T e l e v i s i o n V i o l e n c e a n d Its Effect o n C h i l d r e n
Merrilyn O. Johnson, MSN, RN
Television (TV) has become a large part of children's activities. Much discussion exists as to the level of violence on TV programs and its effect on children's behavior. This article reviews the literature, discusses social issues, and presents some interventions available to nursing professionals to assist children and families in coping with the impact of TV on children's lives. Copyright 9 1996 by W.B. Saunders Company

For some children under some conditions some television is harmful. For other children u n d e r other conditions it may be beneficial. For most children under most conditions most T V is probably neither particularly harmful nor particularly beneficial. Schramm, Lyle, and Parker (1961)

ago, the A LTHOUGHasWRITTEN 33 yearswas then. above quote on television (TV) viewing and children is relevant today as it Does watching violence on TV increase or alter the antisocial or aggressive activity of children? The possibility that widespread watching of violent TV programs by children and youth is increasing the level of violence in American society continues to be the most controversial and emotionally arousing issue related to the TV medium. This is because the concentration of violence portrayed on TV has the potential of generating aggressive behavior, both immediately and in the long term (Joy, Kimball, & Zabrack, 1986, cited in Williams, 1986).Aggression in this instance refers to physical aggression with the potential to injure as well as verbal abuse, including threats. TV may affect its viewers in two possible ways: by displacing other activities and through its content (Williams, 1986). American TV contains the most violence of TV in any Western country (Dietz & Strasburger, 1991). Violent

From the Nursing PhD Collaborative Program, Medical University of South Carolina, and the University of South Carolina, Columbia, SC Address reprint requests to USC/MUSC PhD Collaborative Program, MUSC College of Nursing, 171 Ashley Ave, Charleston, SC 29425. Copyright 9 1996 by W.B. Saunders Company 0882-5963/96/1102-000353. 00/0
94

content has not changed appreciably in the past decade despite increasing public awareness and concern. Unfortunately cartoon shows and prime-time programming glorify the use of guns and violence as acceptable, justifiable solutions to complex problems (Dietz & Strasburger, 1991). Ninety-nine percent of American households contain at least one TV, with two thirds containing two or more sets (A.C. Nielson Company, 1988). Children and adolescents comprise between 10% and 20% of the prime-time viewing audience, and they spend more time watching TV (15,000 h) than they do in school (11,000 h). During this time they witness 180,000 murders, rapes, armed robberies, and assaults. In 1989, the average child in the United States spent more time watching TV than performing any other activity except sleeping. The Nielson Report on Television (1989) commented that children age 2 to 5 years viewed approximately 27 hours of TV/wk, children age 6 to 11 years viewed more than 23 hours of TV/wk, and adolescents age 12 to 17 years viewed 22 hours of TV/wk. By the time today's children reach 70 years of age, they will have spent 7 years of their lives watching TV (Dietz & Strasburger, 1991). TV therefore represents an influential force in the lives of children and adolescents. Many variables are involved in the relationship between viewing violence on TV and actual aggressive behavior. Significant developmental and gender variables, family background and attitudes, the viewing context, and the quality and nature of the child's other experiences, as well as his or her perception of TV portrayal, are all important factors that influence TV's impact. Other factors that affect the likelihood
Journal of Pediatric Nursing, Vol 11, No 2 (April), 1996

TELEVISION VIOLENCE

95

of an individual actually performing an aggressive act are characteristics of the viewer, state of arousal, whether the behavior is reinforced, nature of the TV stimuli, and the environment, including the perceived similarity between the observed environment and the viewer's actual environment (Comstock, 1976).

