Monday, Nov. 3, 11 a.m. ET

Teen Sex and Television

Rob Stein
Washington Post Staff Writer
Monday, November 3, 2008; 11:00 AM

Washington Post staff writer Rob Stein and Anita Chandra, a researcher at RAND Corp., was online Monday, Nov. 3 at 11 a.m. ET to discuss a new study being published today in the journal of the American Academy of Pediatrics.

A transcript follows

The report shows that teenagers who watch a lot of television featuring flirting, necking, discussion of sex and sex scenes are much more likely than their peers to get pregnant or get a partner pregnant. Read more in today's story: Study First to Link TV Sex To Real Teen Pregnancies (The Post, By Rob Stein).


Rob Stein: Hello everyone. Thanks very much for joining us today to discuss this very provocative new study about sexual content on TV and teen pregnancy. Before we get started, I wanted to thank Anita Chandra of the RAND Corp., who led the new study, for joining us today for this discussion. I see we already have questions waiting for us. So we'll get started.


I wonder...: I wonder if during the study you took into account the general lifestyles of these teens outside of their TV and sex habits? Because half a dozen years ago when I was at a fairly typical large-suburban-public-school, it often seemed like the kids who were involved in lots of sports or after school activities, were a lot less likely to brag and advertise the fact if they were having sex. And, it seemed like the people who always were pregnant were the ones who weren't involved in anything and didn't try very hard. I think maybe the people with a lot going on in their lives, and who probably were to busy to watch much TV anyway, were more careful because they had more to potentially screw up. Whereas the kids with less to do, that had lots of time to sit in front of the TV, probably worried less about their future and what effect their behavior could have and therefore were probably less cautious. I'm not saying those other kids didn't have sex, but they did have reputations to uphold, and having a baby in school wasn't part of that reputation, regardless of how much TV they watched.

Anita Chandra: Thank you for your question. In our study, we did try to account for factors such as grades (as an indicator of school achievement),other risky behaviors (such as skipping school, other delinquent behavior) and educational aspirations, and we still saw a link between watching this type of television and a later teen pregnancy. However, your point is well taken. We know from many years of research on teen pregnancy that youth who feel like they have opportunities for their career/educational attainment may be more likely to avoid a pregnancy during adolescence.


Arlington, Va.: Doesn't this study highlight the woeful lack of real, comprehensive sex education in this country?

Anita Chandra: Dear Reader:

Our analysis did not examine the role of sex education--abstinence only or comprehensive- so we do not know the role this education has on the risk of a teen pregnancy. What we can say is that if teens are getting any of their information about sex from television, they are rarely getting discussions of potential outcomes such as pregnancy and sexually transmitted diseases.


Arlington, Va.: Maybe I missed it, but I didn't notice the usual caveat used with empirical studies. Watching sex on TV does not necessarily cause an increase in the probability that teens will get pregnant, rather it's correlated with it. It's possible that teens who might be more inclined to get pregnant are attracted to televisions shows involving sex, no?

Anita Chandra: Dear Arlington, Va.:

Thanks for your question. Since our study was longitudinal, we were able to establish a prospective link between exposure (sexual content on television watched during the first or baseline survey) and the outcome (subsequent experience of a pregnancy). One strength of the study is that it was not cross-sectional. However, we do note in our study that there are many factors that contribute to the risk of a teen pregnancy, and we are by no means saying that TV is the only factor. However, after accounting for other known risk factors including interest in having a teen pregnancy, high levels of sexual content viewing still remains linked to a subsequent pregnancy. Now that we have demonstrated this prospective link, it is important to examine how teens are processing the messages they do get and understand how it may shape their sexual attitudes.


PG County, Md.: Many have commented that the "correlation" identified in the study does not suggest (technically) that watching sexual situations on TV causes teens to engage in increased sexual activity. Have there been efforts (other than common sense) by researchers to try to identify some sort of causation mechanism between TV and behavior? Controlled experiments in this area seem impracticable.

