Writing

Media Literacy and Health Promotion Encyclopedia of Adolescence Overview The mass media rank among the most important socialization agents influencing the health behaviors of today’s youth, with some researchers estimating that youth spend 33–50% of their waking hours with some form of media. The impact of the media on health and the large amount of time adolescents spend with media makes it critical to address related health concerns, especially because the adolescents’ developing brains are not adequately equipped to critically analyze and interpret the large number of messages about health that they receive from the media. This essay examines how the adolescent brain responds to risky and mixed health messages in the media; the empowerment versus protectionist perspectives on health-promoting media literacy education as a life skill; the young field of health-promoting media literacy education research, including theoretical foundations, skills practice, and issues of pedagogical approach; and recommendations for advancing the field, including applications, behavior change measurement issues, and future directions. Throughout, the body of research and practice on health-promoting media literacy education is revealed in terms of controversies, key definitions and questions, gaps in knowledge, and major theorists and researchers. Impact of Media on Adolescent Health Today’s health professionals increasingly recognize that the media have a significant influence on the health of young people. In a policy paper that included a review of the large body of research on the media’s influence on health, the Committee on Public Education of the American Academy of Pediatrics stated: “Research has shown primary negative health effects on violence and aggressive behavior; sexuality; academic performance; body concept and self image; nutrition, dieting, and obesity; and substance use and abuse patterns” (American Academy of Pediatrics 2001). The mass media rank among the most important socialization agents influencing today’s youth. Hundreds of experimental studies based in social learning theory over the past 50 years “leave little doubt that exposure to media content causally contributes to subsequent knowledge, beliefs, attitudes, and/or behavior related to the content portrayed,” (Roberts and Christenson 2000) from messages about tobacco and alcohol use, to violence as a way to resolve conflict, to eating a diet of junk food. Some researchers estimate that youth spend 33–50% of their waking hours with some form of mass media (Strasburger and Wilson 2002). In addition, children and teens are spending an increasing amount of time using new media like computers, the Internet, video games, and smart phones, without cutting back on the time they spend with old media like TV, print, and music. A study of media in the life of 8–18-year-olds found that the total daily media exposure of young people increased from 7:29 to 8:33 h between 2000 and 2005, counting time as double when multitasking with two different forms of media (Kaiser Family Foundation 2005). The impact of the media on health and the large amount of time adolescents spend with media make it critical to address related health concerns, especially because their developing brains are not adequately equipped to critically analyze and interpret the large number of risky and mixed messages about health that they receive from the media. The Adolescent Brain Response to Media Messages Advances in developmental neuroscience show that heightened risk taking among adolescents results from the interaction of two brain networks. The first is the socio-emotional network that is particularly sensitive to social and emotional stimuli, such as those coming from rapid, exciting, visual media images. This network is located in the limbic area of the brain that is well developed by early adolescence and becomes abruptly assertive on the brain at the onset of puberty. The second network is the cognitive-control network that regulates the executive functions of thinking ahead, planning, and self-regulation – those functions necessary to assess risk and make healthy decisions. This network is located largely in the neocortices of the brain and it matures gradually over adolescence and young adulthood, largely independent of puberty (Steinberg 2007). Risk taking can be viewed as the product of a competition between the socio-emotional network and the cognitive-control network (Drevets and Raichle 1998). It is the lack of cross talk between the two networks that results in adolescents acting on gut feelings without fully thinking. According to Steinberg (2004) “More than 90% of all American high-school students have had sex, drug, and driver education in their schools, yet large proportions of them still have unsafe sex, binge drink, smoke cigarettes and drive recklessly (often more than one of these at the same time).” Clearly, traditional educational/informational strategies are not enough to prevent unhealthy behaviors among adolescents. What is needed is a strategy founded on developing critical thinking to encourage greater cooperation/cross talk between the two networks of the brain, starting early in adolescence. Health-promoting media literacy education is such a strategy. Health-Promoting Media Literacy Education Perspectives Public health professionals have used many strategies