Blame it on the vodka
Blame it on the henny
Blame it on the blue top
Got you feeling dizzy
Blame it on the a a a a a alcohol
Blame it on the a a a a a a alcohol

--“Blame it on the Alcohol” music video by Jamie Foxx

There’s no question some adolescents use and abuse substances like alcohol, tobacco and marijuana. But what influence do the media have on their use? And does the answer lead to a prevention tool for pediatricians?

Such questions were raised by pediatric resident Elizabeth Tucker at a recent Hopkins Children’s Grand Rounds. Regarding prevalence, she cited studies reporting that 21 percent of elementary school children and 51 percent of 12^th graders have tried alcohol – the leading cause of death among adolescents – and 20 percent of 8^th graders have tried tobacco, a leading cause of morbidity and mortality among adults. Of today’s smokers, 90 percent began by age 19. Also, 50 percent of adolescents have experimented with marijuana, which is associated with other illicit drug use, poor school performance and depression.

Influences for adolescents include their parents and peers, but also so-called “super peers” – music, television and the Internet. Adolescents spend 8.6 hours a day engaged with such electronic media, and only 1.2 hours a day with non-electronic media like books and magazines. More concerning, said Tucker, is the content. Of movies adolescents tend to watch, 93 percent portray alcohol use and 22 percent reference illicit drugs. On television, alcohol is the number one drug portrayed, appearing on 77 percent of TV episodes, according to the Office of National Drug Control Policy. On music videos, alcohol shows up every 14 minutes.

The context of the portrayals, Tucker added, is the hook for adolescents. Of TV drinking scenes, 33 percent are humorous and involve attractive, successful or influential characters; only 23 percent show negative consequences (Pediatrics 2010 Oct;126(4):791-9).

So, do such scenes increase use? And if so, how?

The literature, Tucker said, does show a dose-response relationship. For example, in a study of ninth graders in six public high schools in San Jose, Calif., each increase of 1 hour per day of television viewing was associated with a 9 percent average increased risk of starting to drink alcohol during the next 18 months, and each increase of 1 hour per day of music video viewing was associated with a 31 percent average increased risk of starting to drink alcohol during the next 18 months (Pediatrics 1998 Nov;102(5):E54).

Similarly, a study of German youth 10 to 16 years of age found that the incidence of trying smoking was associated with increased exposure to movie smoking (Pediatrics 2008;121;e108-e117). Yet another study found that exposure to pro-tobacco marketing and media increases the odds of youth holding positive attitudes toward tobacco use and more than doubles the odds of initiating smoking (Arch Pediatr Adolesc Med. 2006;160:1285-1296). Studies show a dose-response relationship between music and marijuana, too, with adolescents significantly more likely to use if exposure is over three hours a day (Substance Use Misuse 2009;44(5):722-39).

How does this exposure translate into initiation of use or increased use? Adolescents, Tucker explained, haven’t completely formed their own identities, so they’re more likely than adults to be in a state of experimenting and modeling behaviors, of shaping their world based on their observations of the world. In developing their own identity, they look at their peers and their “super peers,” and normalize or incorporate what they see in movies, music and TV into their real lives. If an attractive character on TV drinks or smokes, they are at risk of drinking and smoking, too, even if logic tells them otherwise.

“A strong emotional response to messages can bypass logical thinking,” Tucker said. “Even if you know smoking causes cancer, attractive characters who are doing it may attract you to do it, too.”

How do you cure the disease? Traditional prevention programs like DARE (Drug Abuse Resistance Education) support students’ efficacy in saying no, Tucker said, but they tend to be old fashioned and preachy. Newer prevention programs, including media literacy, are aimed at interrupting the progression from negative to positive substance-use expectancies. That includes strengthening logical responses to media messages, raising awareness of your own emotional responses, improving critical thinking as a media filter, and being an active rather than passive viewer.

In a randomized controlled trial of 12 elementary schools in North Carolina, Tucker said, students who participated in a 10-session media literacy program called Media Detective were better able to deconstruct ads and understand their persuasive intent, and consequently decreased their intention to use alcohol (Pediatrics 2010 Sep;126(3):525-31). In another study comparing traditional and new media literacy prevention programs for smoking prevention, 9^th graders in the Media Detective group reported they were more media literate and better critical thinkers, yet they were not more likely to change behaviors (Health Educ Res 2009 Aug;24(4):608-21).

Is this strictly an academic issue? What can pediatricians do?

“This is more of a public health issue than an intervention for pediatricians, but it’s good to know there’re all these images out there influencing adolescents,” Tucker said. “Pediatricians can certainly talk to patients with substance use issues and find out what they do for fun, what kind of music and movies they like. They can help raise media literacy for their patients and families."