Anita Chandra: Dear PG County Md.:

Since the study was longitudinal, we were able to demonstrate a prospective link between watching this type of television content and a later or subsequent teen pregnancy. We acknowledge that there are many factors that contribute to the risk of a teen pregnancy, but our findings suggest that even after accounting for these other factors, TV plays some role. Now that we have demonstrated a link, the next step is to try to understand why this link exists. For example, it could be that because television rarely highlights risk and responsibilities of sex, it may encourage teens to engage in sex before they can make informed decisions. Asking teens about their reactions to the sexual content on television and how it shapes their attitudes about sex should be the next avenue for research.


Washington, D.C.: Did the study show if a minority is more likely to become pregnant?

Rob Stein: The researchers did find that African American teens did have a higher risk for pregnancy, reflecting what a lot of previous research has found. But they weren't able to explore whether TV viewing affected different racial groups differently.


Arlington, Va.: Correlation doesn't prove causation. Is it likely that the kids who watch these shows are predisposed for some other reason to sexual activity?

Rob Stein: That is a concern that several other researchers I interviewed mentioned. And there's is no way to be sure that this is a causal effect. But the researchers did take a number of factors into consideration to try to rule out other explanations. They also feel like the findings are at least supportive of a causal relationship because they were able to follow the subjects over time.


Philadelphia, Pa.: Does the study look at a control group? How do we know that young people who are interested in ultimately having sex aren't more interested in watching show about sex than are other young people, and that is why they match more of such shows?

Anita Chandra: The study does not have a control group, but we were able to compare kids who watched the least amount of sexual content on television with those who watched the most. And we see an increasing risk of teen pregnancy among those who watched the most. Further research will need to examine what motivates teens to watch this kind of content. In our study, we accounted for other risk factors for pregnancy such as desire to have a pregnancy before age 22, and we still saw a link between watching televised sexual content and becoming pregnant as a teen.


Burke, Va: I'm extremely skeptical about the ability of studies like this to separate cause and effect. Doesn't it make sense that teenagers who are more sexually active will be more likely to watch television with sexual content? How do you know which is the cause and which is the effect?

Rob Stein: Yes, that's definitely a concern. And it's true that this study could not rule that out. The researchers did, however, account for a variety of other factors associated with teen pregnancy in an attempt to take that into consideration. And the fact that they followed the teens over time gives them more confidence in the findings.


Silver Spring, Md.: I can tell you even without having done a study, that kids who fill their days watching sexual content will act out sexually. The question is, are parents willing to do what's necessary to stem this tide? Even ultra conservative Sarah Palin excuses her daughter's behavior and then congratulates her; the girl is about to give birth without being married, and the baby's father is a high school dropout. Why can't we get the message out to delay sexual activity until college or after and have children ONLY after starting a solid career? If a high profile politician isn't willing to do it, how can ordinary parents do it?

Rob Stein: Interesting that you raise Sarah Palin. I'd be curious what folks think about what kind of message folks think her daughter's pregnancy sends.


Baltimore, Md.: Rob,

Your colleague Lisa De Moraes always crows when there's a perception of 'censorship' of risque material on TV; she has called people prudes for having a problem with some programming. This seems to confirm that maybe there should be a reason Standards and Practices exist in TV land (such as it is). Yes, it's up to parents to control the remote, but what does that say about broadcast TV? Shouldn't the networks bear some of the responsibility too?

Rob Stein: I spoke to Jim Dyke of the group Television Watch, which was set up and is funded by television networks. His argument is that parents who are concerned about this issue have the power to do something about it. They can use the V Chip and similar technology to block any programs they think are inappropriate for their kids.


Washington, D.C.: So when is the article coming out that rap music encourages violence too, because it does.

