Effectiveness of health-promoting media literacyeducation a systematic review

Lynda J Bergsma1 and Mary E Carney2

Abstract

Media literacy education to promote healthamong youth involves them in a critical exam-ination of media messages that promote riskybehaviors and influence their perceptions andpractices Research on its effectiveness is in itsinfancy Studies to date have been conductedwith more or less rigor and achieved differingresults leaving many questions about effective-ness unanswered To elucidate some of thesequestions we conducted a systematic reviewof selected health-promoting media literacy ed-ucation evaluationresearch studies guided bythe following research question What are thecontext and process elements of an effectivehealth-promoting media literacy education in-tervention Based on extensive analysis of 28interventions our findings provide a detailedpicture of a small 16- to 17-year (1990 to July2006) body of important research including ci-tation information health issue target popula-tionNage research design intervention lengthand setting conceptsskills taught who deliv-ered the intervention and ratings of effective-ness The review provides a framework fororganizing research about media literacy edu-cation which suggests that researchers should bemore explicit about the media literacy core con-

ceptsskills they are including in their interven-tions and should more carefully address whodelivered the intervention with what fidelity inwhat setting for how long and utilizing whatpedagogical approach

Introduction

In recent decades health professionals have in-

creasingly recognized that the media have a signif-

icant influence on the health of young people In

their review of research on the mediarsquos influence on

health the Committee on Public Education of the

American Academy of Pediatrics stated lsquoResearch

has shown primary negative health effects on vio-

lence and aggressive behavior sexuality academic

performance body concept and self image nutri-

tion dieting and obesity and substance use and

abuse patternsrsquo [1 p 423]

Some researchers estimate that youth spend 33ndash

50 of their waking hours with some form of

mass media [2] According to the Kaiser Family

Foundation [3] children and teens are spending

an increasing amount of time using lsquonew mediarsquo

like computers the Internet and video games with-

out cutting back on the time they spend with lsquooldrsquo

media like television print and music Their Gen-eration M Media in the Lives of 8-18 Year-oldsstudy found that the total daily media exposure of

young people increased from 729 to 833 hours

between 2000 and 2005 counting time as double

when multi-tasking with two different forms of me-

dia The large amount of time youth spend with

media makes it critical to address related health

concerns

1Health Promotion Sciences Division Mel and Enid

Zuckerman College of Public Health University of Arizona

Tucson AZ 85724 USA and 2Department of Health

Sciences New Mexico State University Las Cruces NM

88003 USA

Correspondence to L J Bergsma

E-mail lbergsmauarizonaedu

The Author 2008 Published by Oxford University Press All rights reservedFor permissions please email journalspermissionsoxfordjournalsorg

doi101093hercym084

HEALTH EDUCATION RESEARCH Vol23 no3 2008

Pages 522ndash542

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Public health professionals have used many strat-

egies to address the effects of media on health

Regulating media content limiting childrenrsquos me-

dia use and social marketing are approaches that

have been used traditionally but media literacy ed-

ucation has emerged in the last 20 years as a prom-

ising alternative to the censorship of regulating

lsquounhealthyrsquo programming or limiting media use

[4] Media literacy has been defined as lsquothe ability

to access analyze evaluate and create media in

a variety of formsrsquo [5 p 21] Rather than trying

to protect youth from potentially harmful messages

media literacy education to promote health involves

them in a critical examination of media messages

that influence their perceptions and practices It is

designed to give youth the critical thinking skills

necessary to ameliorate the influence of these mes-

sages and make healthy choices Media literacy has

been recommended as an effective health pro-

motion strategy by a number of respected orga-

nizations including the American Academy

of Pediatrics the Office of National Drug Control

Policy and the Centers for Disease Control

Even though the field of media literacy educa-

tion effectiveness research is in its infancy several

studies have tested the ability of various media lit-

eracy curricula to teach young people how to ana-

lyze media messages and to improve their choices

on a variety of health topics Because these studies

have been conducted with more or less rigor and

achieved differing results however many ques-

tions remain lsquoIn spite of research policy and ad-

vocacy centers Web sites and a movement largely

among educators there is little evidence to suggest

that media literacy efforts are either widespread or

effectiversquo [6 p 205] To date there has been no

comprehensive review of the research literature on

media literacy interventions with a health promo-

tion purpose nor has there been an attempt to ana-

lyze the research to determine components that

make such interventions effective

For these reasons we conducted a systematic re-

view of recent publications about health-promoting

media literacy interventions with the intent of de-

veloping a framework for analysis of components

that may make such interventions more or less ef-

fective The conference report on Setting ResearchDirections for Media Literacy and Health Educa-tion stressed the need to document the different

contexts processes and outcomes of health-focused

media literacy education [7] To initiate this we

analyzed selected interventions to identify four de-

pendent variables relating to context and process

(intervention setting intervention length con-

ceptsskills taught and who taught the intervention)

and assigned a rating of effectiveness based on out-

comes Our review was guided by the following

research question What are the context and process

elements of an effective health-promoting media

literacy education intervention

Methods

The methodology used was a systematic review in

which we examined the evidence regarding health-

promoting media literacy education using explicit

methods to identify appraise and select relevant

primary research and to extract and analyze data

from the studies selected for review lsquoSystematic

reviews provide information about the effectiveness

of interventions by identifying appraising and

summarizing the results of otherwise unmanageable

quantities of researchrsquo [8 Phase 1 p4] While sta-

tistical methods (meta-analysis) may be part of

a systematic review the heterogeneity of the studies

reviewed particularly with regard to outcome

measures precluded statistical comparison [9] al-

though we used rudimentary quantitative measures

such as percentages where appropriate

Literature search

Given the multi-disciplinary nature of the media

literacy field we searched the following indexes

CINAHL Plus Communications Abstracts Com-

munication and Mass Media Complete Disserta-

tion Abstracts ERIC Expanded Academic

ASAP Health and Safety Science Abstracts MED-

LINE PsycINFO and Social Sciences Abstracts

Studies were identified by using the following key-

words media literacy media education television

Effectiveness of health-promoting media literacy

523

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education and media analysis For indexes not

health related the keyword lsquohealthrsquo was also used

Studies were also located by reviewing the refer-

ences of primary studies considered in addition to

some articles and reports published about media

literacy in recent years [7 10 11] To further locate

appropriate studies a preliminary list of sources

being considered for inclusion was circulated to

several experts in the field resulting in some addi-

tional recommendations

The literature search was conducted initially by

the first author All publications found were given

to the second author who did her own search and

found several additional studies for a total pool of

65 publications that were reviewed and considered

for inclusion Only 26 met the study selection cri-

teria detailed below

Study selection

The criteria we used to determine study inclusion or

exclusion were as follows

1 Studies were published in English from 1990

through July 2006

2 Studies were peer reviewed (including journal

articles conference proceedings and disserta-

tions) and were publicly available through

a searchable index

3 The sample study design intervention evalua-

tion measures and analysis were described

4 Studies included an experimental media literacy

intervention of 25 or more minutes in length

designed to improve the health of youth

5 The study focused primarily on teaching critical

media literacy skills and did not use media liter-

acy as a small part of a larger curriculum

The time frame for study inclusion was selected

because there have been no comprehensive reviews

of media literacy interventions since 1990 [12]

although the research has continued to advance

Studies that were available to us but were in

press as of July 2006 were excluded from the

analysis [13]

