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Effects of Reducing Children's Television and Video Game Use on Aggressive Behavior

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Effects of Reducing Children's Television and Video Game Use on Aggressive Behavior

A Randomized Controlled Trial

<> Thomas N. Robinson, MD, MPH; Marta L. Wilde, MA; Lisa C. Navracruz, MD; K. Farish Haydel; Ann Varady, MS

Context The relationship between exposure to aggression in the media and children's aggressive behavior is well documented. However, few potential solutions have been evaluated.

Objective To assess the effects of reducing television, videotape, and video game use on aggressive behavior and perceptions of a mean and scary world.

Design Randomized, controlled, school-based trial.

Setting Two sociodemographically and scholastically matched public elementary schools in San Jose, Calif.

Participants Third- and fourth-grade students (mean age, 8.9 years) and their parents or guardians.

Intervention Children in one elementary school received an 18-lesson, 6-month classroom curriculum to reduce television, videotape, and video game use.

Main Outcome Measures In September (preintervention) and April (postintervention) of a single school year, children rated their peers' aggressive behavior and reported their perceptions of the world as a mean and scary place. A 60% random sample of children were observed for physical and verbal aggression on the playground. Parents were interviewed by telephone and reported aggressive and delinquent behaviors on the child behavior checklist. The primary outcome measure was peer ratings of aggressive behavior.

Results Compared with controls, children in the intervention group had statistically significant decreases in peer ratings of aggression (adjusted mean difference, -2.4%; 95% confidence interval [CI], -4.6 to -0.2; P = .03) and observed verbal aggression (adjusted mean difference, -0.10 act per minute per child; 95% CI, -0.18 to -0.03; P = .01). Differences in observed physical aggression, parent reports of aggressive behavior, and perceptions of a mean and scary world were not statistically significant but favored the intervention group.

Conclusions An intervention to reduce television, videotape, and video game use decreases aggressive behavior in elementary schoolchildren. These findings support the causal influences of these media on aggression and the potential benefits of reducing children's media use.

Arch Pediatr Adolesc Med. 2001;155:17-23

VIOLENCE IS pervasive in television, movies, and video games. Children's television programming contains even more violence than prime-time programming; it has been estimated that by the age of 18 years, US children witness 200 000 acts of violence on television alone.<>1

The relationship between media violence and aggressive behavior has been the focus of more than 1000 studies. Exposure to violent media appears to produce 3 effects on children: (1) direct effects, in which children become more aggressive and/or develop more favorable attitudes about using aggression to resolve conflicts; (2) desensitization to violence and the victimization of others; and (3) beliefs that the world around them is mean and scary. Evidence for these effects comes from laboratory experiments,<>2-4 field experiments in which children's aggression was monitored after exposure to violent media,<>5, <>6 natural experiments that monitored levels of aggression after the initial introduction of television into a community,<>7 retrospective, cross-sectional and prospective observational studies,<>8, <>9 and ecological studies.<>10, <>11 Reviews of the literature come to a consensus that exposure to media violence increases children's aggressive attitudes and behaviors.<>1, <>12, <>13

Despite substantial evidence that exposure to violent media is associated with increased aggression, few potential solutions have been evaluated. In the current multimedia, multichannel, remote control environment where heavy media use is the norm, a question of great clinical, practical, and policy importance is: Will reducing television, videotape, and video game use decrease aggressive behavior? Therefore, we conducted a randomized, controlled, school-based trial of reducing third- and fourth-grade children's television, videotape, and video game use to assess the effects on aggressive behavior and attitudes. We hypothesized that, compared with controls, children exposed to the intervention would decrease their levels of aggressive behavior, as measured by peer, parent, and observational measures of aggression, and decrease their perceptions of the world as mean and scary.


All third- and fourth-grade students in 2 public elementary schools in a single school district in San Jose, Calif, were eligible to participate. Schools were sociodemographically and scholastically matched by district personnel. School principals and teachers agreed to participate prior to randomization. Parents or guardians provided signed written informed consent for their children to participate in assessments, and for their own participation in telephone interviews. One school was randomly assigned to implement a program to reduce television, videotape, and video game use. The other school was assigned to be an assessments-only control. Because only 2 schools were randomized, this may also be considered a quasi-experimental design. All assessments were performed by trained staff, blinded to the experimental design, at baseline (September 1996) and after the completion of the intervention (April 1997). Participants and school personnel, including classroom teachers, were informed of the nature



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