BACKGROUND LITERATURE
Parents and social critics express concern regarding the possible negative effects that TV viewing has on children. TV influences children, but in what ways and to what extent is the subject of much debate. The research in this area has focused on the relationship between viewing violence on TV and subsequent aggressive behavior. Numerous researchers have examined media violence in many countries using different methods, providing a degree of consistency of results. A small but genuine association appears to exist between media violence and aggression (Heath, Bresolin, & Rinaldi, 1989). Children are great imitators. Infants as young as 14 months have shown significant and deferred imitation of televised models (Meltzoff, 1988). Bandura postulated that children can learn aggressive behavior from watching characters on TV. His social learning theory suggests that humans learn ways of behaving, as well as appropriateness and effects of behavior, directly from observing real life as well as indirectly through the mass media. Bandura's contention is that the most effective way to teach children desired behavior is to demonstrate the behavior and have the children model it. Thus, in his classic 1963 "Bobo doll" experiments (Bandura, Ross, & Ross, 1963), young children were exposed to televised films in which an adult behaved aggressively toward inflated dolls (Bobo dolls). Children who had viewed this film played more aggressively with a Bobo doll than did children who had not seen the adult model. The conclusions of the Bobo doll experiment were further validated by Steur, Applefield, and Smith (1971) who found that nursery school children who watched violent TV programs during their breaks displayed more aggression on the playground than children who viewed nonviolent programs. College students also showed more aggressive behavior when exposed to a segment of violent film as opposed to not viewing a film or viewing a neutral film (Berkowitz & Rawlings, 1963). These experiments support the notion that a relationship indeed exists

between viewing aggressive behavior and acting aggressively, particularly if the TV aggressor is rewarded for the act. However, some research reviewers have drawn different conclusions from early research findings, suggesting that no significant effect was found between violence on TV and aggression (Hearold, 1986). Feshbach & Singer (1971) even suggest that exposure to aggressive TV content reduces aggressive behavior in some types of children. Commenting on this latter study, Singer (1989) pointed out that the study was marred by procedural flaws that biased and invalidated the findings. Cook, Kendzienski, and Thomas (1983) argue that there is less consistency of results regarding TV violence and aggression than claimed and that biases may have inflated past estimates. They contend that TV's role is probably small compared with other socialization factors. Several studies have produced evidence that the introduction of TV increases the level of aggression in the community. Centerwall (1992) compared homicide rates in the United States, Canada, and South Africa and was able to show that homicide rates increased predictably after the introduction of TV to a community. This effect was maximal 10 to 15 years later. Earlier studies in Canadian towns with varying exposure to TV showed that a cohort of first- and second-grade students had an increased rate of aggression in the 2 years after introduction of TV compared with two control groups (Joy, Kimball, & Zabrack, 1986). Singer, Singer, and Rapaczynski (1984) studied elementary school children for 5 years and found on parent report that TV viewing was a major predictor of physical aggression. A longer-term study shows even more disturbing information. Findings of a study of 875 boys from a semirural US community followed up for 22 years strongly indicated that violence viewing at age 8 years significantly predicted a link between exposure to TV violence at age 8 and antisocial behavior 22 years later (Huesmann, Eron, Lefkowitz, & Walder, 1984). Reviewing the literature in 1989, Heath, Bresolin, and Rinaldi examined studies for behavioral and attitudinal effects of media violence. They looked at laboratory and field research and concluded that the relationship between exposure to media violence and aggressive behavior appeared to be fairly consistent across studies, but methodological weaknesses

96

MERRILYN O. JOHNSON

introduced bias in favor of this conclusion. The researchers emphasized the importance of the "perceived reality of the message" and discussed the lack of realistic consequences for violence shown on TV. They commented on the difference in viewer response where there was a match between personal experience and the media depiction of violence, as this may reinforce violent behavior patterns. They reviewed intervention programs and found that efforts at training parents and children had not been helpful. This article provoked a letter from Gadow and Sprafkin (1990) who believed that the correlation between aggression in the media and viewer aggressive behavior had little support. Earlier, Gadow and Sprafkin (1989) had examined 20 field experiments to determine the short-term effects on children's behavior of viewing aggression-laden TV shows. Careful analysis, taking full account of design patterns of these studies, showed that more antisocial behavior occurred after viewing aggressive content on TV. However, there was a significant increase in antisocial behavior after viewing low-aggression or nonaggressive TV as well. They discussed this as a nonspecific arousal response to the medium, concluding that watching wholesome TV may not ameliorate conduct problems. The researchers commented that "television's ability to produce increased levels of social activity (both appropriate and negative) is controversial" (p. 404). Comstock and Strasburger (1990) recommend further research of the scripting of TV programs and of interventions that may assist children in coping with them. In closing they say that competition among media ensures that the amount of violence in television, as well as in films, will not be lower in the future. In fact, it may become even greater in graphicness and ferocity. Intervention and remedy therefore, fall to parents, the school, and the community" (p. 42).