to address the effects of media on health. Regulating media content, limiting children’s media use, and social marketing are approaches that have been used traditionally, but health-promoting media literacy education has emerged in the last 30 years as a promising alternative to the censorship of regulating “unhealthy” programming or limiting media use (Heins and Cho 2003). Media literacy has been defined (Thoman and Jolls 2005) as “the ability to access, analyze, evaluate, and create media in a variety of forms.” Rather than trying to protect youth from potentially harmful messages, media literacy education to promote health involves them in a critical examination of media messages that influence their perceptions and practices. It is designed to empower youth with the critical thinking life skills necessary to ameliorate the influence of these messages and make their own healthy choices (Bergsma 2004). In contrast to this empowering concept of health-promoting media literacy education that emanates from cultural studies theory, is the protectionist concept of media literacy education for health promotion, which emanates from inoculation theory and places a greater focus on limiting media use through parental intervention (Common Sense Media); through encouraging youth to watch less TV (Center for Screen-Time Awareness that organizes the annual TV-Turnoff Week); or through activist critiques of commercial media and corporate involvement in media and advocacy for media reform (Action Coalition for Media Education). For an excellent discussion of the protectionist versus empowerment perspectives, see the background paper entitled Media Literacy: From Activism to Exploration written by J. Francis Davis for the 1992 National leadership Conference on Media Literacy (Aufderheide and Firestone 1993). Taking the empowerment perspective through an emphasis on critical thinking, the National Association for Media Literacy Education (NAMLE) states that “The purpose of media literacy education is to help individuals of all ages develop the habits of inquiry and skills of expression that they need to be critical thinkers, effective communicators and active citizens in today’s world.” NAMLE is the US national membership organization for those in K-12, college, and afterschool and community settings who help students develop critical thinking and communication skills using mass media, digital media, and popular culture. Following are the six NAMLE Core Principles of Media Literacy Education in the United States with minor adaptations for the purposes of health promotion. These are intended to guide teaching efforts, and in the online NAMLE Core Principles document, each is related to numerous implications for teaching practice (National Association for Media Literacy Education 2007). Health-promoting media literacy education: Requires active inquiry and critical thinking about the messages people receive and create. Expands the concept of literacy (i.e., reading and writing) to include all forms of media. Builds and reinforces skills for learners of all ages. Like print literacy, those skills necessitate integrated, interactive, and repeated practice. Develops informed, reflective, and engaged participants essential for a healthy populace. Recognizes that media are a part of culture and function as agents of socialization. Affirms that people use their individual skills, beliefs, and experiences to construct their own meanings from media messages. Health-Promoting Media Literacy Education Research Over the past 30 years, a small body of research on the effectiveness of health-promoting media literacy education has emerged, although the studies have been conducted with more or less rigor, achieved differing results, and many questions about effectiveness remain to be answered (Bergsma and Carney 2008). Until recently there has been no scholarly journal devoted primarily to media literacy education research and studies in the field have been published in a wide variety of journals, often according to the theoretical underpinnings of the research, such as communication theory (Health Communication), psychological theory (Journal of Applied Developmental Psychology), or health education theory (Health Education Research). In 2009, NAMLE launched the Journal of Media Literacy Education, a peer-reviewed, open-source, online journal to advance knowledge in the field by supporting the development of research, scholarship, and the pedagogy of media literacy education. Theoretical Foundations of Health-Promoting Media Literacy Education There is currently no commonly accepted theory of health-promoting media literacy education. Coming from a communications perspective one model, which has been used in some research on the impact of media literacy education interventions on health behaviors, was proposed by (Austin et al. 1990) and later tested by Austin and Johnson (1997). Originally constructed to explain children’s media decision-making processes about alcohol use, the “Message Interpretation Process” model posits that children interpret media messages through a process that incorporates both logical decision-making (via perceptions of realism and similarity) and emotional processing (via perceptions of desirability and identification). In an attempt to build a model of health-promoting media literacy education from a health promotion/health