Influence of product placement in children's movies on children's snack choices.

BACKGROUND: Media exposure affects health, including obesity risk. Children's movies often contain food placements-frequently unhealthy foods. However, it is not known if these cues influence children's food choices or consumption after viewing. We explored whether children's snack choices or consumption differs based on: 1) recent exposure to movies with high versus low product placement of unhealthy foods; and 2) children's weight status. METHODS: Children ages 9-11 were assigned to watch a high ("Alvin and the Chipmunks," n = 54) or low ("Stuart Little," n = 60) product-placement movie. After viewing, participants selected a snack choice from each of five categories, several of which were specifically featured in "Alvin." Uneaten snacks from each participant were weighed upon completion. Snack choice and amount consumed by movie were compared by t-tests, and differences in snack choices by movie were tested with logistic regression. RESULTS: Participants consumed an average of 800.8 kcal; mean kcal eaten did not vary by movie watched. Participants who watched the high product-placement movie had 3.1 times the odds (95% CI 1.3-7.2) of choosing cheese balls (most featured snack) compared to participants who watched the low product-placement movie. Children who were overweight or obese consumed a mean of 857 kcal (95% CI: 789-925) compared to 783 kcal (95% CI: 742-823, p = 0.09) for children who were underweight or healthy weight. Children's weight status did not significantly affect their choice of snack. CONCLUSIONS: Branding and obesogenic messaging in children's movies influenced some choices that children made about snack foods immediately following viewing, especially food with greatest exposure time in the film, but did not affect total calories consumed. Future studies should examine how the accumulation of these messages affects children's long-term food choices.

Reducing Concurrent Sexual Partnerships Among Blacks in the Rural Southeastern United States: Development of Narrative Messages for a Radio Campaign.

In the United States, heterosexual transmission of HIV infection is dramatically higher among Blacks than among Whites. Overlapping (concurrent) sexual partnerships promote HIV transmission. The authors describe their process for developing a radio campaign (Escape the Web) to raise awareness among 18-34-year-old Black adults of the effect of concurrency on HIV transmission in the rural South. Radio is a powerful channel for the delivery of narrative-style health messages. Through six focus groups (n = 51) and 42 intercept interviews, the authors explored attitudes toward concurrency and solicited feedback on sample messages. Men were advised to (a) end concurrent partnerships and not to begin new ones; (b) use condoms consistently with all partners; and (c) tell others about the risks of concurrency and benefits of ending concurrent partnerships. The narrative portrayed risky behaviors that trigger initiation of casual partnerships. Women were advised to (a) end partnerships in which they are not their partner's only partner; (b) use condoms consistently with all partners; and (c) tell others about the risks of concurrency and benefits of ending concurrent partnerships. Messages for all advised better modeling for children.

Sexual health knowledge and health practices of female sex workers in Liuzhou, China, differ by size of venue.

We conducted qualitative interviews with 48 female sex workers (FSW) recruited from entertainment venues in Liuzhou, China. Analyses found that HIV knowledge and sexual health seeking strategies differed by size of venue: (1) Women in smaller venues said they douched before/after sex and used condoms with all but their regular partners and clients. Most found the brochures distributed by Chinese CDC workers "irrelevant" or "boring" and relied on friends for health advice. (2) FSW in middle and large venues were less concerned about prevention, claiming their clients were "healthy." They relied more on the Internet for health information and were less concerned about the cost of seeing a doctor. (3) Pregnancies and abortions were frequent, especially among the younger women in large venues. This research documents the need to develop tailored HIV-related messages and prevention strategies with the help of FSW to address differences among FSW working in venues of different sizes.

The role of companionship, esteem, and informational support in explaining physical activity among young women in an online social network intervention.