The sample was limited to peer-reviewed publi-

cations due to concerns that non-peer-reviewed

sources would describe less rigorous experimental

procedures and data We debated this decision

however because the youth of the field of media

literacy education research and the small number of

studies that met our criteria made it seem useful to

include sources that had not undergone peer review

but were readily available publicly and seemed to

contribute to the field [14ndash16] including a study

[17] that was reported in a chapter of an edited

book

Some studies were excluded because they did not

describe a rigorous experimental evaluation of

a specific intervention [18 19] One article was

excluded because while it provided information

about the qualitative evaluation conducted none

of the quantitative evaluation measures were de-

scribed and results were not reported [20] Another

study was excluded because the media literacy in-

tervention it used was only 3ndash5 minutes in length

[21] Interventions less than 25 minutes in length

were deemed to be too short to teach critical media

literacy skills and allow students to practice them

using an inquiry approach which is an essential

pedagogical tenet of media literacy education

[22] While most of the selected studies focused

the intervention directly on youth one study was

selected in which the intervention was given to

adult caregivers with a focus on improving the

home nutrition environment to promote the health

of preschoolers [23]

As stated in the fifth criterion above interven-

tions needed to focus on teaching lsquocritical media

literacy skillsrsquo which were operationalized as the

following abilities based on the Center for Media

Literacyrsquos definition [5 p21]

1 To access useful information in the media

2 To analyze media messages using critical think-

ing skills (being able to identify bias and credi-

bility of a source differentiate fact from opinion

determine if a message is unrealistic understand

a messagersquos purpose)

3 To evaluate a message (to determine its truth

applicability)

L J Bergsma and M E Carney

524

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4 To create media messages which achieve spe-

cific goals

To be included in this review the intervention

needed to teach at least one of the four skills listed

above Although critical media literacy skills may

have been taught in three studies reviewed they

were excluded because it was not clear that this

was the case [24ndash26] Several studies that focused

on teaching youth the skills to resist advertising

pressure to smoke cigarettes were excluded for

the same reason Criterion 5 above also stated that

the intervention must focus lsquoprimarilyrsquo on teaching

critical media literacy skills This distinction was

made because some studies incorporated a small

media literacy component in their intervention as

part of a larger curriculum that taught other knowl-

edge or skills which may have influenced effective-

ness findings [27 28]

Some studies were excluded because they fo-

cused mainly on reducing television use instead

of teaching critical media literacy skills [29ndash31]

Although one of the sources selected did include

the concept of reduced television use in its interven-

tion it was included because it allowed participants

to make informed decisions about media use rather

than simply teaching them that media use should be

avoided [32] Most of the study inclusion or exclu-

sion decisions were made independently by the sec-

ond author based upon the criteria established by

both authors and reviewed by the first author

Where there was any question the authors dis-

cussed their conclusions and a final decision was

made by consensus

During peer review of the manuscript five addi-

tional studies were recommended for inclusion

Upon review we found that one study [33] did

not meet selection criterion 3 and two studies did

not meet criteria 4 and 5 [34 35] Two of the rec-

ommended studies were included [36 37]

Twenty-three studies in 26 publications met the

inclusion criteria [23 32 36ndash59] The same data

from two of the 23 studies were reported in two

publications and two articles reported on different

measures and analyses extracted from the same re-

search study Data from these publications were

grouped and considered as one study

Data extraction and analysis

To enable extraction and analysis of a large quantity

of data we developed an extensive database of in-

formation for each of the selected studies The fol-

lowing sections detail first general descriptive data

and second data that were extracted and analyzed

for each measure

General descriptive data

Table I contains descriptive data about the selected

sample Twenty-eight interventions were detailed

in the 23 studies because two studies employed

multiple experimental groups that experienced dif-

ferent media literacy interventions Austin and

Johnson [40] (two interventions) and Byrne [43]

(three interventions) In addition two studies had

multiple interventions but only some of them were

judged to be media literacy interventions Wilsch

Tiggemann and Wade [37] three of five and Irving

and Berel [48] one of three

Health issues included nutrition (two studies)

nutritioneating disorders prevention (nine) body

image (one) substance abuse prevention (five)

and violence prevention (six) Eighteen studies

recruited participants from schools two from both

schools and community groups and three from non-

school locations Participant sample size ranged

from 17 to 723

Studies were categorized according to target age

as follows children (aged 11 and belowGrade

6 and below) adolescents (aged 12ndash19grades

7ndash12) and college students (mean age 22 and below)

When a study targeted youth in different categories

it was categorized according to the larger number

of participants Thirteen studies targeted children

seven adolescents and three college students

Each studyrsquos research design is included in Table

I While in most cases the research design was

stated explicitly in some instances it was inferred

from the methodology description Because all the

studies used a quasi-experimental design this de-

scriptor was omitted from Table I Most of the stud-

ies selected utilized quantitative measures a few

Effectiveness of health-promoting media literacy

525

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Table I Descriptive data concerning systematic review sample

Study Health issue Target population (n) Target age group Research design Number of interventions

Austin and Johnson

[38 39]

Substance abuse (alcohol) Third grade students from

three schools in a northern

mid-western town (246)

Children Solomon four-group

design

1

Austin and Johnson [40] Substance abuse (alcohol) Third grade students from

Roseville MN (225)

Children Solomon four-group

design with two

experimental groups

2

Austin et al [41] Substance abuse (tobacco) Adolescents from 76

Washington state schools

and community groups

mean age 15 (723)

Adolescents Post-test-only design 1

Austin et al [42] Substance abuse (tobacco) Adolescents from

community groups in

three western WA

communities average age

16 (119)

Adolescents Pre-testndashpost-test design 1

Byrne [43] Violence Fourth and fifth grade

students from three west

coast schools (199)

Children Pre-testndashpost-testndashre-test

design with three

experimental groups

3

Coughlin and Kalodner

[44]

Nutrition (eating

disorders)

Female undergraduate

students in introductory

womenrsquos studies course at

a rural university average

age 20 (92)

College students Pre-testndashpost-test design 1

Evans et al [45] Nutrition Fourth and fifth grade

students from two South

Carolina schools (39) and

their parents

Children Pre-testndashpost-test design 1

Fuller et al [36] Body image Fourth grade girls from an

urban school (17)

Children Qualitative focus groups

pre-testndashpost-test design

1

Gonzales et al [46] Substance abuse (tobacco) 10th grade students from

four Los Angeles high

schools (609)

Adolescents Pre-testndashpost-test design 1

LJBerg

smaandMECarn

ey

526

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Table I Continued

Study Health issue Target population (n) Target age group Research design Number of interventions

Hindin [23] and Hindin

et al [47]

Nutrition Low-income mothers

(33) a father and

a grandmother of

preschoolers (aged 3ndash6)

from four NYC Head Start

sites aged 22ndash62 (35)

Children Pre-testndashpost-test

comparison conditionndash

intervention condition

design with no control

group

1

Irving and Berel [48] Nutrition (eating

disorders)

Female college students

from introductory

psychology classes at

Washington State

University average age

19 (110)

College students Post-test-only design with

three experimental groups

and a control group

1

Irving et al [49] Nutrition (eating

disorders)

Female 10th grade

students from two English

classes in a WA high

school average age

15 (41)