behavior, ecological perspective, Bergsma and Ferris (in press) have drawn from a combination of the Theory of Reasoned Action (TRA), in which a causal chain of beliefs, attitudes, and behavioral intentions drives behavior at the individual level, and Social Learning Theory (SLT) which explains that people are learning at the interpersonal level not only from their own experiences, but by observing the actions of others and the benefits of those actions (Glanz and Rimer 2005). At the interpersonal level, theories of health behavior assume individuals exist within and are influenced by a social environment. The opinions, thoughts, behavior, advice, and support of the people surrounding an individual influence his or her knowledge, beliefs, attitudes, and behavior. The social environment of youth includes many influences, primary among which are family, friends, school, and the media. It is social learning that is examined in media effects research; for example, see The Role of Media in Childhood Obesity (Kaiser Family Foundation 2004), which reviews more than 40 studies on the role of media in the dramatically increasing rates of childhood obesity in the USA. Social Cognitive Theory (SCT), which evolved from SLT, has been used successfully as the underlying theory for behavior change in areas ranging from dietary change (Baranowski et al. 1993) to pain control (Lorig et al. 1999). Integrating concepts and processes from cognitive, behaviorist, and emotional models of behavior change, it includes the constructs of reciprocal determinism, behavioral capability, expectations, self-efficacy, observational learning, and reinforcement. Constructs of Health-Promoting Media Literacy Education Social Cognitive Theory and the Theory of Planned Behavior (TPB), which evolved from the TRA, contain the same additional behavioral construct – that of self-efficacy or perceived locus of control – which falls within the category of individual empowerment. This empowerment construct is also clearly a component of media literacy education. Pioneer media literacy educator Elizabeth Thoman advocates a philosophy of empowerment through media literacy education, based on the work of Paulo Freire (1970, 1973). At the heart of this philosophy is an inquiry process developed into a construct called the “empowerment education spiral” and consisting of four components – awareness, analysis, reflection, and action – all designed to enable people to fully comprehend and act upon the content, form, purpose, and effects of media messages (Thoman and Jolls 2005). From a public health perspective, Bergsma (2004) shows that the pedagogical links between health promotion and media literacy can be traced to Freire’s empowerment education model. In addition to empowerment, three other constructs must be included within a health-promoting media literacy education intervention to change beliefs, attitudes, intentions, and behaviors. In health promotion, it is generally accepted that knowledge is necessary but insufficient to change health behavior. Therefore, while media literacy education has a knowledge construct that provides information about such things as how and why different forms of media operate as they do, including the manipulating design of advertising, this knowledge alone will seldom result in behavior change, although health-promoting media literacy education research demonstrates that knowledge about the media and the health issue can change beliefs and attitudes (Bergsma and Carney 2008). Finally, media literacy education must help people develop the habits of inquiry and the critical analysis and expression skills (National Association for Media Literacy Education 2007) that they need to be critical thinkers about the health issue, and therefore better skilled at making thoughtful decisions about their behavior. Health-promoting media literacy education to achieve behavior change addresses people at both the individual level and the interpersonal level of social interaction with, and learning from, media messages of all kinds, including those from narrative contexts such as film and persuasive contexts such as advertising and promotion. Figure 1 posits an integrative individual and interpersonal model for achieving behavior change in which the four constructs of health-promoting media literacy education act as buffering influences between the media environment in which one lives (outside the model) and the individual and interpersonal behavioral change constructs of the Theory of Planned Behavior and Social Cognitive Theory. While Social Cognitive Theory may be helpful to address sociocultural risk factors, individual behavioral change must also be addressed through the use of such theories as the Theory of Planned Behavior (Fig. 1). Social Cognitive Theory examines the media context surrounding young people, but the Theory of Planned Behavior individualizes that context. The model in Fig. 1, therefore, takes into account that media literacy education is, and must be, contextual. It is also important to note that within these theoretical contexts, people can be influenced both positively and negatively by media messages, resulting in behavior change that is healthy or unhealthy. Health-promoting media literacy education helps establish the media and health knowledge, critical analysis and expression skills, habits of inquiry, and