Rob Stein: Well, there has been previous research about music videos and earlier initiation of sexual behavior. And, as you probably saw, there was some related research published with this study about violent video games and agression that my colleague Donna St. George wrote about:

Study Links Violent Video Games, Hostility: Research in U.S., Japan Shows Aggression Increased... (Post, Nov. 3)


Lake Ridge, Va.: I believe that U.S. teen pregnancies are at a modern era low point, while sex on TV is surely at an all-time high. So how can one be the cause of the other?

Rob Stein: It's true that even pregnancies have been falling for many years. That's probably due to a mix of reasons, including all the emphasis on safe sex because of AIDS. But there was some disconcerting data recently that suggested that the teen pregnancy rate may have started to inch up again. Researchers are waiting for another year's worth of data to see if that was just a fluke or the start of a real increase. If so, it would come at a time when some research shows there's been an increase in sexual content on TV.


Washington, D.C.: I am very puzzled whenever I hear all this debate about "Sex on TV" in America. As someone originally from Europe, I have never seen any nudity or provocative sex scenes on American TV (with the exception of premium channels like HBO and Cinemax, which only a minority of Americans subscribe to, something like 25%, and it's entirely their choice). In contrast, if you look at Europe, nudity is commonplace on all mainstream public channels. Yet Europe is not even remotely feeling any kind of self-doubt or worry on this subject. America, on the other hand, whose TV is already puritan to a remarkable degree, is constantly debating. What gives? And how do European children manage to grow into healthy, normal adults?

Anita Chandra: Dear Washington D.C.:

This question is interesting, but a bit further afield of what we looked at. We didn't study the content of media(television) in Europe, so we cannot explain why we see differential rates of teen pregnancy. We certainly don't have the same nudity content but we do know that US television rarely highlights the risks related to sex or responsibilities around sex, and this type of programming may not give teens the information they need to make responsible decisions.


London, U.K.: Did you study take into consideration 'safe' sexual activity among those teens watching more? Sexual activity is fairly broad -- people can do a lot that won't lead to pregnancy even if they aren't using condoms. Were teens who watch a lot of television just more likely to have sex without the protection of some sort of birth control? And would that have changed it the television shows focused on safe sex more? (And if so, shouldn't that be the responsibility of the teenagers' parents?)

Anita Chandra: You are right that sexual activity is broad, but we focused on sexual intercourse (sex that could lead to pregnancy). We were unable to get complete information from teens about the contraception that they used. We hope to look at that in our next study since it may be that teens who watch more sex on television use less contraception. We know that TV rarely shows information about contraception or safer sex.


Skeptical: Is it not possible that this is a symptom rather than a root cause? Isn't it possible that teens who watch more sexual content on TV are also teens whose parents take less of an interest in their lives--and that the reasons they have sex earlier is not because they see it on TV, but because their parents and other adults around them don't educate them (and the reason they watch more sexual content is because their parents don't pay much attention to them in general, and specifically to what they watch)?

There were higher rates of teen pregnancy in the 70s and 80s than there were in the 90s, and there was much less sex on TV during the 70s and 80s. There was also more hesitancy in families to talk to their kids about "adult" issues during that time. I'm sorry, I just think this article and the title is a bit misleading.

Rob Stein: That's definitely a possibility, and one that several other researchers I interviewed mentioned. The RAND team did try to account for that by taking into consideration factors known to be associated with an increased risk for teen pregnancy, such as whether they come from a one-parent or two-parent household.


Richmond, Va.: Did the study follow up with those students who reported a pregnancy to discover how many of those were carried to term and how many were terminated? I went to high school in McLean, and for the 4 years I attended, only one student was openly known to be pregnant. I don't suspect that this was because everyone else was too concerned about the consequences of bad decisions to get pregnant, just too concerned about the ramifications of actually carrying that pregnancy to term.

Anita Chandra: Dear Richmond:

We did ask teens to share if the pregnancy resulted in a birth, abortion, or some other outcome. In our study, about 25% of our teens who got pregnant had an abortion. But, we did not focus on pregnancy outcomes in our study. We hope to look at this in any follow-up studies.