In the 4 years since this article was written, we indeed have seen an increase in the phenomena of violence such as Schwarzenegger's "Terminator" movies, "Power Rangers," and the "Ninja Turtles" movies and TV shows. Testimony to Senate hearings in 1993 indicates that many members of the public have concerns about the increasing violence depicted on T.V. (Testimony of Judith Myers-Walls and Ken Auletta, 1993). The community has responded by requir-

ing warnings before violent programs on TV; however, at present no data are available to show any effect of these warnings. The recent growth of cable TV and video movie rentals has increased the number of potential sources of positive and negative programming that may be viewed by children. Competition for a share of the audience appears to have led to greater exploitation of sex and violence in shows on TV. However, there is continued debate as to whether exposure to such programs is universally damaging to children. After analyzing the public debate, court decisions, and scientific consideration of cause and effect, Lande (1993) warns that the role of the viewer is pivotal and that the focus of research should shift to identifying and describing the vulnerable viewer. This concern about features that make an adaptive response to violence difficult is also evident in an article on real violence by Groves, Zuckerman, Marans, and Cohen (1993), and the ensuing correspondence (Butler, 1993; Kosta, 1993). One group that can be considered to be at intensified risk are the individuals suffering from major psychiatric illnesses. In a forensic hospital the elimination of Music Television (MTV) cable programs from units led to a significant decrease in the frequency of overt aggressive behavior (Waite, Hilbrand, & Foster, 1992). It was postulated that the removal of MTV withdrew a source of cues and arousal for aggressive behavior. These dynamics, observed in adults, are consistent with the experiments of the Bobo dolls in children, and this study may be reasonably projected to the pediatric viewing group because they lack the internal capacity to modify their responses to the stimulus of programs like MTV. The "Beavis and Butthead" controversy also arose because MTV claimed that the satirical quality of the writing could not be recognized by the children and the blurring of the distinction between real and imaginary was claimed to have produced some negative behaviors in children viewing the program. It must be noted that although many concerns are voiced and anecdotal incidents cited, no research has been done on the effect of "Beavis and Butthead" on young children. The group of children who have little parental input and are "amoral quick learners out there eager to act out any new TV excitement" represent a group who are at high risk for viewing related violence because "Their teacher

TELEVISION VIOLENCE

97

is a television set" (Coleman, 1993). Modification of their viewing habits and responses to programs will require specific targeted approaches that need to be further developed. Collaboration of educators, psychiatrists, sociologists, pediatricians, nurses, and other health professionals is desirable in this circumstance, and because health care professionals and teachers are consistent "parental-like" figures and are dispersed in the community, this is an acceptable teaching role for nurses. As evidenced by the review of literature, there are much conflicting data on the influences of media and TV violence. However, it seems to be in the best interest of the child to restrict access and exposure to media violence. Despite many efforts of public and professional groups this is difficult to achieve, particularly within the political system of the United States (Anonymous, 1994). If exposure cannot be restricted, then careful adult supervision with interpretation of the meaning of violence is imperative. STRATEGIES FOR ANTICIPATORY GUIDANCE RELATED TO TV Because TV is woven into the fabric of today's family life, children's best interests would be served by limiting TV's use and function within the family rather than hoping to rid society of it altogether (Cohen, 1993). If, as mentioned above, TV has its effect by its content and by displacing other activities, then efforts to contain its negative effects must address both these aspects. The nursing profession is uniquely positioned to offer assistance with this effort. Pediatric and community health nurses interact with many families in different roles and settings. Their advice is heeded well, be it offered in the more affluent private pediatric practice or in the clinics of less prosperous neighborhoods, where the nurse is often the most positive, nonthreatening professional the family meets. It is helpful to include the issue of TV violence in anticipatory guidance given to families whatever the environment. Based on assessment of individual family style, parents' cognition, and social resources available to the family, some useful nursing strategies to assist in creating a balance between TV watching and other activities for children and adults, include the following: (a) educate parents (at an appropriate learning level) about normal child development with emphasis given

