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					Screen Media and Its Effects on
Weight, Aggression & Behavior

         Dimitri A. Christakis, MD MPH
      George Adkins Professor of Pediatrics
            University of Washington
  Director, Center for Child Health, Behavior &
                  Development
      Seattle Children’s Research Institute
“When television is good,
nothing is better. When
it’s bad, nothing is worse.”

         Newton Minow, chairman of the FCC 1960
Two Key Points
   Media is a real, powerful influence on
    children
   Clinicians need to be involved
Media as a Public Health Issue

   Pressing pediatric problems
       Obesity
       Aggression
       Premature sex
       Substance abuse
       Others…..
Parents do want to discuss!
   Majority of parents feel guilty about
    media usage
   Previsit survey of 1800 families
       1.   Development and Behavior 86%
       2.   Media usage              82%
       3.   Home Safety                70%
       4.   Vaccination                69%
Naughty or Nice

    TV Viewing and Preschool
            Behavior
 Bandura and Bobo ’60’s-70’s




Dr Albert Bandura
    (1925- )
                       Bobo
     Albert Bandura
   Psychologist at Stanford
   Interested in roots of behavior, so called
    “Observational Theory”

“Of the many cues that influence behavior,
  at any point in time, none is more
  common than the actions of others”
                                     Bandura 1986
Bobo Doll Experiments (cont)

               Hundreds of Preschool
                Kids & a Bobo doll
               Many different studies
               Similar Approach
                   Some saw violence
                    towards Bobo
                   Some did not
    Bobo Doll Experiments
   Violence towards Bobo
       In person
       On screen
       As a cartoon
       With perpetrator being punished
       With perpetrator being rewarded
After the exposure
   Children were placed in room with toys
    they could not play with
   Then put in room with Bobo
   Observed behind a 1 way mirror
                    Results
                    120
                                           99
Aggression Scores




                    100           92
                          83
                     80

                     60                              54

                     40

                     20

                      0
                          Real   Video   Cartoon   Control
   Models with greatest influence were
       Warm –liked and respected
       Powerful –have status
       Possess desirable objects and characteristics
       Are similar to the children ( e.g. same sex )
Effects Linger!

   In 2007 study, we determined
       Programs watched by ~300 preschoolers
       Aggression 5 years later




                                Christakis et al Pediatrics
Program Classification
   Educational
       Clear educational purpose
   Violent
       Violence is central and more than a typical
        child would experience
   Entertainment
       Neither educational nor violent
          Sample Shows

Category        Boys 2-4 yrs    Girls 2-4 yrs
Educational     Barney          Barney
                Sesame St       Sesame St
                Blues Clues     Winnie the Pooh



Violent         Power Rangers   Aladdin
                Star Wars       Space Jam
                Spiderman       Scooby Doo



Entertainment   Toy Story       Muppet Babies
                Rugrats         Aristocats
                                 TV content 3-5 and Aggression at 8-10
                                 350
Percent Increase in Aggression




                                 300

                                 250

                                 200
                                                                                                   Girls
                                 150                                                               Boys

                                 100

                                 50

                                  0
                                       Educational TV Entertainment TV     Violent TV

                                                                    Christakis & Zimmerman, Pediatrics 2007
     Is that all?
   100’s of other studies
   Debate is scientific circles about media
    and violence is over
   Alive and well in the public arena
       3rd person effect
                                           How sure are we that:

      Self-exams reduce the extent of breast cancer?
Does self examination reduce the extent of breast cancer?

       Homework improves academic achievement?
       Does homework improve academic achievement?

             Exposure lead lower children's IQ scores?
       Does exposure to to lead lowers children's IQ?

                                              cancer?
      Does passive smoking at work cause lung cancer?
       Passive smoke exposure causes

      Does condom use reduce sexually transmitted HIV?
                        Condom use reduces HIV?

                Does media violence cause aggression?
               Media violence increases aggression?

                       Smoking causes lung cancer?
                      Does smoking cause lung cancer?

