Communicating about Media Saturated Lifestyles:
A formative case study of a Community Based Media Risk Reduction Strategy

Risk Factors Associated with the Sedentary Lifestyle
It seems paradoxical that the modern risk sciences that enable us to predict and control threats to our well being also produce an immobilizing sense of anxiety that surrounds those threats (Furedi, 1997). In our risk society, consumers are both more aware of the health and environmental risks they face and more uncertain about what they can do to avoid them. This seems particularly true of the myriad daily lifestyle choices related to their children's health that Canadians make in a growing atmosphere of fear, anxiety and confusion. Of these lifestyle risks, some of the most difficult to manage and control are those associated with children's increasingly sedentary lifestyles - especially the time they spend consuming commercial media.
After over thirty years of public controversy, the differential effects of heavy media use on children remain poorly understood. Yet media researchers believe there are two good reasons for linking children's media saturated lifestyles to developmental issues such as the decline in academic achievement, poor reading skills, youth aggression and overweight children (Kline 2000; Anderson et al.,2001; Amisola & Jacobson, 2003; Zuckerman & Zuckerman, 1985), (See figure 1):

1) Because of what children learn while watching or playing; commercials filled with high fat foods and snack foods are commonly seen by children watching television.
2) Because using media can displace other activities like homework, active play, and peer and family interaction which might provide healthier choices for children.

Children who watch less television will obviously be exposed to fewer violent acts and fewer high fat or sugar food commercials, and also influenced less by the idealized and anti-social role models offered in programming and commercials. Moreover, they will have more time to read and do better at school, to play with their peer groups and learn social skills, and to engage in more healthy activities like sports and games.

Media Consumption as a Safety Risk Factor:
Of the various risks discussed in the scientific literature, the media's role in the socialization of aggression has been the most studied, and perhaps the most controversial. In light of available empirical evidence most health professionals now recognize media as a safety risk factor because heavy media use among children is associated with peer aggression (American Psychological Association 2001; American Pediatrics Societies 2001; Huston et al., 1992). But scientists note that the risks associated with heavy media use are not uniformly experienced. Not all children who watch a steady diet of violent entertainment are aggressive or anti-social because media risks interact with other risk factors such as class, community crime and family dysfunction. Because there are so many mitigating circumstances involved in children's media use - such as familial rules, location of technology, modelling, critical dialogue, dietary practice, and activity levels- these media risk factors are hard to estimate and the models of these interactions are complex (Eron, 1996).

For example, it has been established that family guidance can influence the amount of time spent watching, the programming preferences children develop, and their identification with aggressive role models, all of which in turn can contribute to the socialization of aggressive and anti-social behaviour (Collins et al.,1981; Desmond, 1990; Nathanson & Cantor, 2000; Kline & Stewart, 2000).

In this respect, Garbarino (2001) notes that studies of "developmental assets indicate that for asset-rich children, the risk of aggression can be low while among asset-poor children the risk is high."

Assets are found throughout the social ecology of the child, family, school, neighborhood, and community. The rates of significant violence are “6% for kids with 31 to 40 assets bracket, 16% for those with 21 to 30, 35% for those with 11 to 20, and 61% for those with 0 to 10” (Garbarino,2001).

Surgeon General reports:
Risk and opportunity accumulate, which is why, as Garbarino suggests, "an accumulation-of-risk model is essential if we are to understand where televised violence fits into the learning and demonstration of aggressive behavior." Moreover, these community assets imply possibilities of addressing developmental risks through community-based interventions. The Surgeon General's (2001) report summarized the controversial evidence concerning the media's contribution to youth aggression in the following way:
"Research to date justifies sustained efforts to curb the adverse effects of media violence on youths. Although our knowledge is incomplete, it is sufficient to develop a coherent public health approach to violence prevention that builds upon what is known, even as more research is under way. Unlike earlier Federal research reports on media violence and youth (National Institute of Mental Health, 1982; U.S. Surgeon General's Scientific Advisory Committee on Television and Social Behavior, 1972), this discussion takes place within a broader examination of the causes and prevention of youth violence. This context is vital. It permits media violence to be regarded as one of many complex influences on the behavior of America's children and young people. It also suggests that multilayered solutions are needed to address aggressive and violent behavior."

