television exposure Ward, , exposure to dating-themed reality television programs Ferris et al. Media exposure is also linked to constructs conceptually related to the heterosexual script. Similarly, frequent exposure to music videos is associated with an increased tendency to endorse the sexual double standard Zhang et al.

As in the literature on attitudes toward uncommitted sexual exploration, our perceptions of and motives for using media have implications for how media affect us.

Perceiving media as more realistic Ferris et al. Motives for consuming media that reflect more active modes of engagement i. Thus, how we consume media matters as much as—if not more than—the amount of media we consume. Media also help shape what we hope for, expect, and experience in romantic relationships.

Here, too, more active forms of engagement with media, including perceived realism Lippman et al. Media also affect the types of romantic partners who interest us, as well as our expectations about the nature of the sexual activity we will engage in with them. Among men, watching sexual television content Aubrey et al. In addition to affecting preferences expressed with regard to hypothetical relationships, media are also associated with the functioning of established relationships.

Again, perceived realism is an even stronger predictor of negative relationship outcomes than mere exposure, predicting increased expected and actual relationship costs e. Research in this area has examined adolescents and emerging adults, including middle school students e. Longitudinal surveys following adolescents through their first sexual experiences are a frequent methodological approach e.

In terms of behavioral outcomes, most research has focused on the ways in which the media may influence sexual behaviors known to be associated with mental and physical health risks such as early sexual initiation, frequency of casual sex, number of sexual partners, pregnancy, and occurrences of sexually transmitted infections STIs e.

Many of the studies examine multiple media at once, including television, video games, magazines, music, and film e. This section will provide a general overview of research on sexual media, organized by method. A number of studies examine the relation between media exposure and sexual behavior or intentions using one-time surveys. Looking at overall television exposure, Barr, Moore, Johnson, Merten, and Stewart found that high screen time three or more hours per day was associated with increased risky sexual behaviors, including sexual initiation prior to age 11 and having three or more sexual partners.

Specifically examining the sexual content in the media rather than overall media exposure , other studies have found that increased levels of exposure to sexual media content was associated with increased reports of intentions to have sex, light sexual behavior kissing, holding hands , and heavy sexual behavior oral sex, intercourse Fisher et al. There are some studies whose data do not fit the pattern e.

Overall, this body of research indicates a consistent positive connection between exposure to media, especially sexual or romantic media content, and sexual behaviors.

To gain insight into the process of sexual socialization, many researchers have sought to explore the relation between media exposure and sexual behaviors over time through the use of longitudinal surveys. In some cases, heavier screen time two or more hours was predictive of sexual initiation at later assessments Ashby et al. Yet in several others, general exposure to television was not related to later behaviors e. However, many of these studies focused on pregnancy, rather than sexual initiation, which may explain these findings e.

The majority of longitudinal studies are not concerned with overall media exposure but instead examine exposure to specific sexual media content that includes sexual behaviors, sexual talk, or other sexual content Bleakley et al. These studies have consistently found that heavier exposure to sexual content predicts earlier or heavier sexual activity one year later Bleakley et al. One study suggests that exposure to sexual content in early adolescence may advance sexual initiation by nine to seventeen months Collins et al.

However, there are studies that report null results e. Finally, in some of the longitudinal studies that have been done, evidence has emerged supporting a reciprocal, non-recursive relation between sexual content exposure and sexual activity Bleakley et al. There is some limited experimental research testing contributions of media exposure to sexual behavior, but ethical concerns related to manipulating and measuring sexual behavior limit this approach.

For example, Boot, Peter, and van Oosten exposed young women to a movie clip with a likable or unlikable female character who engaged in casual sex. Their findings indicate that for single women, likeability of the character did not impact their own willingness to engage in casual sex; however, women in a relationship were more likely to report a willingness to engage in casual sex in the unlikable character condition. The authors suggest that this difference may be due to increased self-regulation in women in relationships in the likeable condition.

Other experimental studies have demonstrated that humorous depictions of pregnancy in media can reduce counter-arguing and may trivialize the seriousness of the issue Moyer-Guse et al.

In addition to examining sexual content broadly, many studies have examined the influence of specific genres, scripts, and messages in media that might shape sexual behavior, arguing that it may not be the volume of content but the nature of the content that influences behaviors.

In a longitudinal study, Gottfried and colleagues found that exposure to sexy content in TV comedies positively predicted intercourse initiation, but exposure to sexy content in dramas negatively predicted intercourse initiation.