Adolescents Post-test-only design 1

Kusel [50] Nutrition

(eating disorders)

Female fourth fifth and

sixth grade students from

two suburban NY school

districts aged 9ndash13 (172)

Children Solomon four-group

design

1

Neumark-Sztainer

et al [51]

Nutrition (eating

disorders)

Female fifth and sixth

grade students from 24

mid-western Girl Scout

troops average age

11 (226)

Children Pre-testndashpost-testndashre-test

design

1

Rabak-Wagener

et al [52]

Nutrition (eating

disorders)

Undergraduate students

from healthful living

classes at a medium-sized

metropolitan university in

the mid-west mainly aged

18ndash23 (105)

College students Pre-testndashpost-test design 1

Rosenkoetter et al [32] Violence First second and third

grade students from 13

classrooms in four schools

in or near a community of

population 50 000 (177)

Children Pre-testndashpost-test design 1

Effectiv

eness

ofhealth

-promotin

gmedia

literacy

527

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Table I Continued

Study Health issue Target population (n) Target age group Research design Number of interventions

Scharrer [53] Violence Sixth grade students from

five classrooms in three

northeast towns (93)

Children Pre-testndashpost-test design

with no control group

1

Sprafkin et al [54] Violence Emotionally disturbed and

learning disabled children

from 29 classes in two

Long Island schools aged

6ndash12 (167)

Children Pre-testndashpost-testndashre-test

design with two

experimental and two

control groups

1

Vooijs and van der

Voort [55]

Violence Fourth fifth and sixth

grade students from 18

classes in six Dutch

schools (437)

Children Pre-testndashpost-testndashre-test

design

1

Vooijs and van der

Voort [56]

Violence Fifth and sixth grade

students from 12 classes in

six Dutch schools (300)

Children Pre-testndashpost-test design 1

Wade et al [57 58] Nutrition (eating

disorders)

Eighth grade students

from four private high

school classes in

Australia average age

134 (86)

Adolescents Post-test-only design with

two experimental groups

Pre-testndashpost-testndashre-test

design with two

experimental groups

1

Wilksch et al [37] Eating disorders (media

internalization)

Eighth grade students

from 11 classes at three

metropolitan private

schools in Australia mean

age 139 (237 100 girls

and 137 boys)

Adolescents Pre-testndashpost-test design

with 3 media literacy

education experimental

groups

3

Wolf-Bloom [59] Nutrition (eating

disorders)

Female adolescents from

two Girl Scout Councils

and a private school in

Northeast Ohio aged 10ndash

15 (70)

Adolescents Pre-testndashpost-testndashre-test

design

1

LJBerg

smaandMECarn

ey

528

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utilized some qualitative measures as well and one

utilized qualitative measures only [36] Nineteen

studies had one control group one study employed

two different control groups [52] and three studies

had no control group [37 39 50]

Intervention setting

Intervention settings were grouped into the follow-

ing categories (i) in-class (intervention took place

in class during regularly scheduled class time) (ii)

in-school (intervention took place at a school out-

side of the regular classroom) (iii) community

groups or (iv) location not specified (Table II)

Analysis revealed that 19 interventions took place

in-class one both in-class and in community

groups three in school outside of a regular class

or after class three in community groups and two

studies did not specify the intervention setting

Intervention length

This measure was defined as the number of minutes

allotted to the intervention excluding time for pre-

tests post-tests and re-tests When the intervention

took place in a specified number of class sessions

based on analysis of K-12 and college class length

we assigned an average value of 45minutes to a class

session When it was clear that the pre-test or post-

test had been given during the time designated for

the intervention but the pre-testpost-test time was

unspecified we assumed that each evaluation mea-

sure took 15 minutes When a range was provided

for the intervention length we computed an average

Analysis revealed that intervention length ranged

from 25 minutes to 24 hours To better compare

these lengths with intervention effectiveness we

grouped them into the following categories short

(60 minutes or less) average (1ndash5 hours) or long

(more than 5 hours) There were 11 short interven-

tions nine average and eight long (Table II)

Conceptsskills taught

Because the Center for Media Literacyrsquos lsquoCore

Concepts of Media Literacyrsquo [5] has been used

widely in the United States where most of the se-

lected studies were published we used this frame-

work to assess concepts and associated skills

taught Determining core concepts and associated

skills taught required reviewing the publication

multiple times and making many interpretations be-

cause most studies did not specifically state whether

they taught any core concepts The following

guidelines were used to categorize interventions

1 All media messages are lsquoconstructedrsquo Interven-tion taught about how the media differs from

reality evaluating what is shown compared with

real life experiences or the producerproduction

of media messages

2 Media messages are created using a creativelanguage with its own rules Intervention taught

about recognizing advertisingproduction tech-

niques or creatingproducing media messages

3 Different people experience the same messagedifferently Intervention explored how media af-

fect people what people can do to avoid nega-

tive effects of media or that people can take

action to change the media

4 Media have embedded values and points of viewIntervention taught how to identify stereotypes

myths biases values lifestyles andor points

of view represented in or omitted from media

messages

5 Most media messages are constructed to gainprofit andor power Intervention taught about

the purpose of advertising or marketing strate-

gies skepticism toward advertising or creating

counter-advertising

Analysis revealed that the core concepts and as-

sociated skills were taught with the following fre-

quency one (in all 28 interventions) two (17) three

(19) four (28) and five (13) (Table II)

Because our decision to investigate the presence

of the core concepts in the selected studies was

based on prior knowledge of media literacy rather

than a selection of themes that would emerge from

analysis of each text we analyzed the publications

for additional types of knowledge taught Table II

documents the two themes that emerged from this

analysis how media affects health (17) and knowl-

edge about the targeted health issue (14)

Effectiveness of health-promoting media literacy

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Table II Comparison of intervention setting length core concepts taught and who delivered intervention with effectiveness ratings

Intervention Effectiveness ratingIntervention information

Short

term

Long

term

Setting Length Conceptskills

taughtaWho delivered

interventionb

Fuller et al [36] NR NR School outside class Average 1 2 3 4 5 a b Researchers

Wilksch et al [37] NR NR In-class Short 1 2 4 a Researcher with teacher

present

Byrne [43]mdashbasic Condition 1 1 In-class Short 1 3 4 a Unspecified

Byrne [43]mdashcognitive

activity condition

1 1 In-class Short 1 3 4 a Unspecified

Byrne [43]mdashthird person

condition

1 1 In-class Short 1 3 4 a Unspecified

Irving et al [48]mdashexternally

oriented condition

2 NA Location not specified Short 1 3 4 a Researcher

Irving et al [49] 2 NA School outside class Short 1 2 3 4 5 Teen peer

Scharrer [53] 2 NA In-class Average 1 3 4 a Undergraduate

college student

Wade et al [57 58] 2 1 In-class Average 1 2 3 4 5 a b Teacher assisted by

graduate student

Neumark-Sztainer

et al [51]

2 2 Community groups Long 1 2 3 4 a b Girl Scout troop

leaders

Sprafkin et al [54] 2 3 In-class Long 1 2 4 5 Teacher

Austin et al [42] 3 NA Community groups Average 1 2 3 4 5 b Teen peers

Evans et al [45] 3 NA School outside class Long 1 2 3 4 a b Unspecified

Austin and Johnson

[39 40]3 2 In-class Short 1 2 4 5 Researcher

Kusel [50] 3 2 In-class Average 1 2 3 4 5 a b Researcher

Wolf-Bloom [59] 3 4 Location not specified Average 1 2 3 4 5 a Senior Girl Scout

peers

Austin et al [41] 4 NA In-class and community

groups

Average 1 2 3 4 5 b Teen peers (2)