Longitudinal study:
A recent well-designed longitudinal study published in Science confirmed the importance of these environmental factors as predictors of youth aggression (Johnson et al., 2002). Yet these researchers noted that even after controlling for other factors known to contribute to aggressiveness in young people "like childhood neglect, growing up in an unsafe neighbourhood, low family income, low parental education and psychiatric disorders" there remain "significant associations between television viewing during early adolescence and subsequent aggressive acts against other persons" later in life (Johnson et al, 2002). The relationship is strongest among young boys who watch a lot of television: whereas 45% of the boys who watched television more than 3 hours per day at age 14 subsequently committed aggressive acts involving others, only 8.9% of boys who watched television less than an hour a day were aggressive later in life. Unfortunately, because longitudinal studies are expensive, we are only beginning to understand how these various mitigating and disposing circumstances contribute to the media's long-term influence on children's social development.

Media Consumption as a Health Risk Factor:

Health scientists have long known that childhood obesity is one of the least understood but fastest growing health issues around the world (Leung 1994; Deitz 1991; duToit & van der Merwe, 2003; Guldan, 1999). According to recent studies, 25% of American children, 16% of Russian children, and 7% of Chinese children ages 6 to 18 are either overweight or obese (Hope 2002). The child obesity rate is 10.6% in Chile (Guldan, 1999) and 16% in both Thailand and Saudi Arabia (Macdonald, 1999). In Canada, there is escalating alarm at the growing numbers of overweight and obese children identified in health surveys (Tremblay & Willms, 2000; Katzmarzyk, 2002; Andersen 2000; DeMont & Hawaleska, 2002). Stories about the "obesity epidemic" are now featured in the news with increasing frequency and ever growing alarm.
Studies in the USA have revealed significant increases in BMI for children under 4 years of age, especially over the last 10 years (Dietz & Gortmaker, 2001; Flegal, Carroll et al., 2002). Researchers warn that obesity is often associated with "cardiovascular risk factors such as hypertension, high cholesterol levels, and abnormal glucose tolerance" which have sizeable long term consequences for the health care system (Birmingham et al., 1999; Ebbeling, et al., 2002), yet the "immediate consequences of overweight in childhood are often psychosocial" including bullying and depression (Ogden, Flegal et al., 2002). Pediatricians have also cautioned the public that obese children experience an increased risk of diabetes, heart disease, orthopedic problems, chronic inflammation and many other chronic diseases and psychological problems such as negative self-image and low self-esteem (Andersen, 2000; Ebbeling et al., 2002; Kiess & Bottner et al., 2003).

Fast food culture:
Recent authors note that overweight is associated with both physical inactivity induced by childhood fascinations with television viewing and the worldwide promotion of fast food culture. (Jeffery & French, 1998; French et al., 2001; Chatterjee, 2002; Ebbeling et al.,2002; Coon & Tucker, 2002; Schlosser, 2001). Media use can become a risk factor in obesity to the degree children habitually snack while watching, or if their media consumption displaces more healthy and active leisure pursuits (sports, play, work), or if the media exposes them to role models and messages that convey unhealthy lifestyles. Noting that 10% of 2-through 5-year-olds were overweight, while more than 15% of 6-through 19-year-olds were overweight, recent studies suggest that childhood obesity involves learned risk factors that increase with age and is then sustained through life (Ogden, Flegal et al., 2002). Because these rates have increased recently in many developed countries, it is also believed that the obesity epidemic arises from children's increasingly inactive lifestyle and high fat/ carbohydrate diets (Dietz 1996; Dietz 1998).