Specific sub-genres of television have also been linked to sexual behaviors. Research investigating specific scripts and messages in sexual media content often focuses on the ways in which gender and sexuality are presented.

As noted earlier, much media sexual content endorses traditional gender roles and gendered norms concerning sexual relationships, such as components of the heterosexual script Kim et al. Similarly, regular exposure to music lyrics that describe degrading sexual encounters in which women are objectified is associated with the advancement of non-coital sexual activity and intercourse initiation Martino et al.

The research presented so far has largely focused on direct associations between media exposure and sexual behavior. However, social cognitive theory posits that behaviors are the result of cognitions gleaned from models.

Hence, it is argued that media influence beliefs, attitudes, and cognitions, which then influence behavior. Applications of this specific mediation model to sexual socialization have sought to explore the mechanisms by which media may influence behavior. One of the most influential cognitions related to sexual behavior is the perception of peer norms related to sex Bleakley et al. Chia proposes an alternate model for the influence of peer norms, arguing that adolescents may infer the exposure to and effects of media on their peers and base their own peer norms on estimates of these media effects.

There are also several key moderators that impact the presence and strength of the link between media exposure and sexual behavior. Demographic factors such as race and gender have been found to play a key role. In terms of race, several studies report that although media effects were found for white participants, there was no evidence of an effect for black participants Brown et al.

This racial difference may be due to earlier sexual initiation in that population Brown et al. Black youth may be less inclined to identify with media characters who do not look like them. Another study demonstrated that specific sexual scripts may impact men and women differently Tolman et al.

Beyond demographics, researchers on sex and the media have examined the moderating effects of parental mediation Bleakley et al. In general, more involved parenting related to media exposure is associated with lower levels of sexual experience Schooler et al.

Active mediation—discussion of media content—can serve as a protective factor, minimizing the effects of media on risky sexual behavior Brown et al.

Restrictions on media content, termed restrictive mediation, produced the most consistently pro-social effects, specifically relating to lower reports of oral sex or intercourse and lower intentions to engage in intercourse Fisher et al. Parental co-viewing led to mixed results, relating to lower expectations of positive health outcomes Fisher et al.

Finally, aspects of engagement with the media may moderate the influence of media on sexual behavior. For girls, identification with same sex media figures is associated with more dating and sexual experience Schooler et al.

Some work has also been done examining the role of multi-tasking. Jeong, Hwang, and Fishbein found that the effect of sexual content on sexual behavior was highest for light multi-taskers who were more focused on one medium at a time. In contrast, there is also some limited evidence to suggest that multi-tasking with Internet use as one of the tasks may increase the impact of sexual content on sexual behaviors Collins, More research is needed in this area and in the role of digitization in sexual socialization.

Sexual activity within pornography is largely represented as a purely physical, casual, and oftentimes aggressive act without any consequences to its participants for a review, see Jensen, Prevalence rates of pornography use in the United States vary depending on sample age and on whether or not mode of exposure is taken into account i. Despite variability in prevalence rates, studies consistently find higher exposure among boys and men than girls and women Carroll et al.

Together, concerns over content and prevalence rates have led to a wide body of research examining how pornography may influence viewer experiences. Although a comprehensive review is beyond the scope of this article, we will highlight the most recent findings within the pornography literature that focus on viewer attitudes and behaviors and that were published between and For each area of research, we will provide a summary of cross-sectional and longitudinal findings, as well as findings from adolescent and adult samples.

Sexual attitudes encompass beliefs about sexual behaviors that have traditionally fallen outside of social norms, such as casual, nonrelational, or extramarital sex.

Gender-specific attitudes focus on beliefs about gender roles, both within and outside of sexual contexts. Similarly, Braun-Courville and Rojas found pornography exposure among American adolescents to be associated with recreational attitudes about sex, including positive attitudes towards having multiple partners, one-night stands, and the belief that sex is purely physical. Cross-sectional surveys with adult samples have yielded similar findings, documenting an association between pornography use and more permissive sexual attitudes Carroll et al.

For example, Carroll et al. In addition, Weinberg and colleagues found a relation between pornography use among college students and acceptance of nontraditional sexual acts, such as watching people engage in sexual activity in-person, having sex with more than one person at a time, and anal sex.

