Running head: MEDIA LITERACY AND ONLINE BASED SEXUAL HEALTH CURRICULUMS 1

Media Literacy and Online Based Sexual Health Curriculums: A Literature Review
Kayla McKean
James Madison University
MEDIA LITERACY AND ONLINE BASED SEXUAL HEALTH CURRICULUMS 2

Abstract
This paper explores the impact of online sexual health curriculums for students and teachers as

well as the impact of media literacy components in sexual health education. Twelve sources are

reviewed to answer: What is the impact of including media literacy within sexual health

curriculums on students’ ability to understanding and critique media that relates to sexual health

and relationships? And, what is the impact of hosting sexual health curriculums online rather

than through the traditional face to face setting between a teacher and students? Sources

considered needed to involve youth in the United States between the ages of 12 and 19. The

review shows that media literacy in sexual health education was effective in increasing

preventative behaviors like condom use and communication between partners about the potential

consequences of having sex. Sexual health presented online offered anonymity for students that

made them feel less inhibited to ask questions. In conclusion there are many benefits to including

media literacy in sexual health education and hosting sexual health education online. More

research into curriculum that include media literacy is needed to understand the subject matters

covered.

Keywords: media literacy, sexual health education online, relationships, safer sex
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Introduction
Rationale
As a sexual health educator I am interested not only in what information students already

know about sex, but also where they found that information. While talking with apprehensive

parents we routinely remind them that if their student does not learn about sexual health from us,

they will undoubtedly learn about it somewhere. That “somewhere” could range from a peer to

rumors and myths, magazines and pornography to movies, music videos, and advertising. On

average adolescents will view music videos 30 to 120 minutes daily and up to 75% of those

videos contain sexually suggestive material (Van Horn, 2002). A content analysis of television

shows popular with teens showed that the majority of characters who engaged in sexual

relationships experienced only positive outcomes (Kaiser Family Foundation, 2003 as cited in

Cohen, Chen & Fitzgerald, 2003). Consuming this content is not necessarily a bad thing as long

as the consumer is able to analyze and critique the material for subliminal messages or medical

accuracy which is a part of media literacy. In Smooth’s (2018) overview video, media literacy is

defined as “the ability to access, analyze, evaluate, create, and act using all forms of

communication.” While exploring the impact of teaching media literacy as it relates to sexual

health I also wanted to consider the impact of sexual health education through technology. In an

age where we regularly consume media through technology I wondered about the effect of

sexual health education through technology and the unique possibility of incorporating media

literacy into technology based sexual health education. Online sexual health curriculums ensure

fidelity of the content delivered to students, they are easier to update with current medical

findings, and they offer more opportunities for user interactivity (Widman, Golin, Kamke,

Burnette, Prinstein, 2018).

Objectives
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This paper will examine two main questions including: What is the impact of including

media literacy within sexual health curriculums on students’ ability to understanding and critique

media that relates to sexual health and relationships? And, what is the impact of hosting sexual

health curriculums online rather than through the traditional face to face setting between a

teacher and students?

Methods
Eligibility Criteria
Articles or sources considered for this review needed to be published between 2000 and

2018. They needed to be written in English and include some focus on adolescents aged 12 to 19

in the United States. Sources without a focus on adolescents were used for defining media

literacy or exploring sexual messages in media.

Information Sources/Search
I used the James Madison University online library as well as Google Scholars to locate

relevant sources. I searched specifically within The National Association for Media Literacy

Education’s Journal of Media Literacy Education as well as in the Sex Education journal and

Pediatrics journal. Within JMU’s database I searched for articles with the terms media literacy

and sex education, history of media literacy, sex education online, and effect of sex in media. I

only considered full-text sources.

Method of Summary/Synthesis
I used the resources I found to outline the problem of exposure to sexual content in media

for teens and to define media literacy as well as briefly describe the history of media literacy. For

articles that would inform my media literacy question I looked for the authors to define learning

objectives around analyzing or creating media for students within their study. For the sources
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that would inform my sexual health education online question I looked for the curriculum

delivery method chosen by the researchers. I summarized the resources by their main impact

through history, the chosen interventions, the results of the study, and the perceived advantages

and disadvantages of the intervention.