Sedentary Lifestyles:
A number of U.S. scientists have found evidence that children's sedentary lifestyles are largely linked to excessive media use (Faith, Heo et al., 2001), both in its own right or in interaction with other mitigating familial variables like diet and family modelling which increases the likelihood of inactivity and a high fat and sugar diet among many young people (Taras, Sallis et al., 1989; Anderson, Huston et al., 2001; Crespo, Smith et al., 2001; Burggrat, 2001). Most of this attention is directed to television (TV) viewing, “which has been associated with childhood obesity in both cross-sectional and longitudinal studies" (Faith, Heo et al., 2001). Research conducted by Crespo et al. (2001) has also suggested that "(t)elevision watching was positively associated with obesity among girls, even after controlling for age, race/ethnicity, family income, weekly physical activity, and energy intake". Not surprisingly, researchers regularly find that obesity rates are lowest among children who consume less than 1 hour a day of television. Our own analysis from the Youth Risk Behaviour Survey (2001) of over 13,000 U.S. teens, provides estimates of the developmental risks associated with heavy television viewing: those who view more than 4 hours per day are both significantly less active (sports participation and workouts) and are overrepresented in the overweight group (24.5%), compared with moderate (19.7%) and light (15.2%) media consumers. In Canada too, where children spend 22 hours a week watching television at home, there is escalating alarm that the growing numbers of overweight and obese children identified in health surveys are linked to their media consumption (Andersen, 2000).

Bedroom Culture; Increased access in secluded places:
It is widely believed that the influx of digital media into the home will only amplify the public debates about children's sedentary lifestyles. As Kline and Botterill (2001) note, the trend of placing media in a child's bedroom tends to decrease supervision of media consumption by parents while increasing the amount of time children spend playing, watching and listening. One group of researchers argues that "access to computers increases the total amount of time children spend in front of a television or computer screen at the expense of other activities, thereby putting them at risk for obesity" (Subrahmanyam, Kraut et al., 2000). In the USA there has been growing focus on the presence of media in the bedroom: "Almost 40% of children had a TV set in their bedroom; they were more likely to be overweight and spent more time (4.6 hours per week) watching TV/video than children without a TV in their bedroom" (Dennison, Erb & Jenkins, 2002). Moreover, it has become apparent that the Internet exposes children to new safety risks associated with cyber-stalking and email bullying (Media Awareness Network, 2001). In Canada, 30 minutes using the Internet and an hour of video game play has been added to the 22 hours per week children spend watching TV.

Exposure to Advertisements:
TV is still at the heart of this debate because it remains the pre-eminent channel for children’s marketing. In the course of their entertainment viewing, TV presents children with a constant stream of lifestyle advertising, much of it in children's programming for fast foods, snacks, and sugary cereals (Saelens, Sallis et al., 2002; Lewis & Hill, 1998). By watching TV for 2.3 hours per day, children are exposed to over 20,000 advertisements per year, most of them for snack and fast foods (Gentile & Walsh, 2002). With Channel One beamed into over 30,000 schools, U.S. children are exposed to upwards of 1,000 ads in school. Given current trends in youth marketing of fast foods and video games, heavy media consumption may be expected to compound the inactivity of the digital generation by exposing them to more and more 'unhealthy lifestyle' messages and unsuitable lifestyle models in advertising. Can it be assumed that children under the age of twelve are capable of making risk-informed lifestyle choices when they devour their happy meals and drink their colas (Kincheloe, 2002)?

Impact on Body Image:
The body images projected in advertisements rarely reflect childhood norms (Wolf-Bloom, 1999; Field et al., 1999). As Irving et al. (2002) note: "Children and adolescents may be exposed to conflicting messages regarding food- and weight-related issues from family members and from society-at-large as they are encouraged to maintain a thin body while being exposed to numerous opportunities to overeat (e.g., to 'supersize' a food order at fast-food restaurants)" (Irving & Neumark-Sztainer, 2002). Although the impact of food and diet advertising on children's attitudes, self esteem and behaviour is poorly understood it is generally hypothesized that children who rely on media as their dominant form of entertainment will be less active, exhibit poor dietary knowledge, and develop preferences for high fat and carbohydrate diets. They may also lack self-esteem, have fewer friends and develop inappropriate body images.

Policy Context: limitations in current risk communication:

Since the rapid diffusion of television during the 1950's, the ‘ill effects’ of children's increasingly media saturated lifestyles have been matters of intense public controversy (Barker & Petley, 2001). Yet as in so many cases, public perceptions of lifestyle risks to children are among the most distorted (Kasperson, 1992; Furedi, 1997). One reason is that journalistic coverage of the health and safety risks to children tend to be sensationalized (Sorenson, S. B., Peterson Manz, J. G. et al., 1998). For example, news reporting has tended to overstate the mortality risks associated with spectacular school massacres at Littleton and Taber, while understating the levels of bullying, peer aggression and anti-social behaviour youth face (Maguire, B., Weatherby, G. A. et al., 2002; Dorfman, L., Woodruff, K. et al., 1997). Murray (2001) finds that while news reporting of youth aggression is sensationalized, the actual coverage of the scientific findings about media effects has tended to understate and poorly explain the evidence linking heavy media consumption to peer aggression. Thus the public controversy over media effects serves only to increase the anxiety parents feel about raising their children in a media saturated world.