McLean, Va.: Dear Anita and Rob,

What about confounding factors? I have read research (though can't cite references) that girls whose fathers are present and involved are less likely to become pregnant as teens.

What do you think?

Thank you

Anita Chandra: Thanks for the question. We did include factors like living in single parent household in our study. Teens living in a 2-parent household are less likely to get pregnant. But, there are a lot of factors that contribute to the risk of a teen pregnancy.


Alexandria, Va.: If I watch steady TV diet of the 3 CSI's, Law and Order, Life on Mars, Cold Case, and NYPD Blue reruns, will I turn into a Police Detective?

Anita Chandra: That would be a great experiment--Let us know how that turns out


Washington, D.C.: For Baltimore: as a childless adult, why should my entertainment choices be dictated by what a standards and practices board, over which I have no say, decides is appropriate for children to see? Parents have numerous ways to control and/or monitor what their children see -- up to and including flat-out not having a television.

Rob Stein: That's certainly the argument that a lot of folks make, and the researchers said that one of the implications of their findings is that parents should consider monitoring what their kids watch and talk with them more about what they see.


Reston, Va.: Sarah Palin did the only thing she could at that point: love her daughter. I can't see how publicly bashing her daughter would help matters. The Palin's are people of means and as a family certainly seem capable enough to raise the daughter's child. I don't recall Sarah Palin saying that it was a great thing that her unwed, teenage daughter got pregnant. But, she has dealt with the reality of the situation. I know that if my teenage daughter came home pregnant, I would be quite upset at her. But I would love her and support her any way I could, because both my daughter and her baby would need that love and support.

Rob Stein: I was less interested in bashing anyone and more interested in whether folks think public cases like that influence other teens' behavior.


Cambridge, Mass.: I'm stunned that the authors of this study are presenting the results as if there were a causal effect of television sex on teen sexual behavior. Should we be at all surprised that teens who are more interested in sex would watch shows containing a lot of sex? (I guess I'm echoing the Guttmacher Institute scholar.) Surely if we did a study of adults, we'd find that adults who watch shows about politics were also more politically active. Would we even think about making the same audacious claims about the possible "effects" of TV? No, we wouldn't. As a proud member of the "randomistas," this strikes me as another observational study oversold to an eager media. To Rob Stein: please read an introductory book on causal inference before reporting that a study like this one shows "effects." It doesn't, and the presence of a strong association doesn't mean that we're more likely to find a causal effect. Though I don't doubt that policy makers will eat it up.

Anita Chandra: Dear Cambridge:

We did not use words like causation in our study. Rather, we only demonstrated a prospective link (exposure to TV sex preceding the outcome of a teen pregnancy). This is one hallmark of establishing causation, but it is by no means the only criteria. We know that there are many factors that contribute to the risk of teen pregnancy, and TV is by no means the only factor.


Washington, D.C.: I don't get it: how do you make the leap from correlation to causation in this case? It's hardly surprising that teens that watch TV -- particularly trashy TV -- are more likely to have sex, but it seems the "cleanest" interpretation is that bored teens with no direction, and little familial guidance make poor decisions of all kinds. TV viewing is simply another symptom.

Anita Chandra: Thanks for this question. Our study was able to follow teens over time, so we could demonstrate a prospective link (not merely a correlation) between watching lots of sexual content on TV and later experiencing a teen pregnancy.


Baltimore, Md.: Where's teen sex in the study? -- that is, sexual behavior that didn't result in pregnancy?

Rob Stein: The "sexual content" included in the study included intimate touching, scenes that actually showed sex and people just talking about previous sex or plans for sex in the future.


Baltimore, Ms.: TV is hardly homogeneous. Does the study investigate in any fashion the content of the shows cited as leading to - in some loose fashion - increased rates of teen pregnancy? It is hard to imagine the banal form of (hetero)sexuality represented by "Friends" has the same effect as a show like "Sex in the City." Were qualitative questions like this considered in the analysis of the data, or in the construction of the questions posed to the research subjects?