Further support is also provided by a longitudinal study using a national sample of adults aged 18 to 89 Wright, In this study, pornography consumption assessed in predicted increased positive attitudes towards premarital sex two years later Findings from this line of research indicate a link between pornography consumption and the belief that men are dominating sexual initiators To et al. In their study, exposure to pornography among middle school children predicted later endorsement of traditional gender roles across a variety of domains e.

Similar relations between pornography use and gender beliefs have been found with adult samples. Cross-sectional surveys of adult men indicate a positive association between pornography use and viewing women as sexual objects Omori et al. A related line of research seeks to understand the behavioral associations of pornography consumption and can be divided into three domains: sexual experiences, sexual risk, and sexual aggression.

Sexual experiences include the initiation, occurrence, and frequency of sexual behavior, such as vaginal intercourse, anal sex, or oral sex. In turn, sexual risk encompasses a range of behaviors that may contribute to adverse outcomes, such as having a high number of sexual partners, participating in casual sex, and use or misuse of contraceptives and condoms.

In contrast to research on sexual attitudes, studies published within the last 10 years that have focused on sexual experiences are scarce.

Among adolescents, one cross-sectional study by Luder et al. Conclusions from research examining the occurrence of specific sexual practices are equally inconclusive. Further research with adolescent samples is needed to clarify these findings. Among adults, studies have documented a relation between pornography use and earlier coital initiation Morgan, , more frequent participation in sexual activity Morgan, , and more frequent participation in oral and anal sex Weinberg et al.

Concerns over sexually transmitted infections and unwanted pregnancy have lead to a focus on behaviors that may contribute to adverse sexual outcomes. Such behaviors include participation in casual sex, number of sexual partners, and use of contraception. Studies examining the use of contraception provide mixed findings.

Luder et al. In a study of black adolescent girls, Wingood et al. In contrast, Peter and Valkenburg and Braun-Courville and Rojas found no association between pornography use and unprotected sex. Longitudinally, pornography consumption has been associated with participation in casual sex two years later Wright, Despite significant and consistent findings with regards to casual sex and multiple partners, evidence regarding contraceptive use has been inconsistent.

In cross-sectional U. Investigations into the relation between pornography use and sexual aggression have yielded consistent results with adolescent and adult samples. However, the majority of these studies, including major meta-analyses and reviews, were conducted before e. Since then, cross-sectional studies have identified pornography as a correlate of perpetration of sexual violence Bonino et al. Recent findings from a longitudinal study conducted by Ybarra, Mitchell, Hamburger, Diener-West, and Leaf found that adolescents who were exposed to violent pornographic material were six times more likely to become sexually aggressive compared to those who were not exposed.

There was no decrease in the number of aggressive solicitations in any subgroup. In another analysis of the YISS, Mitchell and colleagues 96 examined whether young bloggers are at greater risk of online sexual solicitation.

They found no evidence that this is the case. As in their prior analyses, those who interacted with people they met online were at greater risk for solicitation, but bloggers were no more likely to do this than those who did not blog. Bloggers were more likely to post personal information, but this was unrelated to risk for solicitation.

The study did find, however, that young bloggers were more likely to report online harassment, suggesting that some nonsexual forms of risk may be increased by the activity. In the Growing Up with Media study, a national survey of to year-olds who had used the Internet at least once in the six months prior to survey conducted in August through September , 15 percent reported receiving an unwanted online sexual solicitation in the prior year.

The same survey provides the only published data regarding perpetration of unwanted sexual solicitation. In an analysis of the Growing Up with Media data, Ybarra and colleagues 97 find that 3 percent of Internet users aged years report engaging in this behavior in the past year. That report and others suggest that sexual solicitation overlaps with other forms of interpersonal victimization.

Ybarra and colleagues 95 found that 13 percent of all youth reported being victims of both Internet harassment and online solicitation, and 3 percent of youth said they were perpetrators of both. All youth who were perpetrators of online sexual solicitation reported being either a victim or a perpetrator of harassment. Internet harassment involves making rude or mean comments online, spreading rumors about someone online, or making aggressive or threatening comments online.

Others have linked online receipt of sexual solicitations with a history of child abuse victimization. They found that youth who had experienced offline physical or sexual abuse were more likely to be aggressively solicited online. In addition, girls were at more risk than boys, as were youth who participated in chat rooms or used a cell phone to access the Internet.

In a study with a convenience sample of girls aged years, more than half of whom were selected for participation based on a history of child abuse, 40 percent reported experiencing an online sexual solicitation, and 26 percent reported meeting someone in person whom they originally met online. This same study provides some novel insight into a factor that may place adolescents at risk for solicitation.

