Watching Sex on Television Predicts Adolescent Initiation of Sexual Behavior Rebecca L. Collins, PhD*; Marc N. Elliott, PhD*; Sandra H. Berry, MA*; David E. Kanouse, PhD*; Dale Kunkel, PhD‡; Sarah B. Hunter, PhD*; and Angela Miu, MS* ABSTRACT. Background. Early sexual initiation is an important social and health issue. A recent survey sug- gested that most sexually experienced teens wish they had waited longer to have intercourse; other data indicate that unplanned pregnancies and sexually transmitted diseases are more common among those who begin sex- ual activity earlier. The American Academy of Pediatrics has suggested that portrayals of sex on entertainment television (TV) may contribute to precocious adolescent sex. Approximately two-thirds of TV programs contain sexual content. However, empirical data examining the relationships between exposure to sex on TV and adoles- cent sexual behaviors are rare and inadequate for ad- dressing the issue of causal effects. Design and Participants. We conducted a national longitudinal survey of 1792 adolescents, 12 to 17 years of age. In baseline and 1-year follow-up interviews, partic- ipants reported their TV viewing habits and sexual ex- perience and responded to measures of more than a dozen factors known to be associated with adolescent sexual initiation. TV viewing data were combined with the results of a scientific analysis of TV sexual content to derive measures of exposure to sexual content, depictions of sexual risks or safety, and depictions of sexual behav- ior (versus talk about sex but no behavior). Outcome Measures. Initiation of intercourse and ad- vancement in noncoital sexual activity level, during a 1-year period. Results. Multivariate regression analysis indicated that adolescents who viewed more sexual content at base- line were more likely to initiate intercourse and progress to more advanced noncoital sexual activities during the subsequent year, controlling for respondent characteris- tics that might otherwise explain these relationships. The size of the adjusted intercourse effect was such that youths in the 90th percentile of TV sex viewing had a predicted probability of intercourse initiation that was approximately double that of youths in the 10th percen- tile, for all ages studied. Exposure to TV that included only talk about sex was associated with the same risks as exposure to TV that depicted sexual behavior. African American youths who watched more depictions of sexual risks or safety were less likely to initiate intercourse in the subsequent year. Conclusions. Watching sex on TV predicts and may hasten adolescent sexual initiation. Reducing the amount of sexual content in entertainment programming, reduc- ing adolescent exposure to this content, or increasing references to and depictions of possible negative conse- quences of sexual activity could appreciably delay the initiation of coital and noncoital activities. Alternatively, parents may be able to reduce the effects of sexual con- tent by watching TV with their teenaged children and discussing their own beliefs about sex and the behaviors portrayed. Pediatricians should encourage these family discussions. Pediatrics 2004;114:e280 –e289. URL: http: //www.pediatrics.org/cgi/content/full/114/3/e280; con- doms, media, sex, television. ABBREVIATIONS. STD, sexually transmitted disease; TV, tele- vision. A key period of sexual exploration and devel- opment occurs during adolescence. During this time, individuals begin to consider which sexual behaviors are enjoyable, moral, and appropriate for their age group. 1 Many teens become sexually active during this period; currently, 46% of high school students in the United States have had sexual intercourse. 2 Although intercourse among youths is common, most sexually active teens wish they had waited longer to have sex, 3 which suggests that sex is occurring before youths are prepared for its consequences. Additional evidence of this is pro- vided by public health data. Each year, 1 case of a sexually transmitted disease (STD) is diagnosed for every 4 sexually active teens in the United States, 4 and the US rate of teen pregnancy is among the highest of all industrialized countries. 5 Unplanned pregnancies and STDs are more common among those who begin sexual activity earlier. 6 Therefore, early sexual initiation is an important health issue. This raises the question of why individ- uals become sexually involved at younger ages. What factors hasten sexual initiation, and what fac- tors delay its onset? There are many well-docu- mented predictors of age of intercourse initiation, both social and physical. However, 1 factor com- monly cited by parents and policy makers as pro- moting sex among teens has received little systematic scientific investigation, namely, television (TV). There is good scientific reason to think that TV may be a key contributor to early sexual activity. Sexual behavior is strongly influenced by culture, 7,8 and TV is an integral part of US teen culture. The average youth watches 3 hours of TV daily. 9 There, sexual messages are commonplace, according to a scientific content analysis of a representative sample of pro- From *RAND, Santa Monica, California; and ‡University of California, Santa Barbara, California. Accepted for publication Apr 1, 2004. DOI: 10.1542/peds.2003-1065-L Reprint requests to (R.L.C.) RAND, 1700 Main St, Santa Monica, CA 90407. E-mail: collins@rand.org PEDIATRICS (ISSN 0031 4005). Copyright © 2004 by the American Acad- emy of Pediatrics. e280 PEDIATRICS Vol. 114 No. 3 September 2004 http://www.pediatrics.org/cgi/content/full/114/3/e280 by guest on November 16, 2016 Downloaded from