Coughlin and Kalodner [44] 4 NA In-class Average 1 2 3 4 a b Researcher

Rabak-Wagener et al [52] 4 NA In-class Long 1 2 4 5 a b Researcher and

instructor (assisted)

Rosenkoetter et al [32] 4 NA In-class Long 1 2 3 4 5 a b Researcher

Gonzales et al [46] 5 NA In-class Long 1 2 3 4 5 a b Unspecified

Hindin [23] and Hindin

et al [47]

5 NA Community groups Long 1 2 3 4 5 a b Unspecified

Vooijs and van der

Voort [56]

5 NA In-class Average 1 3 4 b School television

broadcast series

and teacher

Vooijs and van der

Voort [55]

5 5 In-class Long 1 3 4 b Researcher

Austin and Johnson

[40]mdashalcohol-specific

condition

5 5 In-class Short 1 4 5 Researcher

Austin and Johnson

[40]mdashgeneral condition

5 5 In-class Short 1 4 5 Researcher

NR = not rated NA = not applicableaNumbers refer to media literacy core concepts taught and letters refer to (a) how media affect health and (b) knowledge about healthissuebAssumed to be researcher (research project staff) if unspecified

L J Bergsma and M E Carney

530

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Who delivered the intervention

Analysis of each intervention revealed that the per-

son who most frequently delivered the intervention

was the researcher (11) In one study the researcher

was assisted by the class instructor In six studies

where the person who delivered the intervention

was not specified we assumed it was a member

of the research staff Other modes of delivery in-

cluded teen peers (four) some by themselves and

some in teams of two Two interventions involved

the use of college students one utilized a trained

undergraduate student and another utilized the

classroom teacher assisted by a graduate student

Classroom teachers were the primary person deliv-

ering the intervention in three cases although one

intervention utilized a series of school television

broadcasts facilitated by teachers using a guide In

one study the intervention was delivered by Girl

Scout troop leaders (Table II)

Intervention effectiveness

lsquoIntervention effectivenessrsquo was difficult to assess

due in part to the many different health issues

addressed and research designs theoretical models

and outcome measures used Effectiveness was de-

fined very differently in each of the studies which

made it impossible to impose a common framework

upon them In an attempt to find elements by which

to compare the studies the following information

was compiled for each intervention health issue

research design theoretical approach intervention

outcomes (Table III) results at pre- and post-test

results at re-test (delayed post-test) and elaborated

results In addition we recorded how much signif-

icant change the intervention achieved on its meas-

ures at post-test and re-test

This method of standardizing each studyrsquos eval-

uation excluded considerable information For ex-

ample in the research by Austin and Johnson

[38ndash40] analyses were conducted to compare each

measurersquos success in predicting outcomes on other

measures as hypothesized in their Message Inter-

pretation Process Model By choosing to focus only

on the media literacy interventionrsquos direct effect on

each of the selected measures a great deal of useful

information was excluded For this reason we in-

cluded an elaborated description of each studyrsquos

results in the database that was developed from

which to determine the effectiveness ratings

As we reviewed the outcome evaluation meas-

ures to identify ways in which they might be

grouped we found that all of them fell into one of

the following categories knowledge attitudes

behaviors risk factors for the health problem inten-

tions skills or process evaluation Then we re-

reviewed the measures and their results and

recorded which measures corresponded with each

category and the amount of statistically significant

change that the intervention achieved for each cat-

egory at post-test and re-test

Using all of the information compiled about the

results of each study as well as background knowl-

edge about each theoretical approach and the

strengthslimitations of each research design we

attempted to make an unbiased rating of each inter-

ventionrsquos effectiveness Given the diversity of the

data available for comparison we determined that

each studyrsquos rating of effectiveness would primarily

be a function of whether the intervention appeared

to achieve a significant change on evaluated mea-

sures that were of importance according to the

selected theoretical approach Interventions were

rated for short-term effectiveness (outcomes at

post-test) and long-term effectiveness (outcomes

at re-test) on a scale of one to five with five being

the highest effectiveness All 24 interventions rated

included a post-test and 12 included a re-test yield-

ing a total of 36 assigned ratings (Table II) Note

that the two studies recommended for inclusion

during peer review could not be assessed using

the same procedures and raters due to the fact that

the research team was no longer intact These stud-

ies are included in Table II but are marked NR for

not rated

Several measures were taken to insure the reli-

ability of effectiveness assessment First each in-

tervention was labeled with a number and

interventions were sorted randomly so that each re-

viewer got a differently ordered data set Second

the two authors independently made their ratings at

different times with little conversation about how to

Effectiveness of health-promoting media literacy

531

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Table III Intervention outcomes

Intervention Effectiveness rating Outcomes

Short term Long term Post-test Re-test

Byrne [43]mdashbasic condition 1 1 [ willingness to use aggression but no

significant improvement in ability to critically

evaluate violent characters

Significant Y willingness to use aggression

(still above control) and no effect in ability to

critically evaluate violent characters

Byrne [43]mdashcognitive

activity condition

1 1 Y willingness to use aggression (still well

above control) and no effect on ability to

critically evaluate violent characters in the

media

No significant effects

Byrne [43]mdashthird

person condition

1 1 [ willingness to use aggression and no effect

on ability to critically evaluate violent

characters

No significant effects

Irving and Berel [48]

mdashexternally oriented

condition

2 NA Y perceived realism similarity and

desirability of media portraying thin ideal of

beauty Somewhat Y intention to diet No

effect on body dissatisfaction or

internalization of sociocultural physical

appearance standards

Irving et al [49] 2 NA Y internalization of thin beauty standards and

perceived realism of media portrayals No

effect on body dissatisfaction anxiety about

weight-related appearance awareness of

beauty standards in the media desirability of

looking like a media image positive

expectations associated with looking like

a media image or affect

Scharrer [53] 2 NA Quantitative measures showed some [comprehension of key concepts and critical

thinking about the topic of media violence

Qualitative measures showed enhanced

sophistication in analyzing media violence

Wade et al [57 58] 2 1 Y levels of weight concern No significant

effects for eating disorder risk factors body

dissatisfaction or self-esteem

Significant [ dietary restraint and some +differences in self-esteem

LJBerg

smaandMECarn

ey

532

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Table III Continued

Intervention Effectiveness rating Outcomes

Short term Long term Post-test Re-test

Neumark-Sztainer

et al [51]