Rob Stein: The study involved a detailed analysis of the sexual content of shows and how much kids were exposed to over time. So they could get a rating of having been exposed to a lot of sexual content by seeing a little bit of sexual content in a lot of different shows or by watching just a few shows with a lot of sexual content, like Sex and the City.


Fairfax, Va.: This is surprising? Even furred and feathered animals learn things from watching like creatures. Visual aides in a highly-sexualized society without "traditional" societal restrictions (such as chaperone's, or stigmatizing sexually active unmarried's, or out-of-wedlock births) of course this is going to happen! Why does our culture only accept common sense when a "researcher" confirms it? Gee whiz guys.

Anita Chandra: Thanks Fairfax. But, sometimes "common sense" has said that TV can't possibly have any effect on teens. So, we need good evidence before we waste a lot of time and resources to help teens make better decisions about sex or ask TV networks to change the way that they present sex in their shows.


Abstinence education: "Why can't we get the message out to delay sexual activity until college or after and have children ONLY after starting a solid career?"

Because it's unrealistic and ineffective? Humans are animals with powerful sex drives and teenagers are impulsive. You can't disarm their sex drives (they will only lie to you and sneak out) but you can arm their impulsiveness with education on how to keep their bodies safe.

Rob Stein: That's the crux of the debate over "comprehensive" sex education and programs that focus on encouraging abstinence. Proponents of comprehensive programs argue that teens need to have information about effective contraception so that if they do become sexually active they can protect themselves against sexually transmitted diseases and unwanted pregnancies. Proponents of abstinence programs argue the best protection is abstinence.


Virginia: Did you look just at the US or also in Europe? There seems to be less concern about nudity in particular in Europe and there is sex and nudity on TV. Just wondering if the finding is limited to the US and, if so, whether there is any discussion about trying to examine Europe and other countries to see if the influence is global or just in the US?

Rob Stein: This study focused exclusively on U.S. teens. That's a good question about whether anyone plans to do some comparative work in other countries.


Washington, D.C.: I am a Public Policy student at the George Washington University and am very interested in your study. Is there any way for me to view your entire study without a subscription?

Rob Stein: I just went online and it appears you can get the abstract:

Watching Sex on Television Predicts Adolescent Initiation of Sexual ... (PEDIATRICS, Oct. 31)


Boston, Mass.: Thanks for coming online. Did you look at all at the relationship contexts of sexual relationships? If there was any further correlation between watching more sex on TV and teens who were actively "hooking up," or if they were engaging in more conventional boyfriend/girlfriend relationships, depending on how much TV and the kind of content?

Rob Stein: The study involved more than 2,000 teens, but focused on the 718 who were sexually active. I don't think there was any additional information available about the nature of their relationships.


So...: How much television does Bristol Palin watch?

Rob Stein: You got me. Anyone know if the Palins have cable?


Madison, Wisc.: In your study, 571 teens were not sexually active. That is more than 1/3 of the participants who did not drop out. How much sexual content on TV did they watch? Due to their abstinence, we know that 0% became pregnant or were responsible for a pregnancy. So what percentage of those teens were exposed to sexual content on TV?

I do not think it is appropriate to omit these abstinent teens from your results. By omitting this entire group, you are omitting a segment of teenagers who had high exposure to sexual content but continued to be abstinent. By ignoring these students, you weight your study toward implying that viewing more sexual content causes teens to get pregnant more frequently, which still may be true -- but your statistics are weighted toward implying it has a greater effect than it actually does.

Anita Chandra: For this study, we only studied sexually active teens because they are the only ones who could be at risk for a teen pregnancy. We wanted to see if television had a role among this group of teens only, and found that those who watched more and were sexually active were more likely to experience a pregnancy than those who watched less and were sexually active. Earlier RAND research looked at all teens (abstinent or not) to see if television was related to earlier initiation of sexual intercourse, and we demonstrated that link.