individual empowerment that potentially will lead individuals to make healthy decisions for themselves. Media Literacy and Health Promotion, Fig. 1 Integrated individual and interpersonal health-promoting media literacy education model The Practice of Health-Promoting Media Literacy Education In practice, health-promoting media literacy education provides students with a set of key questions (NAMLE 2007) that they can use to critically analyze the media messages they are receiving, as well as an empowering inquiry environment in which teachers and students learn from each other as they practice asking the questions and sharing/explaining responses that are individualized with no “right” answers. These questions are divided into three categories as follows: Audience and Authorship Authorship – Who made this message? Purpose – Why was it made? Who is the target audience (and how do you know)? Economics – Who paid for this message to be made/distributed? Impact – Who might benefit from this message? Who might be harmed by it? Why might this message matter to me? Response – What kinds of actions might I take in response to this message? How might other people respond? Messages and Meanings Content – What is this message about (and what makes you think that)? What ideas, values, information, and/or points of view are overt? Implied? What is left out of this message that might be important to know? Techniques – What techniques were used to make this message? Why were those techniques used? How do they communicate the message? Interpretation – How might different people understand this message differently? What is my interpretation of this message and what do I learn about myself from my reaction or interpretation? Representations and Reality Context – When was this made? Where or how was it shared with the public? Credibility – Is this fact, opinion, or something else? How credible is this message (and what makes you think that)? What are the sources of the information, ideas, or assertions in the message? Although all the questions above are important for critical analysis, a key question for health-related subjects is “What is left out of this message that might be important to know?” because media messages about health issues like tobacco, alcohol, sex, and violence often glamorize them and frequently portray them without consequences. For example, sex in the media is generally portrayed without the three C’s: no commitment, no condoms, and no consequences. Pedagogical Approach A large proportion of the studies on the effectiveness of health-promoting media literacy education conclude that media literacy education has significant potential to promote healthy knowledge, attitudes, and behaviors and merits further study. Many questions remain, however, regarding which variables (e.g., length of intervention, age of participants, type of instructor including peer-educators, researchers, or classroom teachers) contribute more or less to the effectiveness of health-promoting media literacy education (Bergsma and Carney 2008). One variable that is seldom examined is pedagogical approach. While the studies provide considerable information on what the intervention taught, they provide little, if any, information on how the intervention taught it. In other words, the content that was taught is known, but not the pedagogical approach that was used. Yet successful health-promoting media literacy education results not so much from what is taught as how it is taught (Bergsma and Carney 2008), and as outlined in the Core Principles of Media Literacy Education (National Association for Media Literacy Education 2007), media literacy education must be grounded in inquiry-based, process-oriented pedagogy. Unfortunately, whether the pedagogical approach used in most published studies is one of inquiry or indoctrination is unclear. In order to greatly enhance the field of research on health-promoting media literacy education, future studies must provide more reliable information on the pedagogical approach used by the intervention and examine it as a variable that affects outcomes. Advancing the Field Applications Media literacy education interventions have been used to promote the health of children and adolescents in numerous areas, including violence prevention, tobacco use prevention, alcohol abuse, nutrition and dieting behavior, body image, eating disorders (Bergsma and Carney 2008), sexual behavior (Pinkleton et al. 2008), drug abuse prevention (Doba and Doukoullos 2001), and prevention of marijuana use (DeKorne et al. 2002). Given this body of practice and research on the use and effectiveness of media literacy education to promote health, it is reasonable to assume that this approach to health promotion could be applied to numerous health issues among youth. Interestingly, however, there is little research on its use to promote physical activity. Yet certainly the media give many mixed messages about physical activity that require analysis on the part of both youth and adults in order for them to think critically about the numerous constructions of reality about physical fitness activities that the media portray, the values and points of view about physical fitness activities that are conveyed, and how different people might understand the messages differently. Another application would be to engender more critical thinking and behavior