                                                            0     0.05 0.1 0.15 0.2 0.25 0.3 0.35                    0.4   0.45
                                                                More Sure
                                                                        Absolute Value of Correlation Coefficients
How does screen violence affect
us?
1) Desensitizes us
2) Justifies aggression
3) Induces aggression
    Screen violence desensitizes us

   University of Utah study children 5-12 yrs
   40 heavy TV viewers (>25 hrs/week)
   40 light TV viewers (<25 hrs/week)
   Assessed reactions to screen violence
     Galvanic Skin Response
   Skin conducts electricity better when
    sweaty
   Nervousness induces sweat
   Component of polygraph testing
Watched 3 shows
   Ski film (non violent)
   Between rounds of boxing match
   Violent boxing match
                   Results
                         25
Galvanic Skin Response




                         20
    More Excited-->




                         15
                                                                                             Heavy Viewers
                                                                                             Light Viewers
                         10


                         5


                         0
                              Before Film   After Ski Film     During non   During Violent
                                                             violent boxing    Boxing
                                                               segments      Segments
Screen violence justifies violence

   University of Wisconsin study
   Undergraduate students
   Watched scene from “Mod Squad”
   Motorcycle gang encircles middle aged
    man
               Randomly Assigned




Told Nothing      Justified        Random Act
                 Retaliation
     Afterwards….
   Students asked to participate in an
    experiment
   Purpose “to see how people function
    under stress”
   Asked to “shock” subjects who got
    answers to test questions wrong
                                  Results

         4   5                         4   5                         4   5
     3           6                3            6                3               6
 2                   7        2                    7        2                       7
1                     8   1                            8   1                            8


    No Explanation                    Random                        Justified


     0.63 sec                 1.38 sec                         1.26 sec
Screen violence induces violence

    Southern CA Public School
    52 elementary school children
    ½ boys; ½ girls
    Mean age 7 ½ years
    Random 22 min “Power Ranger”
     episode chosen
        140 acts of aggression

                              Boyatzis et al, Child Study Journal 1995
“Express your anger responsibly”
             Randomly Assigned




Watch Show              Regular Day




      Observed for 2 minutes
          during recess
Assessing Aggression
   Two observers (99% agreement)
   Verbal Aggression
       Speaking/yelling in insulting or threatening
        way
   Physical Aggression
       Hitting, shoving, kicking, tripping
        intentionally
Power Rangers        Control      p

   1.6 acts          .22 acts    <.02
                Boys
  2.79 acts           .31 acts   <.01
                Girls
   0 acts             .14 acts   NS
                            Does prosocial television
   Prosocial programs increase good behavior
                                increase "good" behavior?


                          Does self examination reduce
Self-exams reduce the extent of breast cancer?
                              the extent of breast cancer?


Homework improves academic achievement?
                         Does homew ork improve
                                  academic achievement?


         Exposure to lead lowers children's IQ?er
                           Deos exposure to lead low
                                 children's IQ scores?


                                 Does passive smoking at
 Passive smoke exposure causes lung cancer?
                          w ork cause lung cancer?


                              use reduces reduce
                       Condom Does condom use HIV?
                                 sexually transmitted HIV?


         Media violence increases aggression?
                            Does media violence cause
                                      aggression?


                                 Does smoking cause lung
                   Smoking causes lung cancer?
                                    cancer?
Summary
   Behaviors (good and bad) on the screen
    are mirrored in real life
   Advice for parents
       Find good ones
       Mediate bad ones
Mashing the Couch Potato Theory


      TV’s Role in Childhood Obesity
   TV viewing is a cause of childhood
    obesity
   Why is less clear
How might TV increase weight?

           Physical
            Activity




 TV         BMR        Overweight



              Food
             Intake
How might TV increase weight?

           Physical
            Activity




 TV         BMR        Overweight



              Food
             Intake
     TV & ↓ Physical activity
   No evidence that this occurs
   TV displaces other sedentary activities
   Kids watch TV because they are
    sedentary they are not sedentary
    because they watch TV
   Reading is also sedentary!
How might TV increase weight?