to the effect that visual media, especially TV, can have on early child development (presentations at Parent-Teacher Association meetings and information sharing in parent newsletters and flyers sent home from schools and daycare centers); (b) encourage parents to spend time with their children; (c) support parents in exercising control over the use of TV in the homes; (d) encourage parents to be role models for their children by participating in activities other than TV viewing and by changing their own TV viewing habits; (e) encourage children to engage in physical activities and exercise; (f) introduce children to games such as Candyland, Monopoly, cards, and other board games; (g) encourage reading as an alternate form of entertainment; (h) counsel parents in the provision of structured bedtime rituals that include reading and talking and less TV; (i) discourage the acquisition of a second TV set or cable TV in households with unsupervised young children; and (j) advise parents against the use of TV as a babysitter or as a reward or punishment. Family styles are so diverse today that these strategies may not be suitable in every case. However, health care providers need to present options and encourage families to choose the most appropriate ones to best meet the needs of the children. Strategies to mediate the impact of the content of TV programs on children would include the following: (a) parents watch TV with children to determine the suitability of programs and explain what is being viewed; (b) while watching TV with children, parents provoke discussion and ask questions regarding program accuracy and content; (c) parents block or do not subscribe to cable channels that are considered undesirable for children's viewing; (d) parents foster other creative activities such as active play or production of theatrical, musical, dance, or visual arts activities where children participate in the imaginative experience. RECOMMENDATIONS FOR COMMUNITY ACTION The mounting evidence of effects to some children of watching violence on TV is enough to alarm parents, nurses, teachers, and legislators, but the media industry has been slow to respond. It is gratifying to see that cable TV has instituted a violence rating system and that time-control locks for TV receivers are avail-

98

MERRILYN O. JOHNSON

able. Advocacy organizations for positive children's programming include Action for Children's Television and the American Academy of Pediatrics. TV exists to sell audiences to advertisers, so economic pressure on advertisers creates change. It is essential for health care professionals to play a role in educating the public regarding optimal TV viewing habits. As part of a standard health care package, information for parents on developmentally appropriate TV for children and how it educates and influences them should be readily available. Nurses can be involved in the development and testing of such interventions. Parents can become involved with helping their children to develop critical viewing skills while limiting viewing time and providing TV substitutes (eg. reading, sports, hobbies). Being a fitting role model for children is the responsibility of every adult. Another critical area requiring the involvement of health care professionals is that of policymaking and legislative initiatives to ensure that high-quality children's TV programming is required for TV station license renewal. Building coalitions with other groups to monitor and improve TV for children would be most beneficial. Professionals in health care roles can also conduct more research to further define the link between TV violence and childhood aggression. In the past this has been undertaken by psychologists, sociologists and media specialists, with less research documented by educators and those in the business of caring for children's general health and well-being. It is essential that future research be interdisciplinary in nature to address the issue of TV violence

from a holistic perspective and to raise the understanding of the effect of repeated exposure to TV violence on the behavior of impressionable infants and children. Nursing has much to offer teams that develop and promote scientifically developed interventions to prevent childhood violence. SUMMARY The literature points to the negative impact on children of viewing violence on TV. It is essential that nurses concerned with the health and well-being of children include TV violence as a major issue in their work with individual clients and in their community activities. This would include interventions with families to affect family TV viewing habits and involvement in political action by petitioning Congress and the Federal Communications Commission to regulate violence on TV. As professionals, nurses can assist in the investigation and testing of the effectiveness of these interventions. Finally, we must remember, in the words of Dorothy Singer (1989),
Professionals and parents must be aware of all sources of input for their children, not only peers, textbooks, teachers, and relatives but also from the subtle "stranger" in the living room who talks to children daily with complex messages of fear, violence, materialism, and, only infrequently, with messages of sharing, friendship, and concern for others (p. 446).

ACKNOWLEDGMENT The author thanks Marie L. Lobo, PhD, RN, FAAN, for help as mentor and for comments on the manuscript and Graeme H. Johnson, MB, ChB, FRACP, for valuable assistance.