The report found that youth who have experienced online solicitation tend to construct avatars animated images that represent the youth in online encounters that are more sexualized in appearance. This may indicate either an outcome of experiencing sexual solicitation i. Another key factor in online solicitation appears to be the pattern of youths' online relationships.

Those who converse with persons they meet online are more at risk than others. Exchanging personal information and photos with others, talking about sex, and harassing others are associated with much higher rates of online sexual solicitation. Similar findings have been reported by Ybarra and colleagues. Finally, we note that sexual solicitation of minors is more likely to be perpetrated by other minors than by adults. This is consistent with national surveys looking at "sexting," the sending of sexual text messages and suggestive photos via cell phone, email, or social networking sites, which we describe below.

Like Internet sexual solicitation, when sexting involves a sexual solicitation, it is usually between teens. No studies of sexting have been published in peer-reviewed venues. However, there have been four surveys or polls on the issue whose results have been published. According to one national survey conducted by the National Campaign to Prevent Teen and Unplanned Pregnancy the National Campaign 71 20 percent of teens aged years have sent or posted nude or seminude pictures or video of themselves.

The number of youth posting or sending messages that are sexually suggestive but do not necessarily include pictures is approximately double these rates 39 percent. Thirty-one percent of teens reported having received a nude or seminude picture via cell phone or email from someone i. A subsequent survey conducted by Cox Communications reported rates approximately half of these: Nine percent of teens years have sent, and 3 percent have forwarded, a nude or nearly nude photo via text or email.

Seventeen percent have received such a message. Ten percent of youth aged years reported sending images of themselves, and 22 percent have received naked images of someone else. It is difficult to point to a single factor that might account for this wide variety of estimates.

The National Campaign survey was conducted online, and as such may have elicited more candid responses from participants than did Pew's phone survey. It may also be a less representative sample, however, drawing a more Internet-savvy group than the average teen.

Pew used a telephone survey and sampled randomly from those with cell phones and household landlines and may therefore have produced better estimates.

The context of the questions also varied substantially i. Pew focused only on messages sent via cell phone, while Cox and the National Campaign asked respondents to include "email, IM, etc. Finally, the substantial press coverage of sexting during the period covered by these studies may have changed the way adolescents think about and report their sexting experiences. Surveys conducted after major news stories may either exaggerate levels of sexting if youth wish to appear part of a trend or underestimate them if youth wish to disassociate themselves from a practice portrayed as risky or illegal.

A clear understanding of the prevalence of these messages and the characteristics of those involved as senders or as recipients will require collection of data from a nationally representative survey using items that distinguish these various methods of digital communication and collection data in a nonreactive and private manner.

What are the correlates of sexting? None of the studies find gender differences in the sending or posting of sexual messages, 63 , 71 but they do find an increasing likelihood of sending and receiving these messages as teens reach young adulthood. It is unclear to what extent these various factors are independent contributors to sexting. It is likely that they are highly correlated, and multivariate analyses were not reported. Most of these exchanges, like most online interaction, 84 are with persons already part of teens' offline social networks.

The survey conducted by the National Campaign found that most teens sending these messages online or via cell phone sent them to a boyfriend or girlfriend 71 percent of girls and 67 percent of boys who have sent such messages. Many also sent them to someone they wanted to date or "hook up" with 21 percent of girls and 39 percent of boys who have sent such messages.

Thus, "sexting" may be an extension of behavior that was equally commonplace but involved paper and pencil or telephone audio in the past, although text messaging may be increasing the prevalence of sexually suggestive communication between sex partners, friends, and acquaintances. The ubiquity of cell phone ownership among youth, ease of communication, and the apparent tendency to be more disclosing via relatively impersonal digital media 88 could certainly lead to the latter.

Available data make it difficult to assess this, since no historical information on sexual messages between teens was published prior to the wide availability of the Internet and text messages. There is some indication that at least a portion of this behavior goes beyond the mere transfer of sexual messages from print to digital media.

Some teens report that they are more forward and aggressive in their use of sexual words and images online than offline. Thus, sexting may be resulting in greater exposure of youth to sexual messages, and greater incidence or prevalence of creating sexual messages among youth. If so, this may affect adolescents' developing attitudes toward sex or their sexual behavior.

It is important to note that sexting may also affect youth in ways other than through altering their sexual attitudes, beliefs, or behaviors. The ease with which sexual messages can be shared with very broad audiences suggests a greater potential to result in social stigma.