The primary objective of the current study was to examine the relationship between social support and physical activity within the theory of planned behavior (TPB) theoretical framework. This study used data from the Internet Support for Healthy Associations Promoting Exercise randomized controlled trial. A total of 134 female undergraduate students participated in the study, which included baseline and post measures of perceived social support for physical activity (esteem, informational, and companionship), TPB variables related to physical activity (perceived behavioral control, intention, and attitude), and physical activity behavior. Path analysis revealed a significant indirect relationship between change in companionship support and physical activity mediated by change in intention (.13, p < .01) and a significant direct relationship between change in esteem support and change in physical activity (.26, p = .03). The model explained 27% of the variance in physical activity and 59% of the variance in intention. Overall, change in social support exerted a small to medium amount of influence on change in physical activity in this modified TPB model when controlling for traditional model constructs. Encouraging companionship and esteem support should be considered as a strategy for increasing physical activity in this population.

Direct-to-consumer antidepressant ads and young adults' beliefs about depression.

This study examined the extent to which exposure to direct-to-consumer (DTC) antidepressant ads is associated with young adults' understanding of depression as a medical condition. A vignette-based questionnaire was presented to 285 college students. Among those who had not experienced depressive symptoms, high exposure to a DTC antidepressant commercial was significantly associated with recognition of depression cases and listing antidepressants as a treatment option. As their exposure to the DTC ad increased, respondents also demonstrated a more positive evaluation of antidepressant treatment. Such effects were not found, however, for those who had experienced depressive symptoms.

Concordance of Child and Parent Reports of Children's Screen Media Use.

OBJECTIVE: Little is known about the concordance of parent and child reports of children's media consumption, even though parents are often asked to report for their children in clinical care settings. Our objective was to understand how parent and child reports of children's media consumption differ in an era of changing screen media consumption via personal devices. METHODS: As part of a larger study about the reception of health-related cues from children's media, children ages 9 to 11 years (N = 114) and their parents independently completed identical questionnaires about specific media use and health behaviors. To examine concordance between child and parent reports of children's screen media use, we calculated the mean number of minutes per day and proportions reported by the child and parent and assessed concordance with t-tests and chi-square tests. RESULTS: On a typical day, children reported nearly an hour each of video and app game use, computer use, and television exposure. Overall, child and parent reports were similar, usually within 10 minutes of each other; however, among 3 measures of TV use, parents consistently reported less TV exposure than children. There was significant discordance in the percentages of parents and children reporting the presence of a TV in the child's room. CONCLUSIONS: Parent and child reports of children's media use were generally concordant; however, there were important disagreements, such as TV use in the child's room and during meals. We discuss possible causes of discrepancies and implications.

"Let's Talk About Sex": pilot study of an interactive CD-ROM to prevent HIV/STIS in female adolescents.

The purpose of this study was to develop and pilot-test an interactive CD-ROM aimed at the prevention of sexually transmitted infections (STIs) in female adolescents. The CD-ROM includes prevention information, models skills for negotiating abstinence and consistent condom use, teaches media literacy, and allows the user to choose a culturally appropriate host to guide them through the CD-ROM. Forty-seven female adolescents attending a health department clinic were randomized to receive the CD-ROM plus an educator-led didactic session versus the didactic session alone. The CD-ROM was highly acceptable and feasible for use among female adolescents in the clinic setting. Hispanic and African American adolescents were more likely to choose hosts of the same race/ethnicity to guide them through the CD-ROM. HIV/STI knowledge increased significantly and nearly all adolescents intended to use condoms at next intercourse after viewing the CD-ROM. However, there were no significant differences measured between CD-ROM and comparison groups.

R-rated movies, bedroom televisions, and initiation of smoking by white and black adolescents.