2 2 Notable + influence on internalization of

sociocultural ideals self-efficacy to impact

weight-related social norms and print media

habits Little effect on dieting behaviors

Dieting behaviors and body-related

knowledge and attitudes were not

significantly different at 3 months follow-up

Sprafkin et al [54] 2 3 Significant [ knowledge of television

realism Emotionally disturbed children

significantly Y their identification with

aggressive television characters but learning

disability children did not No significant

changes in attitudes about television or

viewing habits

Significant changes in perceptions of media

portrayals of reality versus fantasy

knowledge of special effects and veracity of

commercial messages

Austin et al [41] 3 NA Significantly [ knowledge of tobacco

marketing skepticism regarding persuasive

messages efficacy to counter tobacco

advertising perceived peer norms and peer

influence [ desirability of smoking

portrayals Some effect on perceived realism

of media messages and no effect on tobacco

use behavior peer discussion perceived

similarity with people in the media

identification with media portrayals and

expectancies to smoke

Evans et al [45] 3 NA Significant [ motivation to eat fruits and

vegetables (FV) and home environment

changes No significant change in FV eating

Austin and Johnson [38 39] 3 2 Significant change in understanding of

persuasive intent perceptions of realism

perceptions of social norms and pre-drinking

behavior No significant change in perceived

similarity to television identification with

television portrayals and expectancies for

drinking alcohol

Some change was detectable 3 months but

only significant for perceived realism

Effectiv

eness

ofhealth

-promotin

gmedia

literacy

533

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Table III Continued

Intervention Effectiveness rating Outcomes

Short term Long term Post-test Re-test

Kusel [50] 3 2 Significantly Y dieting body dissatisfaction

internalization of body stereotypes perceived

realism desirability and expectancies and [self-esteem No effect on changing attitudes

and behaviors about restricting food or

purging body distortion awareness of ideal

body stereotype understanding of persuasive

intent perceived social norms similarity or

identification

At 3-month follow-up significant Y body

dissatisfaction perceived realism and

perceived similarity and [ awareness of body

stereotypes No effect on other measures

Wolf-Bloom [59] 3 4 Significantly Y tendency to compare

physical appearance with models and rating

of television importanceinfluence

Significantly [ self-esteem and body image

Some + effect on ideal-body internalization

No effect on self-reported eating disordered

symptomatology mastery and coping or

perceptions of current ideal figure

discrepancy

At 2-month follow-up there was an effect on

all measures except ideal-body internalization

and eating disordered symptomatology

Austinet al [41] 4 NA Significantly Y perceived realism perceived

similarity expectancies about smoking and

susceptibility to peer influence Significantly

changed perceived peer norms and almost

significantly Y identification with people in

tobacco advertisements

Coughlin and Kalodner [44] 4 NA Women at high risk for an eating disorder

had significantly Y body dissatisfaction

drive for thinness feelings of ineffectiveness

and internalization of societal standards of

beauty No significantly Y perfectionism

physical appearance comparisons or

awareness of societal standards for beauty

No changes in eating disorder risk factors

found among low-risk participants

LJBerg

smaandMECarn

ey

534

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Table III Continued

Intervention Effectiveness rating Outcomes

Short term Long term Post-test Re-test

Rabak-Wagener et al [52] 4 NA Significant improvement in beliefs about

body image but no significant changes in

behavior Women not men had

significantly [ beliefs that models have

ideal body sizeshape and that dieting

exercising decisions should be based more

on looks than health status

Rosenkoetter et al [32] 4 NA Among girls significantly Y viewing of

violent television and identification with

violent characters Significantly Y + attitudes

toward television violence Boys had no

significant change in television violence

viewing identification with violent characters

or attitudes about television violence

Classmates reported Y behavioral aggression

among boys

Gonzales et al [46] 5 NA Significantly [ knowledge about tobacco use

and Y pro-tobacco attitudes and tobacco use

behavior

Hindin [23] and Hindin

et al [47]

5 NA Significant effects on Head Start parentsrsquo

understanding television advertising

attitudes about television ads outcomes

expectations of talking with children about

television ads while co-viewing self-efficacy

television mediation behavior and ability to

read food labels

Vooijs et al [56] 5 NA Significant + effect on measures of perceived

realism and factual knowledge

Vooijs and Van Der Voort [55] 5 5 Significantly Y readiness to see violence

approval of violent actions and perceived

realism Effects were found among fifth and

sixth graders not among fourth graders

Effects were weaker but still significant at 2-

year follow-up

Effectiv

eness

ofhealth

-promotin

gmedia

literacy

535

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do it and provided only with the data described

above for each study and some basic information

about theoretical models used Finally two public

health graduate students independently rated the

interventions based on the same information In

two cases where the reviewers were evenly split

the rating of the senior researcher was used

Using Cohenrsquos kappa inter-rater statistics were

calculated to measure agreement on assigning the

interventions to effectiveness categories A kappa

statistic of gt061 indicates a substantial strength of

agreement [60] When the rating was 1 the kappa

statistic was 091 when the rating was 5 the kappa

statistic was 080 and when the rating was 2ndash4

there was more variability in the kappa statistic

Overall all four raters had a kappa statistic of

063 for all ratings The effectiveness ratings were

entered into a database (Table II) and used as an

independent variable against which to analyze each

of the four dependent measures

Results

Results of our systematic review were as follows

Intervention setting

Table II illustrates the relationship of intervention

setting with short-term and long-term effectiveness

Because the majority of the interventions occurred

in classrooms in-class interventions were well rep-

resented at every level of effectiveness Insufficient

numbers of the other intervention settings pre-

vented detection of a clear relationship

Intervention length

Table II shows that short interventions were some-

what more likely to be rated as ineffective (rated

1ndash2) whereas longer interventions were more

likely to be rated as effective (rated 3ndash5) although

several interventions did not follow this pattern For

example two interventions of Austin and Johnson

[40] were only 45 minutes but they were given

the highest effectiveness rating Conversely theTable

III

Con

tinu

ed

Intervention

Effectivenessrating

Outcomes

Shortterm

Longterm

Post-test

Re-test

Austin

andJohnson[39]mdash

alcohol-specific

condition

55

Effectsincluded

[understandingof

persuasiveintentviewingofcharacters

as

less

similar

torealpeoplethey

knew

andless

desirable

andYdesireto

belikethe

charactersexpectationofpositive

consequencesfrom

drinkingalcoholand

likelihoodto

choose

analcohol-related

productIndirecteffectsfoundonperceptions

oftelevisionrealism

andviewsofsocial

norm

srelatedto

alcoholTreatmentmore

effectiveam

onggirlsthan

boys

Delayed

effectsat

3monthswereconfirm

ed

onexpectancies

andbehavior

Austin

andJohnson[39]mdash

general

condition

55

Treatmentwas

effectivebutsomew

hat

less

than

thealcohol-specifictreatm

ent

Treatmentwas

effectivebutsomew

hat

less

than

thealcohol-specifictreatm

ent

[increasedYdecreased+positiveNA

=notapplicable

L J Bergsma and M E Carney

536

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Dow

nloaded from

Neumark-Sztainer et al [51] intervention and the

Sprafkin et al [54] intervention were both long

(540 and 420 minutes respectively) but were given

a rating of 2

Conceptsskills taught

When examining the media literacy core concepts

skills taught effective interventions seemed some-

what more likely than ineffective interventions to

have taught all the core concepts Table IV gives

percentages for the amount that each core concept

was taught in short-term and long-term effective

and ineffective interventions

Because core concepts one and three were taught

in 100 of all cases it is impossible to determine

how they contributed to the effectiveness or inef-

fectiveness of the interventions Differences be-

tween effective and ineffective interventions were

evident for core concepts two and five when these

variables were compared with the measure of short-

term effectiveness For core concept two 73 of

effective interventions taught this concept as com-

pared with 44 of ineffective interventions For

core concept five 73 of effective interventions

taught this concept compared with 33 of ineffec-

tive interventions Differences in the same direction

were found for core concept five when compared

with long-term effectiveness ratings but the same

did not hold for core concept two For core concept

three the relationship was in the opposite direction

with more short-term ineffective interventions

(88 ineffective versus 73 effective) and more

long-term ineffective interventions (86 ineffec-

tive versus 40 effective) teaching this concept

Effective interventions appeared to be somewhat

more likely to have taught knowledge about the

targeted health issue 73 effective compared with

22 ineffective at short term Interestingly ineffec-

tive interventions appeared to be more likely to

teach participants about how media affect their

health 77 of ineffective compared with 53 of

effective interventions at short term and 86 of

ineffective compared with 20 of effective inter-

ventions at long term

Who delivered the intervention

There seemed to be some association between who

delivered the intervention and effectiveness at short

term with 10 (73) of the 15 effective interven-

tions and four (44) of the nine ineffective inter-

ventions being delivered by research staff (Table II)