One posting to a social networking profile, or one photo sent via cell phone, can quickly reach hundreds of people. Moreover, the difficulty of permanently deleting all copies of a digital message means that risks to college admission, employment, and personal relationships could persist for many years. Most web information is available even after a site has been altered or deleted, and users can easily save and redistribute text messages and photos from their cell phones.

Evidence reviewed in the earlier section of this paper on prevalence and use of new media indicates that game playing, more than any other activity, crosses platforms.

Playing offline, on consoles, handheld devices, and cell phones is currently more common than online play. Next, we review what is known about both on- and offline games and how they might provide opportunities for youth to be exposed to or otherwise engage with sexual content.

A few studies of the content of offline games played on consoles or computers but not connected to the Internet have been published. In one, Haninger and Thompson sampled 80 video games rated T "Teen" from the full population of such games that had been released by April The 80 games were randomly selected within strata reflecting 10 different game genres.

Haninger and Thompson found that 27 percent of their sample 22 games contained sexual themes defined as "behaviors e. When they expanded their definition of sexual material to also include "pronounced cleavage, large breasts, or provocative clothing," they estimated that 46 percent of games included sexual content. Games were significantly more likely to depict female characters partially nude or engaged in sexual behaviors as compared with male characters.

The same research group conducted a similar study of the content of M "Mature" -rated games. Thirty-six percent of the sample 13 games included sexual themes; only 15 percent of the sample had received a content descriptor from the ESRB that indicated this. Sexual themes appeared for an average of 4.

Prostitution appeared in 17 percent of games. The authors do not note this, but it appears from the tables that sexual behavior did not differ by gender. However, female characters were significantly more likely than male characters to appear partially nude. When the definition of sexual material was expanded in the same way as for the authors' earlier study, 47 percent of games contained sexual content.

Other researchers have also found that women are scantily clad in video games, with one estimate suggesting that 28 percent of games contain depictions of women as sex objects. Typically, women are wearing tank tops, halter tops, or bathing suits in these portrayals.

When youth play games online, many interact with other players, sending instant messages or using voice-over-Internet protocols that allow them to meet others and socialize as they play. However, it is unclear whether online gaming might influence sexual attitudes or behavior. To do so, it would need to involve sexual content either in the games or in exchanges with other players. We did not identify any published studies addressing issues of sexual content in online games or in online gamers' interactions, nor did we uncover studies that identified sexual attitudes or behaviors as correlates of using those games.

There is very little research evidence regarding the unintended effects of new media on sexual health, and more is clearly needed. The most thoroughly studied area is Internet pornography. Research in this area indicates that intentional exposure to such depictions may influence adolescent attitudes, promoting more recreational attitudes toward sex.

But the research evidence has so far come from only one lab, and no longitudinal studies of U. There are also no longitudinal studies of sexual behavior or sexual risk-taking subsequent to viewing pornography on the Internet. What indirect evidence there is regarding the prevalence of exposure among youth and the cross-sectional correlates indicates that this topic is worthy of further study, as there may well be negative effects on sexual health. The other area in which there has been considerable research is that of sexual solicitation via the Internet.

Here, the research has focused primarily on the issue of whether youth who use a variety of online media might become victims of adult sexual predators. The conclusion is that this is unlikely. Indeed, most of these solicitations come from same-age peers who are known offline.

But there may be other negative effects of both receiving and generating these solicitations. Their presence may create a more sexualized, and perhaps a more sexually harassing, environment that affects those exposed, directly or as bystanders. Here, again, such solicitation appears common enough that it may be worth pursuing additional research. A key issue in such research would be to separate the processes of selection and influence.

The fact that youth who report receiving solicitations are likely to be involved in online harassment as victims or as perpetrators, and are often victims of child abuse, suggests a strong potentially biasing factor in understanding and estimating the effects of any exposure. Similarly, the sending or receipt of sexual messages or text via cell phone or email does not appear to pose a direct threat to youth. But, like sexual solicitations more generally, it may contribute to a sexualized environment that affects normative perceptions.

Longitudinal survey studies testing for relationships between exposure to or participation in sexting and changes in sexual attitudes, norms, and behavior among youth are needed. Apart from issues of changes in sexual attitudes or behavior, it is also important to keep in mind that the creation of digital content, particularly nude or provocative photos of oneself, may pose other risks.