           Physical
            Activity




 TV         BMR        Overweight



              Food
             Intake
     TV and ↓ BMR
   20 minutes of vigorous exercise
    increases BMR for 24-48 hours
   Might TV do the opposite?
     Klesges et al
   31 kids ages 8-12 years
   Laid in bed
   Then watched Wonder Years
   Then laid in bed
   BMR calculated before, during, after TV
    viewing
    TV and ↓ BMR
            1600



            1500


 Basal
Metabolic   1400
  Rate

            1300



            1200

                   Before TV   During TV   After TV
     TV and ↓ BMR
   Initial excitement but no corroboration
How might TV increase weight?

            Physical
             Activity




  TV         BMR        Overweight



               Food
              Intake
How much intake does it take?

    Not much!
    100 excess calories per day for 1 year
     10 lb excess weight gain in adults
  2 Pathways to ↑ Intake
(1) Intake while viewing
(2) Intake overall (poor choices)
Intake While Viewing
   Swanson executive Gerald Thomas’
    Turkey Problem (1953)
   270 Tons of left over Thanksgiving
    turkey
   No room in corporate refrigerators
   Thomas visits Pan Am Airlines food
    production site
   Impressed with food trays
   Eureka!
“Television was the talk of the day.
Television was something that if
you had one, your were
contemporary. If it were today,
we’d probably call it the digital
dinner…”

                        Gerald Thomas AP
TV dinners take off
   5,000 dinners made in first run
   10 million sold that year
   1 year later, 25 million TV dinners
    served in front of the TV
Eating in front of TV is common

    ~30-50% of Households do so
    TV snacks are an industry
    People eat more when they watch
Overall Intake & Food Choices
40 years of TV and Weight Gain
                                                   40 Years of Change in Children's Weight and TV Watching


                                    8.00                                                                                          20.0%

                                                                                                                       7.10
                                                                                               6.95                               18.0%
                                    7.00
                                                                           6.75

                                                         5.95                                                                     16.0%




                                                                                                                                          percent of children who are overweight
                                    6.00                                                                              16.0%
                                           5.50
mean hours of TV watched each day




                                                                                                                                  14.0%

                                    5.00
                                                                                                                                  12.0%


                                    4.00                                                     11.0%                                10.0%


                                                                                                                                  8.0%
                                    3.00

                                                                                                                                  6.0%
                                    2.00                                   6.0%
                                                         5.0%                                                                     4.0%
                                           4.5%                                          mean hours of TV watched each day
                                    1.00
                                                                                         percent of children who are overweight   2.0%


                                    0.00                                                                                          0.0%
                                           1960s         1970s             1980s              1990s                    2000s
                                                                          Decade
        What has changed?
   1980’s deregulation increased options
   More Channels, More Ads
       More targeted greater potency
   The “long tail”
    Why are young kids especially
    vulnerable
   <~7 do not recognize “ads” as such
   Many countries ban advertising to
    children (not US)
Marketing Food to Children and Youth

“Among the various environmental
influences, none has more rapidly assumed
central socializing roles for young people
than the media, in its multiple forms. With
its growth in variety and penetration has
come a concomitant growth in the
promotion of branded food and beverage
products in the marketplace.”
                          Institute of Medicine (2006)
      Ad Minutes/Prime Time Hour

20
18
                              16
16
14   US Children see >40K ads/year!
                  12.1
12
10
 8      6.75
 6
 4
 2
 0
       1982      2001        2007
    Ad Revenue Sources
   Primary market, ( $8 billion)
       Discretionary spending
   Influence market, ( $300 billion)
       Pester power
   Future market (unmeasurable)
       “Adult” consumers
“Children are often the key decision
makers concerning where a family goes
to eat. Although the parents decide when
to go out, the children many times
“decide” where to go. This means that
you should do everything you can to
appeal to children’s love for Ronald and
McDonalds.”
           1991 McDonald’s Employee Manual
TV and Food Choice
                   Eating what They See
                                    5
Average # of Children's Cereal in