Discussion

Media literacy education has the potential to be

a useful health-promoting strategy for ameliorating

a number of harmful health behaviors To date

however evidence for its potential is based more

on theory than on rigorous demonstrations of effi-

cacy or effectiveness In this review we have docu-

mented a selection of peer-reviewed studies in

which media literacy education has been used to

promote health among youth and have taken a first

step toward developing a framework for research

that will ultimately determine the effectiveness of

this health promotion strategy The research ques-

tion that guided this effort was lsquoWhat are the context

and process elements of an effective health-

promoting media literacy education interventionrsquo

Because this field of research is relatively new

there is a limited pool of studies that have been

reported and those that are available vary greatly

Table IV Percentages of ineffective and effective

interventions teaching media literacy core concepts andhealth-related information

Core concept or other

knowledgeaShort term Long term

EffectiveIneffectiveEffectiveIneffective

One 100 100 100 100

Two 73 44 40 57

Three 73 88 40 86

Four 100 100 100 100

Five 73 33 80 43

How media affects

health

53 77 20 86

Knowledge about

selected health issue

73 22 20 43

aSee Conceptsskills taught section above for the core conceptrelated to each number

Effectiveness of health-promoting media literacy

537

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nloaded from

with respect to intervention methodological preci-

sion and outcome measurements As a result we

conducted a systematic review of a small sample

of studies with no statistical analysis of results that

can lead to correlations of context and process var-

iables with effectiveness ratings The most defini-

tive trends in this review emerged around the

variables concerning the intervention setting (con-

text) and who taught the intervention (process)

Our review shows a clear trend that most health-

promoting media literacy programs are conducted

in classrooms Although it is interesting to specu-

late on why this is so the data provide no reason to

believe that health-promoting media literacy educa-

tion programs conducted in community or other

non-school settings would not be effective

More of the short-term effective interventions

were delivered by research staff than by others It

seems reasonable to assume that research staff

would be more familiar with the concepts and more

facile with the pedagogical techniques of the inter-

vention than someone who had received a limited

amount of training (eg others who were trained to

deliver the educational program in some of the stud-

ies received anywhere from an hour to a day of

training) This finding is also corroborated by many

observations of the first author in her own work and

discussion with others who train people to incorpo-

rate media literacy education into their curricular

areas It often takes teachers who are trained in

the concepts and skills of media literacy education

at least a year of consistent practice to become

skilled enough that they can readily identify and

facilitate media literacy teachable moments in

which they feel confident with allowing students

to discover concepts for themselves [5 61]