Failure of Regulations:
In spite of parental support to provide a legislated buffer zone against media violence and children's marketing, the trends are towards growing de-regulation of media and greater responsibility placed on parents to manage those media risks (Kline 1993, 2000). Even much trumpeted technological solutions such as the V-chip have proven of limited value in reducing children's exposure to violent programming (McDowell & Mailtland, 1998; Roberts, 1998). There has been strong public support for regulation of children's advertising (Montgomery, 1998). The European Community, for example, recently considered extending the laws governing the advertising of cigarettes and alcohol products in prime time TV to other product categories like fast foods - or banning children's advertising entirely (Hansen et. al., 2002). However, increasingly, regulation of the promotion of risky products (from cigarettes, spirits, video games, prescription drugs), even to children, finds protection in constitutional guarantees of free speech (Kunkel, 1990). Moreover, because lifestyle risk campaigns (i.e. ‘Speak Out Against Violence’) are mostly distributed through commercial media channels, they can be swamped by popular culture and lifestyle marketing messages. It is hardly surprising, therefore, that although the public experiences deep anxiety about the media, they perceive that very little can be done about the risks associated with their children's heavy consumption, other than regulation (Coulter & Murray, 2001).
Need to examine Media as Risk:
Moreover risk communicators have largely ignored children themselves. Although it was once hoped that media would provide them with a "window onto the world,” fifty years of studying children's media indicates that children growing up in the media saturated household develop patterns of media consumption which are entertainment oriented rather than information seeking. Children rarely follow the news or watch educational programs, preferring to spend their time in front of the television watching drama, general entertainment and sporting programmes. So too, despite initial optimism about the digital generation, it is increasingly clear that the Internet is primarily used by children for entertainment, play and social communication (Media Awareness Study 2001); the information children seek through networked computers pertains to their leisure interest in music, sports, games and celebrity gossip, more than it does to homework assignments or health information. The chat room gossip exchanges are more likely to talk about Britney Spears' clothes than her work-out routine. In short, children's media use is unlikely to help them understand the risks they encounter while using the media.

Communicating about Media Related Lifestyle Risks to Parents and Children

Realizing the magnitude of these lifestyle risks, health promotion professionals have called for high profile campaigns targeting sedentary lifestyles and excessive media consumption to be directed at both adults and children (Klein, Brown et al., 1993). Yet some health educators doubt that the current medical channels for health promotion can be effective on their own. However interested parents are in understanding risks associated with children's sedentary lifestyle, the medical information is available long after their children's media use patterns are well established. Moreover, as Irving and Neumark-Sztainer (2002) suggest, the tendency among medical professionals is to treat media risks in a fragmented way: "Despite the fact that obesity, eating disorders, and unhealthy weight loss practices are cultivated in the same cultural context, for the most part these problems are regarded as distinct, with different origins, courses, and approaches to prevention and treatment." Although "the evidence linking media exposure to these health outcomes is well-documented and accepted by many pediatricians," researchers state "it is troubling that so few pediatric training programs examine the potent risk factors of media exposure" (Rich & Bar-on, 2001). Because pediatric information is directed at parents, they find their children do not always share their concerns about media use.

Social Marketing:
Noting the extensive resources devoted to public health promotion campaigns directed at youth (anti-smoking, anti-drugs, etc.), critics of social marketing approaches have developed campaigns to counteract the sedentary lifestyle risks associated with heavy media consumption using 'subvertorials' (e.g. Adbusters). Yet health promotion professionals know that advertising campaigns are only marginally effective in reducing smoking or drug taking -- which represent lifestyle choices which are subject to peer group pressure (Bloor, 1999). Even high profile campaigns such as the 1994/1995 Canadian Association of Broadcasters' 10 million dollar 'Speak Out Against Violence and the 1996/1997 ‘Violence: You Can Make a Difference,’ have had marginal effect on public attitudes, behaviour or policy. Without funding on a scale of anti-smoking, anti-drug, and AIDS awareness campaigns, it is unlikely that advertising campaigns will prove very effective in reducing media risks, let alone counter-balancing the impact of unhealthy lifestyle information presented in children's advertising.