Results
Resource Selection
Nine scholarly articles, two educational videos, and one magazine column were included

in this review. Around 25 articles were screened for this review.

Findings
Impact of media literacy.

As a society we spend more time with media than we ever have in history. Jay Smooth

(2018a) describes media as a vehicle for a message. Breaking news, movies, advertising, music,

emails, books, painting, videogames, tweets, signs, podcasts are all forms of media. Smooth

(2018a) defines media messages as “the values and ideas promoted by the media and media

effects as the influences and consequences on audiences.” People are not passive sponges while

consuming media. They interpret messages and choose whether or not they will pass on the

message, believe the message, or disregard it. In a society that consumes media at most every

point of the day it is important to remain in an active state of interpreting media messages. For

youth that are heavily influenced by their peers and media messages it is essential that they see

positive portrayals of sex in the media or at the very least can critique messages for accuracy.

One study found that youth that viewed television episodes that depicted condom use reported

that their beliefs had changed about condom efficacy. While students once believed condoms to

be ineffective and rarely used, seeing characters in media use condoms reversed those beliefs
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(Collins et al., 2017). It is hard to imagine the change in behavior we might see in adolescent

sexual health if the media norm was to depict safer sex and healthy relationships. Until that is the

norm it is essential that youth be able to think critically about why the standard they see every

day does not encourage these safer sex.

The sexual messages routinely viewed by teens do not often promote safer sex or healthy

relationship expectations. Pornography has become more widely available than ever before and

can be viewed privately and anonymously. It is more likely to depict characters in non-

consensual and aggressive sexual situations and rarely shows characters using forms of

protection (Collins et al., 2017). Online viewing of pornography from a variety of devices makes

it difficult for parents to monitor because it is nearly always available. Van Horn (2002) writes

that sex is used to sell just about anything from potato chips to cars, so even in the advertising of

everyday items youth are consuming sexual messages. With the emergence of social media was

the creation of a new venue where youth can not only create their own sexual images or videos to

share, but can view those created by their peers (Collins et al, 2017). The common sexual

message in American media whether it is pornography, advertising or social media expects men

to pursue sex more often than woman, prioritize pleasure over emotion and to view women as

sexual objects. In this regularly communicated message women are expected to be sexually

passive, use their bodies to attract men, prioritize emotion, and minimize desire (Collins et al,

2017). Messages outside of those that perpetuate gender stereotypes are often medically

inaccurate and lack messaging around using condoms and birth control. Adolescent characters

who engage in sexual activity rarely exercise prevention or experience negative outcomes (Scull,

Malik, Kupersmidt, 2014). While we know that youth are influenced by the messages they

consume, it is not realistic that an adult will always be present to help youth interpret those
MEDIA LITERACY AND ONLINE BASED SEXUAL HEALTH CURRICULUMS 7

messages. Smooth (2018b) reasons that by taking a closer look at the creation of media it

becomes more obvious to the consumer that they are being sold a story rather than facts. Media

has trained consumers to seek a story and to crave drama. The messages that those stories give

have commercial and political implications. Keller and Brown (2002) explain that media literacy

is believed to lead to a greater understanding of these constructed stories, including stories

related to sex. They explain that understanding this construction can lead to personal changes

like an improvement in self-esteem, adopting a responsibility to engage in safe sex, negotiating

consistent condom use with others, and expressing oneself. Keller and Brown (2002) state that

media literacy should also be hands on and participatory. As seen in other studies, they conclude

that sexual health behavior is linked to media exposure and that when safer sex is portrayed in

the media it increases viewers’ condom use and decreases teen sexual activities. They also note

that sexual health done through a media literacy framework is ideal for communicating sensitive

information because it allows students to view sexual health decision making through characters

in a story who are not themselves or their peers.