Although we would like to draw more global

conclusions from the data regarding intervention

length and conceptsskills taught our review does

not provide definitive trends with regard to these

variables What the data do tell us is that there

has been a number of both effective and ineffec-

tive health-promoting media literacy education

programs that have varied widely with regard to

length and conceptsskills taught Both effective

and ineffective interventions may be short or long

Although it makes intuitive sense that education

provided for a longer period of time should result

in greater change because the participants have

more opportunity to learn media literacy concepts

and practice associated inquiry skills we cannot

draw this conclusion from our review Although

the most effective interventions seemed somewhat

more likely to have taught all of the core media

literacy concepts as well as knowledge about the

targeted health issue because of the small sample

size the data on conceptsskills taught in each in-

tervention is inconclusive as to whether certain

core concepts may have more or less impact on

effectiveness

Our review results outline characteristics of the

majority of the important health-promoting media

literacy studies that were conducted from 1990

through July 2006 including health issues

addressed (nutrition body image and eating disor-

ders violence and alcohol and tobacco abuse) We

were unable to locate studies about media literacy

education interventions focused on prevention of

unsafe sexual behaviors even though this is a key

health concern There is some evidence that this

type of education is taking place [62] but we could

find no peer-reviewed research on media literacy

curricula that address this issue This may be due

to the human subjects protection concerns involved

with children under 18 as well as the fact that many

educational settings shy away from dealing with

this controversial issue

Limitations

Despite our methodological efforts to minimize bi-

as and errors it is important to note that this review

relied on many subjective judgments For example

the literature search was a collaborative effort of

both authors and could have been done more sys-

tematically to improve yield Even though we uti-

lized numerous methods to identify studies that met

our selection criteria we inadvertently omitted

studies that would have contributed to this research

as evidenced by study inclusion recommendations

emanating from peer review

Systematic reviews are also biased by the amount

of textual table and figure information allowed by

L J Bergsma and M E Carney

538

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nloaded from

the journals in which the studies are published For

example studies describing lengthy media literacy

curricula are often forced to omit important details

about methodology used such as specific skills

taught or pedagogical approach used Contacting

the primary investigator of each study would prob-

ably clarify some questions about methods used

but was beyond the scope of this study An example

of this bias can be found in our own reporting of

this review Spatial limitations for tables prevented

us from including several additional columns of

data that we extracted and textual limitations pre-

vented us from citing every study considered and

the reasons for excluding each one

Our assignment of intervention effectiveness rat-

ings could also be biased by several factors For

one the ratings were influenced by the number

and type of outcome measures in each study This

made results difficult to compare because some

studies demonstrated significant change on all of

the variables they measured but did not investigate

many factors Conversely other studies that mea-

sured more variables found significant change on

several important factors but were portrayed as

having a low percentage of change overall because

a difference was not detectable on many variables

Another limitation of the present review is that

the methodology used cannot determine if the four

selected measures are the main factors responsible

for effectiveness of health-promoting media literacy

education In fact media literacy education propo-

nents maintain that successful media literacy edu-

cation results not so much from lsquowhatrsquo is taught

as lsquohowrsquo it is taught [58 63] Although interven-

tion setting length and who taught the intervention

provide some information about how these health-

promoting media literacy interventions were taught

investigating the pedagogical approach used would

more significantly inform the lsquohowrsquo question Me-

dia literacy education is grounded in inquiry-based

process-oriented pedagogy Unfortunately whether

the pedagogical approach used in the sample stud-

ies was one of inquiry or indoctrination was un-

clear Only curriculum review and observation of

its teaching can provide reliable data on pedagogi-

cal approach

Implications and recommendations

Systematic literature reviews that identify both what

we know and do not know can help in planning new

research [8] The main benefit of this review is that it

provides a detailed picture of the health-promoting

media literacy education research that has been con-

ducted and published in the years from 1990 through

July 2006 This information can help future re-

searchers interested in investigating both what con-

text and process elements make a health-promoting

media literacy education intervention effective and

what are the outcome measures that best demon-

strate effectiveness It should also provide support

to health educators wanting to implement media lit-

eracy education as a health promotion strategy but

facing questions from others about its effectiveness

Likewise the effectiveness analysis of interven-

tion outcomes provides some insights that may help

to improve the health and media literacy outcomes

of such efforts The majority of outcomes involved

knowledge and attitudes and revealed less about

actually preventing or changing risky health behav-

ior which would demonstrate an effective interven-

tion This has implications for the fact that we need

to design studies which measure more behavioral

outcomes such as amount of smoking or clinical

outcomes such as BMI change Our review did suc-

ceed in quantifying effectiveness to allow for anal-

ysis of four variables across many different types of

studies We hope the current review will inform the

work of other researchers to clarify the outcome

measures that best demonstrate health-promoting

media literacy education effectiveness

Future research is needed to examine other aspects

of media literacy education that could be responsible

for effectiveness For example researchers could an-

alyze the pedagogical style used the amounttype of

training provided to the instructor the key concepts

and skills taught the health behavior theory used to

guide the intervention etc Studies could also be an-

alyzed specifically for variations among participants

of different ages genders racesethnic groups socio-

economic status or other demographic variables

This review provides a framework for organizing

research about media literacy education Our analysis

Effectiveness of health-promoting media literacy

539

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nloaded from

and discussion of the dependent measures suggest

that researchers should be more explicit about the

media literacy core conceptsskills they include in

their interventions and should more carefully ad-

dress who delivered the intervention with what fidel-

ity in what setting for how long and utilizing what

pedagogical approach Although it was not published

at the time this review was conducted the Alliance

for a Media Literate Americarsquos (AMLA) Core Prin-ciples of Media Literacy Education [64] served as an

implicit foundation for developing our inclusion cri-

teria and determining what variables to explore since

the lead author of this review was one of 10 authors

of the Core Principles published in April 2007 TheAMLArsquos Core Principles document now provides

a significant foundation for developing media liter-

acy education research frameworks in the future

Overall more research evaluating the effective-

ness of media literacy education to address a variety

of relevant public health concerns is greatly needed

The small size of the sample that met the criteria for

inclusion in this review is indicative of the lack of

peer-reviewed research on health-promoting media

literacy education Additional rigorous research

carefully reported using the measures established

in the framework for this review and those addi-

tional measures recommended in the discussion

especially pedagogical approach and more defini-

tive outcome measures will help to improve media

literacy education and advance it as a useful health

promotion strategy

Acknowledgements

Many thanks to Sue Forster-Cox Assistant Profes-

sor New Mexico State University for her help in

preparing the thesis that led to this article Thanks

also to Jennifer Peters Mel amp Enid Zuckerman

College of Public Health University of Arizona

for her help in preparing the tables

References

References marked with an asterisk indicate studies included

in the systematic review

1 Committee on Public Education American Academy of Pe-diatrics Children adolescents and television Pediatrics2001 107 423ndash6

2 Strasburger VC Wilson BJ Children Adolescents and theMedia Thousand Oaks CA Sage Publications 2002

3 Kaiser Family Foundation Generation M Media in theLives of 8ndash18 Year-OldsAvailable at httpwwwkfforgentmediauploadGeneration-M-Media-in-the-Lives-of-8-18-Year-olds-Reportpdf Accessed 06 January 2006

4 Heins M Cho C Media Literacy An Alternative to Censor-ship 2nd edn New York NY Free Expression PolicyProject 2002

5 Thoman E Jolls T MediaLit KitmdashLiteracy for the 21st Cen-tury An Overview and Orientation Guide to Media LiteracyEducation Available at httpmedialitorgmedialitkithtmlAccessed 06 February 2006

6 Dennis E Out of sight and out of mind the media literacyneeds of grown-ups Am Behav Sci 2004 48 202ndash11

7 Center for Media Studies Conference Report Setting Re-search Directions for Media Literacy and Health EducationAvailable at httpwwwmediastudiesrutgersedumh_con-ferenceconf7012pdf Accessed 06 January 2006

8 Centre for Reviews and Dissemination Undertaking System-atic Reviews of Research on Effectiveness CDRrsquos Guidancefor Those Carrying Out or Commissioning Reviews CDRReport 4 2nd edn Available at httpwwwyorkacukinstcrdpdfcrd4_ph0pdf Accessed 15 February 2007

9 Lipsey MW Wilson DB Practical Meta-Analysis Thou-sand Oaks CA Sage Publications 2001

10 Kaiser Family Foundation Key Facts Media LiteracyAvailable at httpwwwkfforgentmediauploadKey-Facts-Medai-Literacypdf Accessed 06 January 2006

11 Yates BL Media literacy a health education perspectiveJ Health Educ 1999 30 180ndash4

12 Brown JA Television lsquolsquoCritical Viewing Skillsrsquorsquo EducationMajor Media Literacy Projects in the United States andSelected Countries Hillsdale NJ Lawrence Erlbaum Asso-ciates 1991

13 Pinkleton BP Austin EW Cohen M et al State-wide evalu-ation of the effectiveness of media literacy Training to preventtobacco use among adolescents Health Commun 2007 2123ndash34

14 Bergsma LJ Ingram M Blowing Smoke Project EvaluationFinal Report Available at httpwwwblowingsmokearizonaedufinalresults2pdf Accessed 06 February 2006

15 Graham JW Hernandez R A Pilot Test of the AdSmartsCurriculum A Report to the Scott Newman Center LosAngeles CA Scott Newman Center 1993

16 Hobbs R Girls and Young Womenrsquos Understanding of Di-etary Supplement Advertising Assessing Critical AnalysisSkills Report prepared for the Office on Womenrsquos healthDepartment of Health and Human Services Available athttpwwwreneehobbsorgreneersquos20web20sitePubli-cationssample_of_recent_publicationshtm Accessed 06February 2006

17 Levine MP Piran N Stoddard C Mission more probablemedia literacy activism and advocacy as primary preven-tion In Piran N Levine M Steiner-Adair C (eds) Prevent-ing Eating Disorders A Handbook of Interventions andSpecial Challenges Philadelphia PA Brunner-Routledge1999 3ndash25

L J Bergsma and M E Carney

540

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Dow

nloaded from

18 Hill SC Lindsay GB Using health infomercials to developmedia literacy skills J Sch Health 2003 73 239ndash41

19 Rich M Health literacy via media literacy Am Behav Sci2004 48 165ndash88

20 Moore J DeChillo N Nicholson B et al Flashpoint aninnovative media literacy intervention for high-risk adoles-cents Juv Fam Court J 2000 23ndash34

21 Nathanson AI Yang M The effects of mediation contentand form on childrenrsquos responses to violent television HumCommun Res 2003 29 111ndash34

22 Bergsma LJ Empowerment education the link betweenmedia literacy and health promotion Am Behav Sci 200448 152ndash64

23 Hindin TJ Development and evaluation of a nutrition ed-ucation intervention on Head Start parentsrsquo ability to medi-ate the impact of TV food advertising to their children DissAbstr Int 2001 62 2264

24 Kline S Countering childrenrsquos sedentary lifestyles an eval-uative study of a media-risk education approach Childhood2005 12 239ndash58

25 Posavac HD Posavac SS Weigel RG Reducing the impactof media images on women at risk for body image distur-bance three targeted interventions J Soc Clin Psychol 200120 324ndash40