Such content may be passed on to other teens, causing embarrassment at best and psychological distress at worst, or cached on websites where future employers, colleges, and others may find them. While it is the subject of much speculation, there are no studies so far that test for links between sexting and these important social and mental health outcomes.

Results suggest that there is a substantial amount of sexual content in teen chat rooms, both constructed by teens names, utterances and present for teen users to be exposed to as observers.

It is also clear that the majority of users do not create such content, though the number of those who do is not insubstantial. A useful next step would be to study the evolution of users over time to understand to what extent those who are not generating sexual posts initially come to do so later, and to what extent users continue with or leave these sites as they are exposed to or participate in the creation of sexual messages.

Because chat rooms are not particularly popular with teens, it may be wise to focus such efforts on Internet sites and activities that resemble chats but have not yet received much study, such as discussions among participants in online video games, posted comments on YouTube, and comments on social networking sites. Selection versus influence is also an important issue in understanding any effects of visiting social networking sites.

The data reviewed above indicate that sexual references are common on public pages. An adolescent who browses profiles on MySpace or YouTube is likely to encounter sexual references or pictures in anywhere from 15 to 24 percent of profiles.

It is unknown, and perhaps undeterminable, what percentage of private profiles contain sexual references. But it is reasonable to believe that youth who use these sites encounter sexual messages suggesting that casual sex is normative and reflect a preoccupation with sexuality. Nonetheless, most youth who visit these sites do so to check in with people they already know, at least indirectly, and so they may encounter messages that simply support what they were already hearing from offline peers.

The Moreno study 88 showing homophily in the sexual references that appear on friends' profiles indicates as much. Analyses that look at the evolution of sexual information in profiles over time, within online networks, might help to separate selection and influence processes and determine the extent to which online interaction alters young people's developing sexual attitudes and behaviors.

Even if such work suggests that there may be online network influences on teens' behavior, in order to fully understand them, it will be important to try to estimate the magnitude of these associations relative to offline processes of peer influence.

Because the Internet is a mass medium, selection processes might be exaggerated over those offline. Thus, we might see a greater tendency for similar people to associate than would be observed offline. For the same reason, influence processes may be greater: Unusual beliefs that would otherwise fail to find validation in everyday life may be normalized when other persons are encountered who share these beliefs.

The Internet may create the illusion of consensus because someone can be found to support one's ideas, even when the number of such people is actually quite small. But it is also possible that association patterns will be no different from those observed in offline networks, or when they do differ, may have a smaller influence on those who participate. The apparent distancing of oneself that has been conjectured to lead to sexualized and calloused online interactions may also buffer people from the effects of online interactions.

Estimates regarding the amount of sexual content in video games indicate high levels, with percent of games containing explicitly sexual language or pictures and percent containing sexualized images of women. Given the large number of studies that have looked at violent content in these games and its possible effects, it would seem appropriate and fairly straightforward to conduct analogous work regarding sexual content in games.

It may be that this content, because it appears to be less integral to game play than violence, is not particularly likely to influence teens. However, because youth are currently spending more time with this activity than with any other except listening to music and watching television, an understanding of effects on sexual attitudes and associations with subsequent behavior should be a priority.

Glaringly absent from the research literature, given its popularity with youth, are studies of YouTube or other online video sites. Visits to YouTube are among the top three online activities identified by the Kaiser Family Foundation, and while we uncovered no relevant content analyses, a quick search of the website youtube.

YouTube allows the creation of personal profiles and networks of friends, as well as the posting of comments about each video.

Thus, it also affords many of the same opportunities for social influence and sexual involvement provided by more general social networking sites. Among the gaps we have identified, this is perhaps the one that needs to be filled most urgently.

Research addressing a variety of issues related to new media is sorely needed in order to understand whether their use contributes to the sexual socialization and sexual behavior of U.

Digital media interventions involve the use of computers, the Internet, cell phones, and video games to try to improve sexual health or reduce risky sexual behavior. Given their reach and the level of youth involvement, digital media have tremendous capacity to reduce sexual risk-taking.

Other advantages of cell phone and Internet interventions include the ability to reach populations isolated by rural location, lack of transportation, or stigma. For teens who may fear being seen entering an intervention facility or who may have to account for their whereabouts during free time, an intervention that can be accessed in a private area at home, at school, in a library, or on a bus may afford both access and privacy.

Noar and colleagues have discussed some additional advantages, including the inherent scalability of the intervention i. It is also possible to eliminate or greatly reduce the training of facilitators and ensure fidelity through the use of standardized materials.