Risk Communication and Risk Reduction Programmes:
A less tried strategy for risk communication involves the development of risk communication and risk reduction programmes which use community channels for health risk communication (Maccoby et. al., 1977; Dietrich, 2000; Maxwell, 2002; Hanlon & Richards et al., 2002). One study found that increasing physical activity through family involvement was a more effective means of health education: "finding that children who are reinforced for reduced sedentary behavior do not simply substitute one sedentary behavior for another but reallocate a certain portion of time to other physical activities" (Faith, Heo et al., 2001). Other researchers have developed a media education prevention program called "New Moves" which teaches critical viewing skills to girls (Neumark-Sztainer et al., 2000). These researchers suggest that a media literacy/advocacy approach helps children to become critical consumers through discussions of issues like "body dissatisfaction, weight preoccupation, and preferences for high-fat food products, all of which will help to prevent the establishment of unhealthy eating practices " (Irving & Neumark-Sztainer, 2002). Although the programme focuses classroom discussion on the child's eating and lifestyle choices in a way which identifies "role models of all shapes, sizes, and diverse backgrounds...” as well as discussing ways of coping with pressures to diet (e.g., teasing, discrimination based on weight), it also builds social support from family, peers, and others into the learning activities (Irving & Neumark-Sztainer, 2002). This integrated approach targets the peer group as a whole, by helping both unaffected and affected individuals understand eating-related issues, healthy lifestyle choices, and issues of body image attempting to lessen "pressures (e.g., from peers, media, family) to engage in unhealthy behaviors" (Irving & Neumark-Sztainer, 2002).

Dr. Thomas Robinson Media Reduction Intervention:

Recognizing the pivotal role that television and video games increasingly play in children's lives, and the significant costs associated with their related health risks, Dr. Thomas Robinson, at the Medical Center of Stanford University, remarked how little effort has been expended on reducing these health and safety risks associated with media use. Robinson reasoned that if heavy media consumption increases the risks of obesity then reducing use should lessen those risks. His team developed an in-school media education program for young children in grades 3 and 4, which not only communicated about these health risks but challenged children to limit their total media use (films, TV, and video games) during one month. The programme promoted media use time budgeting and selective viewing or playing as well as providing a media education programme that extended over 18 weeks. Early lessons included self-monitoring and self-reporting of television, videotape, and video game use to motivate children to want to reduce the time they spent in these activities. Newsletters designed to motivate parents to help their children stay within their time budgets were distributed to parents ; theses also suggested strategies for limiting television, videotape, and video game use for the entire family.
The Stanford team not only found that this media education program successfully promoted reduced media use resulting in less aggression and bullying on the playground (Robinson et al., 2001) but also noted a slowing in weight gain among test schools where the programme was delivered (Robinson, 1999). In a carefully controlled experiment, these researchers found that at the end of this eight month study, children in the intervention group had reduced their TV viewing by about one-third and their ratings of peer judged aggression were about 25 percent lower than those at the control school. The reduced media consumption school also engaged in about half as many verbally aggressive behaviours - such as teasing, threatening, or taunting their peers - on the playground when compared with students at the control school. Both boys and girls benefited from the intervention curriculum, and the most aggressive students, according to the study, experienced the greatest drop in combativeness. Comparing students in the media education group with those at the control group also showed reduced risk of obesity (measured by BMI and skin fold), although there was no evidence of more active leisure. In short this study demonstrated that targeting media use in the primary classroom provided a viable way of intervening in the cluster of interrelated developmental factors associated with a sedentary lifestyle.
Towards a Canadian Risk Reduction Demonstration Project: Approach and Method:
Robinson's promising research indicates that targeting media consumption through the schools may be a highly effective strategy for reducing the interacting sedentary lifestyle risks to playground aggression, overweight and inactivity among children. However Robinson's pilot study did not address the various other risk factors and mitigating circumstances or community assets that are known to support risk communication as well as reduction. With the help of the Crime Prevention Community Mobilization Fund of Canada, the Media Analysis Laboratory at Simon Fraser University is currently piloting a community risk reduction strategy in North Vancouver focused on improving school safety. This strategy targets elementary children (grades 3-6) because they are in the process of forming their sedentary lifestyle practices, are subject to peer influence, and because parental concern and involvement in media use or its alternatives is highest. The goal of this study is to make children and parents at the pilot schools more aware of media risk factors and more willing to participate in a media reduction week challenge.
We are proposing herein to turn this pilot project into a formative evaluation of a community based media risk reduction strategy that uses educational channels to target families. Our overall goal will be to develop, conduct and evaluate a community health promotion initiative that demonstrates whether family focused community risk reduction strategies can increase parental awareness of sedentary lifestyle risks, reduce the time children spend using media, increase their active leisure and promote healthier eating. The research will be conducted in three stages:
• Stage 1 involves the preparation and analysis of sedentary risks and mitigating factors survey;
• Stage 2 involves the design, production and delivery of lifestyle risk education to parents and students; and
• Stage 3 involves the evaluation of risk reduction treatment based on a comparison of changes in risk knowledge and sedentary risk factors and health status in the target families.