26 Slater MD Rouner D Murphy K et al Adolescent counter-arguing of TV beer advertisements evidence for effective-ness of alcohol education and critical viewing discussionsJ Drug Educ 1996 26 143ndash58

27 Levine MP Smolak L Schermer F Media analysis and re-sistance by elementary school children in the primary pre-vention of eating problems Eat Disord 1996 4 310ndash22

28 McVey G Davis R A program to promote positive bodyimage a 1-year follow-up evaluation J Early Adolesc 200222 96ndash108

29 Clocksin BD Integrated health and physical education pro-gram to reduce media use and increase physical activity inyouth Diss Abstr Int 2005 66 126

30 Nathanson AI Mediation of childrenrsquos television viewingworking towards conceptual clarity and common under-standing In Gudykunst WB (ed) Communication Year-book 25 Mahwah NJ Lawrence Erlbaum Associates2001 115ndash51

31 Robinson TN Wilde ML Navracruz LC et al Effects ofreducing childrenrsquos television and video game use on aggres-sive behavior Arch Pediatr Adolesc Med 2001 155 17ndash23

32 Rosenkoetter LI Rosenkoetter SE Ozretich RA et al Miti-gating the harmful effects of violent television J Appl DevPsychol 2004 25 25ndash47

33 Piran N LevineMP Irving LM GOGIRLSMedia literacyactivism and advocacy project Healthy Weight J 2000 1489

34 Goldberg ME Niedermeier KE Bechtel LJ et al Heighten-ing adolescent vigilance toward alcohol advertising to fore-stall alcohol use J Public Policy Mark 2006 25 147ndash59

35 Yamamiya Y Cash TF Melnyk SE et al Womenrsquos expo-sure to thin-and-beautiful media images body image effectsof media-ideal internalization and impact-reduction inter-ventions Body Image 2005 2 74ndash80

36 Fuller HA Damico AM Rodgers S Impact of a health andmedia literacy curriculum on 4th-grade girls a qualitativestudy J Res Child Educ 2004 19 66ndash78

37 Wilksch SM Tiggemann M Wade TD Impact of interac-tive school-based media literacy lessons for reducing inter-nalization of media ideals in young adolescent girls andboys Int J Eat Disord 2006 39 385ndash93

38 Austin EW Johnson KK Direct and indirect effects ofmedia literacy training of third gradersrsquo decision-makingfor alcohol Proc Int Commun Assoc 1995 1ndash40

39 Austin EW Johnson KK Immediate and delayed effects ofmedia literacy training on third gradersrsquo decision making foralcohol Health Commun 1997 9 323ndash49

40 Austin EW Johnson KK Effects of general and alcohol-specific media literacy training on childrenrsquos decision mak-ing about alcohol J Health Commun 1997 2 17ndash42

41 Austin EW Pinkleton BE Funabiki R The desirabilityparadox in the effects of media literacy training Proc IntCommun Assoc 2005 1ndash46

42 Austin EW Pinkleton BE Hust SJT et al Evaluation of anAmerican legacy foundationWashington state departmentof health media literacy pilot study Health Commun 200518 75ndash95

43 Byrne S Effective and lasting media literacy interventionsProc Int Commun Assoc 2005 1ndash35

44 Coughlin JW Kalodner C Media literacy as a preventionintervention for college women at low- or high-risk for eat-ing disorders Body Image 2006 3 35ndash43

45 Evans AE Dave J Tanner A et al Changing the homenutrition environment effects of a nutrition and media liter-acy pilot intervention Fam Community Health 2006 2943ndash54

46 Gonzales R Glik D Davoudi M et al Media literacy andpublic health integrating theory research and practice fortobacco control Am Behav Sci 2004 48 189ndash201

47 Hindin TJ Contento IR Gussow JD A media literacynutrition education curriculum for Head Start parents aboutthe effects of television advertising on their childrenrsquos foodrequests J Am Diet Assoc 2004 104 192ndash8

48 Irving LM Berel SR Comparison of media-literacy pro-grams to strengthen college womenrsquos resistance to mediaimages Psychol Women Q 2001 25 103ndash11

49 Irving LM DuPen J Berel S A media literacy program forhigh school females Eat Disord 1998 6 119ndash31

50 Kusel AB Primary prevention of eating disorders throughmedia literacy training of girls Diss Abst Int 1999 60 1859

51 Neumark-Sztainer D Sherwood NE Coller T et al Pri-mary prevention of disordered eating among preadolescentgirls feasibility and short-term effect of a community-basedintervention J Am Diet Assoc 2000 100 1466ndash73

52 Rabak-Wagener J Eickhoff-Shemek J Kelly-Vance LThe effect of media analysis on attitudes and behaviors re-garding body image among college students J Am CollHealth 1998 47 29ndash35

53 Scharrer E lsquolsquoI noticed more violencersquorsquo The effects of a me-dia literacy program on critical attitudes toward media vio-lence J Mass Media Ethics 2006 21 69ndash86

54 Sprafkin J Watkins LT Gadow KD Efficacy of a televisionliteracy curriculum for emotionally disturbed and learningdisabled children J Appl Psychol 1990 11 225ndash44

55 Vooijs MW Van Der Voort THA Learning about televi-sion violence the impact of a critical viewing curriculum onchildrenrsquos attitudinal judgments of crime series J Res DevEduc 1993 26 133ndash42

Effectiveness of health-promoting media literacy

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56 Vooijs MW Van Der Voort THA Teaching children toevaluate television violence critically the impact of a Dutchschools television project J Educ Telev 1993 19 139ndash52

57 Wade TD Davidson S OrsquoDea JA Enjoyment and per-ceived value of two school-based interventions designed toreduce risk factors for eating disorders in adolescents Aust EJ Adv Mental Health 2002 1 Available at httpwwwau-seinetflinderseduaujournalvol1iss2wadepdf Accessed1 February 2006

58 Wade TD Davidson S OrsquoDea JA A preliminary con-trolled evaluation of a school-based media literacy programand self-esteem program for reducing eating disorder riskfactors Int J Eat Disord 2003 33 371ndash83

59 Wolf-Bloom M Using media literacy training to preventbody dissatisfaction and subsequent eating problems in earlyadolescent girls Diss Abstr Int 1998 59 4515

60 Landis RJ Koch GG The measurement of observer agree-ment for categorical data Biometrics 1977 33 159ndash74

61 Thoman E Jolls T Media literacy education lessons fromthe Center for Media Literacy In Schwarz G Brown PU(ed) Media Literacy Transforming Curriculum andTeachingmdash104th Yearbook of the National Society forthe Study of Education Malden MA Blackwell Publish-ing 2005 180ndash205

62 Teen Futures Media Network Teen Aware Sex Media andYouAvailable at httpdeptswashingtonedutawareview-cgisection Accessed 06 April 2006

63 Worsnop C Screening Images Mississauga OntarioWright Communications 1998

64 Alliance for a Media Literate America Core Principlesof Media Literacy Education Available at httpwwwamlainfoorguploadscE7AcE7AyUoKFH3zm-aNaVy7P-QAMLA-Core-MLE-Princ-6-07-Final-Revpdf Accessed07 May 2007

Received on October 23 2006 accepted on October 16 2007

L J Bergsma and M E Carney

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