REFERENCES
A.C. Nielson Company. (1988). 1988 Report on Television. Northbrook, IL: A.C. Nielson. Anonymous. (1994). Reel violence. (editorial) Lancet, 343(8890), 127-128. Bandura, A., Ross, D., & Ross, S. (1963). Imitation of film-mediated models. Journal of Abnormal Social Psychology, 66, 3-11. Berkowitz, L., & Rawlings, E. (1963). Effects of film violence on inhibitions against subsequent aggression. Journal of Abnormal Social Psycholog% 66, 405-412. Butler, D.A. (1993). Children who witness violence. (Letter to Ed.). JAMA, 270(80), 941. CenterwaU, B.S. (1992). Television and violence: The scale of the problem and where to go from here. JAMA, 267(22), 3059-3063. Cohen, S. (1993). Television in the lives of children and their families. Childhood Education, 70(2), 103-104. Coleman, T.H. (1993). Entertainment is killing us. ColoradoMedicine, 90(9), 312-314. Comstock, G. (1976). The evidence of television violence. Santa Monica, CA: Rand Corp. Comstock, G., & Strasburger, V.C. (1990). Deceptive appearances: Television violence and aggressive behavior. Journal of Adolescent Health Care, 11, 31-44. Cook, T.D., Kendzienski, D.A., & Thomas, S.V. (1983). The implicit assumptions of television research: An analysis of the 1982 NIMH report on television and behavior. Public Opinion Quarterly, 47, 161-201. Dietz, W.H., & Strasburger, V.C. (1991). Children, adolescents, and television. Current Problems in Pediatrics, 21, 8-31. Feshbach, S., & Singer, R. (1971). Television and aggression; An experimental field study. San Francisco: Jossey-Bass. Gadow, K.D., & Sprafkin, J. (1989). Field experiments of television violence with children: Evidence for an environmental hazard? Pediatrics, 83, 399-405. Gadow, K.D., & Sprafkin, J. (1990). Television violence. Archives of General Psychiatry, 47, 595.

TELEVISION VIOLENCE

99

Groves, B.M., Zuckerman, B., Marans, S., & Cohen, D.J. (1993). Silent victims: Children who witness violence. JAMA, 269, 262-264. Hearold, S.A. (1986). A synthesis of 1045 effects of television on social behavior. In G. Comstock (Ed.), Public communication and behavior. New York: Academic. Heath, L., Bresolin, L.B., & Rinaldi, R.C. (1989). Effects of media violence on children: A review of the literature. Archives of General Psychiatry, 46, 376-379. Huesman, R.L., Eron, L., Lefkowitz, M., & Walder, L. (1984), The stability of aggression over time and generations. Developmental Psychology, 20, 1120-1134. Joy, L.A., Kimball, M.M., & Zabrack, M.L. (1986). Television and children's aggressive behavior. In T.M. Williams (Ed.), The impact of television: A natural experiment in three communities (pp. 303-360). Orlando, FL: Academic. Kosta, L.A. (1993). Children who witness violence. (Letter to Ed.). JAMA, 270(8), 941. Lande, R.G. (1993). The video violence debate. Hospital and Community Psychiatry, 44(4), 347-351. Meltzoff, A.N. (1988). Imitation of televised models by infants. Child Development, 59, 1221-1229. Nielson Report on Television. (1989). Northbrook IL: A.C. Nielson Co.

Schramm, W., Lyle, J., & Parker, E.B. (1961). Television in the lives of our children. Standford, CA: Standford University Press. Singer, D. (1989). Children, adolescents, and television-1989: 1. Television violence: A critique. Pediatrics, 83(3), 445-446. Singer, J.L., Singer, D.G., & Rapaczynski, W.S. (1984). Family patterns and television viewing as predictors of children's beliefs and aggressions. Journal of Communications, 34, 73-89. Steur, F.B., Applefield, J.M., & Smith, R. (1971). Televised aggression and interpersonal aggression of pre-school children. Experimental Child Psychology, 11, 442-447. Testimony of Judith Myers-Walls, PhD, & Ken Auletta (1993). Oversight hearing on the Television Program Improvement Act of 1990, US Senate Committee on the Judiciary, Washington, DC, November 16 & 20. Waite, B.M., Hillbrand, M., & Foster, H.G. (1992). Reduction of aggressive behavior after removal of music television. Hospital and Community Psychiatry, 43(2), 173175. Williams, T.B. (1986). The impact of television: A natural experiments in three communities. Orlando FL: Academic.