One example of a sexual health curriculum to include media literacy education is called

“Take it Seriously.” The “Take it Seriously” Abstinence and Media curriculum implemented

with 11-19 year olds included lessons on marketing strategies using sex, teen sex myths, STI

statistics, personal choices, and creating media messages (Pinkleton, Austin, Cohen, Chen and

Fitzgerald, 2008). The curriculum provided a cognitive framework for understanding and

resisting media influence. Pinkleton et al., (2008) concluded that students who engaged in “Take

it Seriously” showed a decrease in the allure of sex and a decrease in positive expectations of

teen sex. The impact of a media literacy framework on sexual health education was that it

allowed youth to critique and create media messages related to sex. This hands on experience
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encouraged participants to question media and to make decisions around sex based on their own

beliefs and not the beliefs of others. Similarly Scull, Malik, & Kupersmidt (2014) evaluated the

online sexual health curriculum “Media Aware Sexual Relationships” (MASH) with high school

aged youth. MASH included eight comprehensive lessons on sexual health that included

identifying and analyzing gender stereotypes, tactics used by media, critical thinking about

accuracy of media messages depicting sex, drug and alcohol use during sexual encounters,

identifying healthy and unhealthy relationships, as well as STIs and pregnancy prevention.

Students who completed MASH were more likely than their peers to be skeptical of media

messages. Again in this example, providing students with media that included teens in sexual

relationships allowed participants to communicate more openly about the situations as it was not

their own experiences they had to discuss. The results of this study showed an increased

intention of condom use, increased intention of communication between partners, parents, and

doctors and a decreased perceived realism of teens in the media. The impact of media literacy

education as a component of sexual health is that students feel more comfortable to discuss a

sensitive topic and are less likely to believe the glamorized version of sexual encounters

portrayed in the media.

Scull, Malik, Kupersmidt & Keefe (2018) evaluated “Media Aware” a self-paced, on

demand, multimedia, web based curriculum for 18 and 19 year olds. As compared to the control

group, the intervention group in this study reported higher levels of using dental dams and

communicating about sex as well as higher levels of using protection for oral sex. Participants in

the intervention group developed skills for deconstructing media by exploring gender

stereotypes, comparing the media norm to the social norm, searching for the missing messages in

media, and comparing the effectiveness of birth control and condoms that is reported in media
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versus what is medically accurate. Results showed that instances of oral, vaginal, and anal sex

were fewer in intervention participants as well as instances of sex under the influence of drugs or

alcohol. Acceptance of rape and rape myths was also lower for students in the intervention group

as compared to those in the control group (Scull et al., 2018). Media literacy educators have a

responsibility to teach about the history of educational technology and media literacy so that

youth today can understand media’s ever changing capabilities and tactics. Students must

become active authors of media messages using a full range or digital media and technology

tools so that they may develop skills for self-expression, advocacy, and education (Hobbs &

Jensen, 2009).

Impact of online sexual health education.

Media literacy education is more impactful when it includes hands on applications and

when it is easily accessible. Using technology to host sexual health education can over

interactivity and accessibility to students. Goldman’s (2016) study of sexual health education

across all ages and developmental stages identified several advantages of using MOOCs. MOOC

is an acronym for a massive, open and online course of study. MOOCs allow for computer and

internet based learning and teaching. Goldman reviewed the implications of using MOOCs for

sexual health education in preschool (focusing on the body and family through rhyme or sight

games), adolescence (visual learning and interactivity for understanding ovulation, conception,

and STIs), all the way through post-retirement and older age (learning about voluntary health

occupations and review of sexual health). Today’s learners are already familiar with applications

and devices online and may feel more at ease with online instruction. MOOCs are easier to keep

updated and are widely available across race, age, socioeconomic circumstances, and culture

(Goldman, 2016). Some disadvantages to using MOOCs include human interaction being limited
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and access is still an issue in areas of poverty and where gender equality, literacy skills, and

interest access are lacking. In general the impact of using MOOC for sexual health education

could mean greater access across ages and the increased likelihood of learning sexual health

information when there is an option of anonymity. In a study done by McGinn and Arnedillo-