Perhaps the greatest advantage in terms of potential program efficacy is that digital interfaces allow individualized and interactive intervention. In the past, video or print materials were largely limited to use in didactic programs, but cell phone and Internet-based intervention make it possible to create multiple pathways through such materials in response to participants' individual inputs. For example, this could be achieved by exposing boys and girls to different information based on their reported gender, or providing information about condom use to sexually active youth and information about abstinence to those who have never had sex.

Increasing evidence suggests that tailored interventions are more effective in changing behavior and that discussion leads to greater change than didactic intervention. Digital formats can also lend themselves to simplified evaluation, automatically or very easily collecting data from participants see Pequegnat et al. There may also, however, be some downsides to digital intervention.

It is possible that youth pay less attention to material when it is presented online or on a cell phone, since there is sometimes no teacher or group facilitator present to keep them on task. Users might also skip through the material or miss entire modules of a program, likely reducing effectiveness. We encountered no data on fidelity of delivery and use of new media interventions; collecting such information should be part of future intervention evaluations just as it is in offline research.

Many organizations promoting sexual health appear to be taking advantage of youths' online participation. We reviewed the published literature on the development and evaluation of sexual risk interventions and also attempted to identify promising programs that have not yet been subject to evaluation.

Table 2 provides an overview of studies that have been evaluated. Following the table, we describe what we found in detail.

Two studies have examined text messaging as a method of reaching youth with sexual health information. Such studies of "reach" look at how many individuals receive a message and often consider who is reached and the barriers and facilitators of message receipt rather than message effects on beliefs, attitudes, or behavior.

Cornelius and St. Lawrence conducted a qualitative exploration of the feasibility of using text messaging among African-American adolescents to supplement the Becoming a Responsible Teen BART intervention. BART appears on the U. The study included two focus groups with a total of 14 participants, aged years, and a small survey of the same group. Participants were enthusiastic about using text messages to supplement an existing HIV prevention curriculum the existing curriculum involved multiple in-person group sessions designed to build skills and knowledge.

The authors noted that the use of such messages as a booster post-intervention may help to prolong curriculum effects, which typically diminish over time. The optimal number of messages per day ranged from one to three, with participants perceiving more messages as desensitizing recipients to the information they contain.

Other potential issues noted included the best time of day for receiving messages, how to pay the costs of a messaging plan without creating abuse of the service for personal messages, and what to do about phones lost or damaged by participants the study was considering providing these phones.

Because the original HIV prevention curriculum involved participants in creating the intervention and emphasized communication skills, the focus groups were asked about creating as well as receiving messages, a procedure that would take advantage of the interactive nature of digital media in attempting to change sexual risk behavior.

Participants were also excited about the possibility of designing and sending text messages themselves. They suggested formats for adapting the curriculum to text messaging, including sending a fact-based message to intervention participants as a multiple-choice or true-false question that could be responded to with a return text indicating "A," "B," or "C," or "T" or "F," for example.

It was emphasized that messages and responses should be quick and simple. The San Francisco Department of Public Health has implemented a text messaging intervention for African-American youth, based on a program developed in London.

This links them to a menu of options, asking them to, for example, text "B2 if u think ur pregnant," and responds with basic information and referrals for diagnosis or other consultation. Responses were no more than characters in length and developed by health educators in conjunction with focus group participants.

The messaging service is supplemented by a website that shows examples of these messages. The program was promoted with posters, street marketing, and banner ads on Yahoo! As reported by Levine and colleagues, the messaging service received 4, texts in its first 25 weeks. Surveys of two convenience samples of youth suggested that it reached the target demographic of African-American youth. Of those who remembered seeing ads for the service, "nearly 10 percent" reported that they had used it.

The surveys also found that those with less expensive cell phone providers were more likely to report awareness of the SEXINFO program, and those who remembered seeing ads for the service stated that the use of text messaging caught their attention.

It is important to note that the focus groups used to develop the SEXINFO cell phone intervention felt that it was important for users to initiate the messaging themselves, not the intervention provider. It is not possible for those who use such services to be fully anonymous, since their phone numbers are accessible to the intervention providers.

Many users may be unaware of this when they decide to use the service. The service provides weekly sexual health messages. Users can get further information in two ways, noted in each weekly text.

They can get the same referrals and additional sexual health information by visiting a website. After nine months, 2, subscriptions had been received from across the state, and 33 percent of users had obtained clinic referrals via text message. But it is unknown whether subscribers are in the target age range or at high risk of STIs; some subscribers might even be sexual health professionals interested in trying the program rather than using its services.