regarding safe driving practices among teenagers, despite the mixed messages they receive from the media. Measurement Issues Over the past 30 years, numerous studies have employed health-promoting media literacy education interventions with a relatively broad range of children, adolescents, and young adults, (Bergsma and Carney 2008) and utilizing many different theoretical bases, which implies that this relatively young field of research has not yet identified an ideal critical age group nor a best practice approach. Research suggests that health-promoting media literacy education interventions may be more effective in preventing unhealthy behaviors than correcting them once they are established (Neumark-Sztainer et al. 2000). As a result, many health-promoting media literacy education interventions are designed to prevent a behavior as opposed to change a behavior. Although most studies of health-promoting media literacy education interventions include some measure of attitudes and beliefs, measures of behavior are not as prevalent, and those studies that do address behavior change report mixed and sometimes incomplete results. In addition, studies often use different scales to measure behavior change, making it impossible to compare them in any meaningful way. Past research in health promotion and education demonstrates that it is more difficult to change behaviors than beliefs. This finding is supported by a recent systematic analysis of health-promoting media literacy education research studies, which showed that the majority of outcomes involved knowledge and attitudes and revealed less about actually preventing or changing risky health behavior (Bergsma and Carney 2008). In addition, few studies in the analysis reported any results of change in behavioral intention, even though the Theory of Planned Behavior clearly identifies it as an important precursor to behavior change. This means that more longitudinal studies are needed to measure, preferably, more concrete behavioral outcomes such as changes in body mass index or changes in daily dietary regimen to include more fresh fruits and vegetables and less processed foods. At the least, changes in behavioral intention should be measured with some follow-up attempt to determine if such behavioral intentions become manifest. Finally, while achieving changes in media attitudes and behaviors is often specifically addressed in health-promoting media literacy education intervention studies with a strong degree of success, there has not been enough definitive research to show that changes in media attitudes and media behaviors result in positive changes in health behaviors. Future Study Recommendations While the research on health-promoting media literacy education is promising, a great deal more study must be done to develop best practices in this field of endeavor. Researchers must continue to develop and test theoretical foundations for health-promoting media literacy education, such as the Message Interpretation Process (Austin et al. 2000) and the Integrated Individual and Interpersonal Model of Health-Promoting Media Literacy Education proposed here (Fig. 1). Successful studies must be replicated. New studies should utilize at least some of the same measurement tools as past ones so that meaningful comparisons can be made (Bergsma and Ferris in press). More tangible efforts should be made to measure actual behavior change resulting from the interventions or, at the least, changes in behavioral intention(s). Finally, because the pedagogical approach utilized in health-promoting media literacy education must be inquiry-based and grounded in critical thinking, not the more traditional health education approach of teacher bestowing knowledge upon pupil, research must pay significantly more attention to how the interventions are taught while continuing to examine what is taught. Future research is needed to examine many aspects of media literacy education that could be responsible for effectiveness, as well as clarify the outcome measures that best demonstrate the efficacy of health-promoting media literacy education. More research that addresses a variety of adolescent public health concerns is greatly needed. Growing the body of rigorous research in this field will help to improve media literacy education and advance it as a useful adolescent health promotion strategy. Cross-References Media Violence Video Games References American Academy of Pediatrics, C. o. P. E. (2001). 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Sage Thousand Oaks. Thoman, E.; Jolls, T. (2005). Medialit kit—Literacy for the 21st century: An overview and orientation guide to media literacy education. Retrieved September 20, 2007, from http://medialit.org/medialitkit.htm. Lynda Bergsma(21) Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N Martin Avenue, Rm A268 Drachman Hall, 245209, 85724 Tucson, AZ, USA Email: lbergsma@u.arizona.edu © Springer Science+ Business Media B.V. 2018 APA citation: Bergsma, L. (2018). Media literacy and health promotion. In R. J. R. Levesque, Encyclopedia of adolescence (2nd ed.). Springer Science+Business Media. Credo Reference: https://ezproxy.gardner-webb.edu/login?url=https://search.credoreference.com/content/entry/sprgstv/media_literacy_and_health_promotion/0?institutionId=5562 Need a different citation style? Find it on Credo Online Reference Service