Violence and sex in music, movies, television and video games pose such a serious threat to children and teenagers that the nation's chief organization of pediatricians wants doctors to do something about it.
"The evidence is now clear and convincing: media violence is one of the causal factors of real-life violence and aggression," the American Academy of Pediatrics' council on communications and the media concluded in one of two statements published in the November issue of Pediatrics.
Likewise, the group said, music plays an important part sending the wrong messages to youngsters about sex, drugs, alcohol and tobacco, too.
When children show up for medical exams, doctors should ask them specific questions about how much and what kind of music they listen to, how much time they spend on TV and video games, and whether they have TV in their rooms.
The answers could be warning signs that prompt additional evaluations and talks with both parents and children about the time they spend watching, listening and playing -- as well as way their time might be better spent.
Although concerns about violence on TV and games have long been an issue with parents' groups and psychologists, the APA's panel cited studies suggesting that children and teens actually spend more time listening to music than watching TV each day.
This can be an issue because parents are often unaware of the lyrics of the music to which their kids are listening, especially when they're downloading music online and listening with earphones.
Lyrics have become more explicit in references to sex, drugs, alcohol, tobacco, and violence, the authors noted, and studies have linked a preference for certain types of music to specific behaviors.
For example, the kind of electronic music played at raves has been associated with use of drugs and alcohol, while heavy metal and rap have been associated with reckless behavior and below-average academic performance, the authors said.
Heavy metal and some types of rock music have also been associated with an increased risk of suicide, depression, delinquency risk behavior, smoking, and conduct problems.
"With the evidence portrayed in these studies, it is essential for pediatricians and parents to take a stand regarding music lyrics," the authors said.
Music videos have also been shown to have an influence on the behaviors and attitudes of children and teens. For instance, watching music videos has been associated with the development of false stereotypes and an unhealthy concern about appearance and weight among adolescent girls.
Taking these findings into consideration, the authors recommended that pediatricians do urge parents to take an interest in the music their youngsters buy and listen to.
The AAP panel also focused on violence in various media, including TV, music, movies and video games in particular. They reviewed a variety of studies that found associations between media violence and aggressive behavior, bullying, desensitization to violence, nightmares, depression, sleep disturbances, and a fear of being harmed that could result in a teen carrying a weapon or acting more aggressively.
The data show that the strength of these relationships is greater than more widely accepted medical associations, such as those between calcium intake and bone mass, lead ingestion and lower IQ, and condom nonuse and sexually acquired HIV infection, the authors asserted.
In fact, they wrote, the associations between violence on screen or in games and really life aggression are nearly as strong as the association between cigarette smoking and lung cancer.
Though pediatricians have accepted this as fact, they said, the American public, politicians, and parents have been slow to respond, and violent media remains easily accessible.
"Although exposure to media violence is not the sole factor contributing to aggression, antisocial attitudes, and violence among children and adolescents, it is an important health risk factor on which we, as pediatricians and members of a compassionate society, can intervene," the authors said.
They recommended that doctors routinely ask children how much TV they watch, and if there's a TV in the child's bedroom.
If the youngster reports heavy media usage, the panel said the doctor should "evaluate the child for aggressive behaviors, fears, or sleep disturbances."
Meanwhile, the group called on the entertainment industry to make its products friendlier to children. Its reports included the following suggestions:
Do not glamorize weapon carrying.
Eliminate the use of violence in a comic or sexual context.
Eliminate gratuitous portrayals of interpersonal violence.
The pain and loss suffered by victims should be shown if violence must be used.
Music lyrics should be made easily available to parents so they can read them before purchasing music.
Video games should not use humans or other living targets and points should not be awarded for killing.
Violent video games should be limited to age-restricted areas of arcades.
"Pediatricians and other child healthcare providers can advocate for a safer media environment for children by encouraging media literacy, more thoughtful and proactive use of media by children and their parents, more responsible portrayal of violence by media producers, and more useful and effective media ratings," the authors said.