Another text messaging intervention that has yet to be fully evaluated used cell phones as a method of communicating STI test results to youth tested in Washington, DC, high schools. Youth who opted in to the text message system received a text notifying them when their results were available. All participants were able to call a toll-free number to receive results, counseling, and referrals, as appropriate.

A series of three studies involving a total of nearly 8, youth and 33 schools was conducted. Results appear promising. Across venues, percent of those attending the informational session provided a urine specimen, and an STI was detected among percent of these. Follow-up confirmed that treatment was received by percent of those who tested positive.

However, a full write-up of these results has yet to be completed, and findings have not undergone peer review to date. A third study did not look specifically at cell phones but was conducted with potential cell phone applications in mind. It examined the use of a handheld computer with a four-inch screen to deliver a video soap opera intended to influence cognition and behavior related to sexual risk for HIV.

The intervention video, the minute A Story About Toni, Mike, and Valerie , was designed to challenge "internal sexual scripts" that suggest that women use sex as a way of winning and holding onto men, and unprotected sex as particularly serving that function. To this end, the actors revisited scenes and discussed different reactions through which the female character might have asserted power e.

The study found that viewers were less likely to complete a second unfinished story in a manner consistent with stereotypical gender roles e. This suggests their "internal sexual scripts" ideas about where and when certain kinds of sexual behavior are appropriate were less linked to unprotected sex. The authors point to the adaptability of such an intervention to the streaming of video to smartphones, and thus the potential opportunity to deliver entertainment with embedded sexual health messages to youth.

Freimuth and colleagues explored viral dissemination of a video designed to promote HIV testing among young men. This not-yet-published study highlights some of the difficulties of studying this phenomenon using controlled research protocols. Video was sent to participants' cell phones all participants were screened to ensure that their phones had this capability.

After viewing the video and answering a few questions, participants then sent the video to the phones of two additional individuals, whose contact information was provided to researchers for follow-up. The study found that only 15 percent of those who were sent the video by "seed" participants recalled receiving it, and a much smaller percentage reported that they passed it on to an additional contact for viewing.

It is unknown whether the low rate of dissemination was an artifact of the appeal of the particular video studied, the fact that the video was about HIV testing i. Individuals could participate in the intervention without using text messaging or even a cell phone. However, 43 percent of participants in one of the studies opted into the text message notification that results were ready this was not reported for the other two studies. Anecdotally, the program staff believes that cell phones and the availability of texting increased participation and were preferred communication modes for many youth.

However, in the long run, as the novelty of text messaging and cell phones wears off, unless programs make use of the mobility feature that is unique to cell phones e. In spite of their popularity with youth and great potential to harness social influence processes among interconnected peers, we encountered only one evaluation of an online intervention involving social networking sites. In an adjunct to their study of the risk behaviors displayed by young adults with profiles on MySpace, Moreno and colleagues sent an email from "Dr Meg," to users who made three or more references to sexual behaviors or substance use in their profiles.

Recipients of the email were a randomly selected subgroup of this population, with the remainder serving as controls. The email warned that there might be risks to disclosing information about sex and substance use in one's online profile and encouraged the recipient to consider revising his or her information. At follow-up, Reductions in the control group were 5. In addition, there was a trend for the intervention group to reset their profiles to private Although changes were small and not statistically significant, the study shows the feasibility and potential effectiveness of a simple intervention using social networking sites.

Other computer-based interventions have used more traditional approaches, taking advantage of computer or Internet platforms to varying degrees. It's Your Game: Keep it Real is a middle school sexual health program that includes computer components along with a more traditional classroom intervention: a virtual world interface, educational activities such as quizzes and fact sheets, and teen serials that allow real-time classroom discussion.

The intervention was tested in schools in Southeast Texas with a predominantly African-American and Hispanic, low-income, urban student population. The program consists of 12 seventh-grade and 12 eighth-grade lessons. Effectiveness was compared to treatment-as-usual health classes. Approximately one in three students in the comparison condition initiated sex by ninth-grade follow-up, compared with about one in four youth in the intervention group.

After adjusting for covariates, students in the comparison condition were 1. Detailed analyses indicated there were differences in initiation of vaginal, anal, and oral sex in a variety of subgroups. Program effects on initiation of vaginal intercourse were comparable in size to other effective interventions.