                                    4

                                                                                3.81
                                    3
             House




                                    2
                                                         2.23


                                    1       1.23


                                    0
                                        0      1                2           3          4
                                                   Mean Hours of Daily TV
     Distribution of Types of Food in TV Advertising
           Targeted to Children or Teens, 2007
                     Breads and pastries 2%                                                     Fruit juices 1%
                       Dairy
                       Prepared foods                           4%
                                                        4%
          Dine-in restaurants                                                                                  Candy and snacks
                                                 7%

                                                                                                    34%
    Sodas & soft drinks                     9%


                     Fast food
                                               10%


                                                                                                            Sugared cereal
                                                                         28%

SOURCE: Kaiser Family Foundation, Food for Thought: Television Food Advertising to Children in the United States, March 2007.
TV and Caloric Intake
     Weicha et al

   5 Public Schools in Boston
   548 Middle School Kids
   Assessed
       Total Energy Intake
       Intake of foods commonly advertised on TV
Results
   Each Additional hour of TV watched
       167 calories/day
       All of those calories came from foods
        advertised on TV
TV while eating
     Stroeble et al
   78 undergraduate students
   Media and food diaries kept for 1 week
   Also assessed hunger before eating
     Results
   3 ½ vs 2 ¾ meals on TV vs no TV days

  1900 calories on TV days
- 1737 calories on no TV days
  163 more calories on TV days

   Less hungry before eating!
     Conclusions
   TV and eating go together
   Advertising to children is effective
   Advertisements are the hidden hand in
    the childhood obesity epidemic
Clinicians
   Recognize power of media
   Understand its mechanisms of action
   Counsel parents
       Stop don’t ask don’t tell
     Taming Media
   3R’s (rethinking, restructuring,
    reducing)
   Develop a “Strategic Plan”
     “If you don’t know where you
      are going, you might end up
            somewhere else”
                          Yogi Berra
What do you want from Media?

   Entertainment
   Early literacy
   Social Values
   New Horizons
   A Break
What do you not what from Media?

   Aggression
   Obesity
   Risky Behaviors
   Consumerism
   Addiction
Developing a Plan
   How much do they watch?
   What do they watch?
   How do they watch?
   Keep a diary for a week.
     Conrad’s Family
   Conrad (4) and younger sister Chloe, (2)
   Both Parents work
   Parents state
       “Watches about 1 hour/day”
       “Mostly educational TV”
                         Monday, February 19th
Start/Stop    What      TV, DVD,     Where        Who else      What else
                           TIVO                  was present     doing


             Sesame                              Younger
8-830 A                   TV       Kitchen
              Street                               sister
                                                 Younger
8:30-845     Clifford     TV       Kitchen
                                                   sister
                                    Family       Younger       Hitting
5-630 P      Aladdin     DVD
                                    Room           sister      sister

              CBS                   Dinner       Mthr,Fthr, Eating,
7-730                     TV
              News                  Table          sister     Talking
Conrad’s viewing
   Watched about 2 ¾ hours/day
   ¼ Educational
   ½ Entertainment
   ¼ Not for him at all
     Rethinking
   Are your kids getting what you want?
   Are they not getting what you don’t
    want?
   Conrad’s parents surprise by amount
    and content
Restructuring
   Take control of content and context
   Select content
   Minimize quantity
   Conrad’s viewing not consistent with
    parent’s strategic plan
     Reducing
   Often occurs as part of strategic plan
   Conrad’s was reduced because
       Parents used 30 min educational for dinner
        prep (rather than 1 ½ hour)
       Eliminated dinner TV
  Top 10 pitfalls
(10) Feeling guilty about media usage
 (9) Eating in front of the set
 (8) Focusing too much on quantity
 (7) Giving in to pester power
 (6) Letting kids watch alone
Top 10 pitfalls (cont)
(5)   Underestimating commercials
(4)   Missing teachable moments
(3)   Setting a bad example
(2)   TV in bedroom
(1)   Mindless Viewing

				
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