Boston, Mass.:

The study suffers from so many problems that it is difficult to know where to begin. First of all, the study does not, indeed cannot, show that watching sexual content on TV leads to teen pregnancy. The study only looks at whether there is a correlation between sexual content of TV viewing and subsequent teen pregnancy. As anyone who has studied statistics knows, correlation is not the same thing as causation. Two independent events might appear to be correlated, but that does not mean that one caused the other.

Even if the authors had shown a causal relationship between viewing sexual content on television and teen pregnancy, that would not tell us which was cause and which was effect. The authors claimed that viewing sexual content led to pregnancy, but it is equally likely being sexually active led teenagers to prefer sexual content compared to their sexually abstinent peer.

The study suffers from major technical problems. The study was based telephone interviews of teenagers and relied solely on their honesty, accuracy and recall; teenagers are not noted for their honesty, accuracy and recall. Three separate interviews were conducted at predetermined intervals over 3 years. More than 1/4 of the participants dropped out of the study, and the authors simply ignored them. However, those who dropped out of the study might have differed in significant ways from those who remained in the study, and their absence may have led to erroneous findings.

Of the 1461 teens who remained in the study, 146 (fully 10%) refused to divulge whether they were sexually active. The authors simply ignored them. Of the remaining 1315 teens, 571 (43%, or almost half) were not sexually active at all. The authors simply ignored them, too. That is a very bizarre way to handle the data. At a minimum, the 571 teens who were not sexually active should have served as a control group for the sexually active group. How much sexual content did the abstinent teenagers watch? Was it the same amount as the sexually active teenagers? We don't know, although the authors do know and chose to keep that information to themselves.

In the end, the authors looked at the television viewing habits of those teens who did not drop out of the study, were willing to divulge their sexual status, and claimed that they were sexually active. After eliminating those who refused to divulge whether or not they had been involved in a pregnancy, only 718 teens were left of an initial group of 2003 that had started the study. In other words, the authors only looked at 36% of study participants (all of whom were sexually active) and ignored the other 64% (including everyone who was not sexually active).

By deliberately excluding teens who were not sexually active, the authors severely damaged the credibility of their study. Unless they could show that abstinent teens were much less likely to watch sexual content on television, they cannot claim any relationship between television viewing and teen pregnancy. The fact that the authors deliberately left this data out of their study strongly suggests that it does not show that abstinent teens watch less sexual content on television. Indeed, I would not be surprised to find that the authors set out to investigate a connection between watching sexual content and likelihood of sexual activity, but found that there was no relationship at all. Instead, they were reduced to concocting a spurious relationship between sexual content on television and the likelihood of pregnancy among teens who were already sexually active.

Does watching sexual content on television lead to teen pregnancy? We don't know, and this study certainly does not tell us.

Anita Chandra: Please refer to an earlier post with some answers to your questions. In this study, we were only focused on teens who were sexually active during our study period because these are the teens who could be at risk for a pregnancy. Earlier RAND research looked at all teens in our study sample (abstinent and not) and showed that watching more televised sexual content was linked to earlier initiation of sexual intercourse.

In our study, we examined the characteristics of teens who dropped out of the study, which we discuss in our limitations. We know that more teens whose parents had higher educational attainment left the study earlier, but we accounted for this in our analysis.


Baltimore, Md.: The "detailed analysis" that the sexual content of the programming in question still sounds to me like it was exclusively quantitative, a matter of a stopwatch, determining "minutes" of sexual content across shows. Is that the case? Might it matter that these shows portray sex and sexuality differently?

Anita Chandra: For this analysis, we first wanted to demonstrate if there even was a link between watching these shows and the risk of a later teen pregnancy. We hope to delve more deeply into the types of messages that may shape teens' attitudes about sex. But, we should note that we coded television content for references to sexual talk and behavior.


Rob Stein: Well, that hour certainly flew by. Thanks so much to everyone for joining in. Sorry to those whose questions we didn't get to. But I'm sure this is a subject we'll be coming back to again. Thanks again to Anita Chandra from RAND for taking the time to help out this this.


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