Stage 1: We will begin this project with a risk factor survey that examines the relationship between children's media use and preferences and the various risk factors associated with sedentary lifestyle risks (see figure 2). Of primary interest in this phase of the study will be modelling the contribution of media use, attitudes and preferences to overweight health status indicators (measured by BMI, skin-fold, grades, depression and self esteem), and victimization indicators (bullying, teasing, lack of friends), in relationship to other sedentary lifestyle risk factors (inactivity, dieting, leisure preferences, feelings of hostility, identification with aggressive heroes, fast and fatty food preferences, snacking while watching etc.) and environmental mitigating factors (family style factors including media regulation, modelling, diet, sports participation, health system programmes, etc.). A take-home parental survey will examine the degree to which parents are aware of and concerned about sedentary lifestyle risks to their children and what they are capable of and willing to do about these risk factors.

Stage 2: After this risk assessment phase, the project team will design and deliver a media risk education programme through the test schools chosen from those within North Vancouver district. Since we know that providing information about risks will not necessarily be sufficient to change media consumption, eating and active leisure practices of children, this risk communication strategy will adapt, script and produce 12 media education units (e.g. adapted from Robinson, Bar On, Irving and others) covering safety and health related risk factors (what makes a hero, bully-victim roles, fast food advertising, body image issues, etc.). The delivery of this classroom curriculum will be supported with a sedentary lifestyle risk communication programme for parents, which will be designed not only to communicate what is known about those risk factors, but also what is known about various ways of mitigating these risk factors (such as removing media from the bedroom, enforcing media use rules, stopping snacks while watching, using community resources). Pamphlets and a website will be supported by parental information sessions and workshops discussing family mitigation factors (arranged with the North Vancouver Parent Advisory Council). We will also work with various health and safety agencies to ensure that where possible, community support for alternatives (in public spaces, after school groups, recreation centers as well as sports and fitness groups) are available for children who choose to limit their media consumption practices.

Stage 3: The third stage of the study will include a systematic evaluation comparing pre and post health status, risk factors and family attitudes and practices in our treatment schools.

Dissemination: Our dissemination plan includes not only reporting this result to Health Canada but making the results available to the community, to various audiences including community medicine and health education professionals as well as to agencies and advocacy groups with an interest in reducing media risks (i.e. Media Awareness Network, Media Watch, RCMP, Children's Advertising Board etc.)

Relevance: We believe this project will contribute to Health Canada policy:
1) by gathering new Canadian evidence about the little understood media risk and risk mitigating factors in sedentary lifestyles;
2) by demonstrating to what degree a well designed community risk education strategy (executed with the support of parents, teachers, local media, health professionals and community centres) can communicate about sedentary lifestyle risks to both children and parents; and
3) by assessing the degree to which reduction of various media consumption risk factors can improve the health and safety of children.