OBJECTIVE: To test movie exposure and television use as predictors of smoking initiation among white and black adolescents who had never smoked cigarettes. DESIGN: Survey research using audio computer-assisted self-interviews at baseline and at 2-year follow-up (2002-2004). SETTING: Participants' homes located in central North Carolina. PARTICIPANTS: A sample of 735 12- to 14-year-old adolescents drawn from 14 public middle schools. MAIN EXPOSURE: Frequency of exposure to movies rated R, PG-13, PG, or G; frequency, location, and parental oversight of television viewing. MAIN OUTCOME MEASURE: Initiation of smoking, indicated by the first occasion of puffing on a cigarette. RESULTS: Among white adolescents, high relative exposure to R-rated movies predicted a significantly greater likelihood of smoking initiation at follow-up, and private access to television during early adolescence, indicated by having a bedroom television, was also a significant independent predictor of smoking initiation at follow-up. No significant associations were observed between any movie-exposure or television-use variables and likelihood of smoking among black adolescents. CONCLUSIONS: Indicators of risky media use were associated with a significantly greater likelihood of smoking for white but not for black adolescents. These results diverge strongly from past results, which have indicated that all adolescents, regardless of race or place of residence, have a higher risk of smoking initiation as their exposure to movie smoking increases. Research is needed to identify the antecedents of risky media use and to understand how audience attributes, including race and other factors, moderate the effects of risky media use on health-related behaviors.

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.

Obesogenic Behavior and Weight-Based Stigma in Popular Children's Movies, 2012 to 2015.

BACKGROUND: Obesity-promoting content and weight-stigmatizing messages are common in child-directed television programming and advertisements, and 1 study found similar trends in G- and PG-rated movies from 2006 to 2010. Our objective was to examine the prevalence of such content in more recent popular children's movies. METHODS: Raters examined 31 top-grossing G- and PG-rated movies released from 2012 to 2015. For each 10-minute segment (N = 302) and for movies as units, raters documented the presence of eating-, activity-, and weight-related content observed on-screen. To assess interrater reliability, 10 movies (32%) were coded by more than 1 rater. RESULTS: The result of Cohen's κ test of agreement among 3 raters was 0.65 for binary responses (good agreement). All 31 movies included obesity-promoting content; most common were unhealthy foods (87% of movies, 42% of segments), exaggerated portion sizes (71%, 29%), screen use (68%, 38%), and sugar-sweetened beverages (61%, 24%). Weight-based stigma, such as a verbal insult about body size or weight, was observed in 84% of movies and 30% of segments. CONCLUSIONS: Children's movies include much obesogenic and weight-stigmatizing content. These messages are not shown in isolated incidences; rather, they often appear on-screen multiple times throughout the entire movie. Future research should explore these trends over time, and their effects.

Early adolescents' cognitive susceptibility to initiating sexual intercourse.

CONTEXT: Better methods for investigating sexual risk before the initiation of sexual intercourse are needed to support programming for younger adolescents, especially for abstinent adolescents who are susceptible to initiating intercourse. METHODS: A sample of 854 adolescents in seventh or eighth grade who had never had sexual intercourse completed sexuality surveys in 2002 and 2004. A five-item index that assessed beliefs and expectations about the onset of intercourse was created to indicate adolescents' cognitive susceptibility to initiating intercourse. Logistic regression analysis was used to assess associations between levels of susceptibility and initiation of intercourse by follow-up. The construct and predictive validity of the index were examined using a variety of tests. RESULTS: Thirty-eight percent of respondents were classified as being nonsusceptible to initiating intercourse, 34% as having low susceptibility and 28% as being highly susceptible. Adolescents who were susceptible were more physically mature, had greater sexual feelings and competency, perceived that more peers were sexually active and had fewer positive connections with parents, school and religion than nonsusceptible respondents. Males, blacks and older adolescents were more susceptible than females, whites and younger adolescents, respectively. Compared with nonsusceptible respondents, those with low and high susceptibility had higher odds of initiating intercourse two years later (odds ratios, 2.5 and 8.1, respectively). CONCLUSIONS: The cognitive susceptibility index provides a valid method for assessing sexual risk before the onset of intercourse. Assessing susceptibility among early adolescents could support efforts to delay the onset of intercourse through targeted research and health programming.

The mass media and American adolescents' health.

American teens today grow up in a world saturated with the mass media. In general, the media depict a world in which unhealthy behaviors such as physical aggression, unprotected sex, smoking, and drinking are glamorous and risk-free. We summarize what is known about the media's effects on four adolescent health issues that have been studied most comprehensively: violence and aggression; sex; obesity, nutrition, and eating disorders; and alcohol and tobacco use. A number of approaches that have potential for helping turn the media into more positive forces for adolescents' health are discussed

Mass media influences on sexuality.

The mainstream mass media (television, magazines, movies, music, and the Internet) provide increasingly frequent portrayals of sexuality. We still know relatively little about how this content is used and how it affects sexual beliefs and behaviors. The few available studies suggest that the media do have an impact because the media keep sexual behavior on public and personal agendas, media portrayals reinforce a relatively consistent set of sexual and relationship norms, and the media rarely depict sexually responsible models. More longitudinal research, especially with early adolescents is needed to learn more about how media content is attended to, interpreted, and incorporated into developing sexual lives.

Media interventions to promote responsible sexual behavior.

While the media have been used effectively to promote sexual responsibility in other countries for decades, few such opportunities have been seized in the United States. Mass media may be especially useful for teaching young people about reproductive health because elements of popular culture can be used to articulate messages in young people s terms, in language that won t embarrass them and may even make safe sex more attractive. Media can potentially change the way people think about sex, amidst cultural pressures to have sex at a young age, to have sex forcefully, or to have unsafe sex. Information can be communicated through a variety of channels--small media (e.g., pamphlets, brochures, and the Internet) and mass media--and in a variety of formats--campaigns, news coverage, and educational messages inserted into regular entertainment programming. Several international studies show that exposure to family planning messages through television, radio, and print media are strongly associated with contraceptive use. Domestically, safe sex media campaigns have been associated with increased teen condom use with casual partners, and reductions in the numbers of teenagers reporting sexual activity. Due to private ownership and First Amendment concerns, U.S. sexual health advocates have been working with the commercial media to incorporate subtle health messages into existing entertainment programming.

"Love is all you need" A content analysis of romantic love and sex in Chinese entertainment television.

A large sample of entertainment television programs that aired on 28 channels in China in 2004 were analyzed for romantic and sexual content. Romantic scenes, typically portraying men and women already in committed relationships, appeared in 80 percent of the 196 programs analyzed. The analysis suggested that, according to Chinese television in the early part of the 21st Century, emotional love was more important than physical sexual interaction in romantic relationships. More than half of the 1,112 romantic scenes analyzed depicted love between the partners without any discussion or display of physical sexual behavior. Only eight percent of scenes included discussion or depiction of sexual behavior (e.g., touching, kissing, intercourse) without some sense that the partners were in a loving, committed relationship. Sexual intercourse was implied or depicted in fewer than two percent of the romantic scenes. Findings are discussed in light of the Chinese government's periodic regulation of sexually suggestive media content and attempts to filter Internet content. The extent to which such content may affect young viewers' perceptions of romantic relationships and sexual behavior is also discussed.

A social media-based physical activity intervention: a randomized controlled trial.

BACKGROUND: Online social networks, such as Facebook™, have extensive reach, and they use technology that could enhance social support, an established determinant of physical activity. This combination of reach and functionality makes online social networks a promising intervention platform for increasing physical activity. PURPOSE: To test the efficacy of a physical activity intervention that combined education, physical activity monitoring, and online social networking to increase social support for physical activity compared to an education-only control. DESIGN: RCT. Students (n=134) were randomized to two groups: education-only controls receiving access to a physical activity-focused website (n=67) and intervention participants receiving access to the same website with physical activity self-monitoring and enrollment in a Facebook group (n=67). Recruitment and data collection occurred in 2010 and 2011; data analyses were performed in 2011. SETTING/PARTICIPANTS: Female undergraduate students at a large southeastern public university. INTERVENTION: Intervention participants were encouraged through e-mails, website instructions, and moderator communications to solicit and provide social support related to increasing physical activity through a physical activity-themed Facebook group. Participants received access to a dedicated website with educational materials and a physical activity self-monitoring tool. MAIN OUTCOME MEASURES: The primary outcome was perceived social support for physical activity; secondary outcomes included self-reported physical activity. RESULTS: Participants experienced increases in social support and physical activity over time but there were no differences in perceived social support or physical activity between groups over time. Facebook participants posted 259 times to the group. Two thirds (66%) of intervention participants completing a post-study survey indicated that they would recommend the program to friends. CONCLUSIONS: Use of an online social networking group plus self-monitoring did not produce greater perceptions of social support or physical activity as compared to education-only controls. Given their promising features and potential reach, efforts to further understand how online social networks can be used in health promotion should be pursued. TRIAL REGISTRATION: This study is registered at clinicaltrials.govNCT01421758.

The media do matter: comment on Steinberg and Monahan (2011).

Steinberg and Monahan's (2011) reanalysis of the Teen Media longitudinal survey of adolescents does not meet prevailing standards for propensity score analysis and therefore does not undermine the original conclusions of the Brown, L'Engle, Pardun, Guo, Kenneavy, and Jackson (2006) analysis. The media do matter in the sexual socialization of adolescents.

Television use and snacking behaviors among children and adolescents in China.

PURPOSE: Television (TV) use has been linked with poor eating behaviors and obesity in young people. This study examines the association between TV watching and paying attention to TV commercials with buying and requesting snacks seen on commercials, and eating snacks while watching TV among youth in China. METHODS: Data from 1,552 participants (ages 6-17.99) in the 2004 China Health and Nutrition Survey were analyzed cross-sectionally. The 2004 China Health and Nutrition Survey was conducted in nine Chinese provinces. RESULTS: Most respondents (92.2%) reported watching TV; on average children (6-11.99 years old) and adolescents (12-17.99 years old) watched TV for 9-10 hours per week. Nearly half (42.9%) of all the respondents said they "sometimes" or "often" paid attention to TV commercials. Respondents who reported paying attention to commercials had higher odds of requesting snacks (odds ratio [OR] = 3.43; 95% confidence interval [CI] = 2.55-4.60) and buying snacks (OR = 2.73; 95% CI = 2.17-3.43) seen on TV, and eating snacks while watching TV (OR = 1.60; 95% CI = 1.23-2.07) than those who did not pay attention. However, frequency of watching TV was not significantly related to snacking. CONCLUSION: Attention to TV commercials for snack foods may be one of the factors affecting the increase in obesity among children and adolescents in China.

Transitions into underage and problem drinking: summary of developmental processes and mechanisms: ages 10-15.

Adolescents ages 10-15 experience dramatic changes in their biological, cognitive, emotional, and social development as well as in their physical and social environments. These include the physiological and psychological changes associated with puberty; further development of the brain; changes in family, peer, and romantic relationships; and exposure to new societal and cultural influences. During this period, many adolescents also begin to use alcohol. Alcohol use during adolescence has adverse effects on the body and increases the risk of alcohol dependence later in life. To better understand why some children drink whereas others do not, researchers are examining nonspecific and alcohol-specific factors that put adolescents at risk for, or which protect them from, early alcohol use and its associated problems. Nonspecific risk factors include certain temperamental and personality traits, family factors, and nonnormative development. Examples of nonspecific protective factors include certain temperamental characteristics, religiosity, and parenting factors (e.g., parental nurturance and monitoring). Among the most influential alcohol-specific risk and protective factors are a family history of alcoholism and the influences of siblings and peers, all of which shape an adolescent's expectancies about the effects of alcohol, which in turn help determine alcohol use behaviors.