Sánchez (2015) a virtual learning environment was used to support communication between

teachers and students. A four week study included 3 teachers and 28 students in a curriculum

covering friendship qualities, self-esteem, and sexual behavior. Activities were designed to

prompt discussions and included quizzes, videos, podcasts and fact sheets. Students could

engage with peers and their teacher anonymously, or not, through email, chat, or discussion

boards. The majority of the students stated that they felt less embarrassed to ask questions and

engage with the material in the class. McGinn and Arnedillo- Sánchez (2015) noted increased

attention that they attributed to the novelty of an online course for students or just the familiarity

of using applications similar to those that students already used. Again, the anonymity of the

application put the user more at ease which made them feel more comfortable to engage with the

sensitive subject matter. An evaluation of the HEART (Health Education and Relationship

Training) curriculum with 10th grade females showed that after engaging with 5 modules on

safer sex motivation, HIV and other STIs, sexual norms and attitudes, safer sex self-efficacy, and

sexual communication skills participants in the intervention group showed better assertiveness

skills and knowledge of HIV/STIs than that of their peers in the control group. The online

program ensured that each student was receiving the same information and they each had the

opportunity to practice communication skills through the online program which they might have

missed out on in a classroom setting.

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Discussion
Summary
The impact of including media literacy as an essential component in sexual health

education leads to a variety of positive outcomes. Students who view media stories depicting

safe sex including the use of prevention methods like condoms and birth control are more likely

to use them on their own. They are also more critical and skeptical of the media messages they

consume and are able to better understand that what they are viewing is a carefully created

reality that does not consider real life consequences.

When sexual health education is delivered online it gives students the opportunity to

engage with material they may consider uncomfortable in a way that feels familiar to them. The

anonymity that online messaging and classes provided made students feel less inhibited to ask

questions and helped teachers better understand the learning needs of their classroom. Sexual

health online allows for quick updates to an ever changing subject matter and the distribution of

materials to a large audiences at a time. It will be important to ensure that sexual health delivered

online closes face to face conversations between adolescents and adults. To shy away from

questions and conversations could unintentionally create shame, embarrassment, and hesitancy in

seeking advice in relationships and medical attention.

Relevance
Sexual health educators, professionals that work with adolescents, and parents could

highly benefit from understanding the impact media has on youth. Knowing that youth consume

media on a daily basis and that a lot of that media contains sexual messaging could help shape

discussions in classrooms, doctor’s offices and in front of the television. Makers of sexual health
MEDIA LITERACY AND ONLINE BASED SEXUAL HEALTH CURRICULUMS 12

curriculums need to carefully consider the benefits of taking sexual health education online and

the need to include media literacy education in their instruction. Parents and professionals should

regularly have discussions about stories that depict sex in media and how youth are interpreting

and understanding them.

Implications
It is becoming increasingly difficult to keep adolescents away from all media that could

contain sexual messages. While some messages are aggressive and unhealthy, the ultimate goal

should not be a total ban of media with sexual messaging. At some point, youth will engage with

these messages and it will be most beneficial for them to be able to critique and analyze the

message on their own. Educators and policy makers can begin by including media literacy

education as a core learning objective in middle and high school. Policy makers and sexual

health educators can inform parents about the importance of talking to teens about sex especially

as it is depicted in movies, advertising, and music videos. Media producers should also take the

responsibility of linking consumers to resources for further education or helplines for support.

Many of these resources already exist so this addition could look like a simple text screen or

voiceover suggesting the viewer to seek more information.

Limitations

In searching for relevant sources for this review I did not always have access to full text

articles that, judging from their abstract, I think would have been beneficial to include in this

paper. My search for sources to answer my media literacy question was limited to studies of

sexual health curriculums with a strong emphasis on media literacy and did not include sexual

health curriculums with a lighter emphasis on media literacy.

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Conclusions
I think the results show that media literacy is a positive component in sexual health

education and that pieces of sexual health education online can be beneficial not only to students

but to teachers as well. As we develop and consume new media every single day it is important

to keep up with a method for interpreting that media. Adolescents are often the guinea pigs of

new technologies and media, so they need skills to analyze what they are seeing. Teachers and

parents should be prepared to talk to youth about the messages delivered in media and how it

relates to their teens’ own reality. I think more research on how and what media is chosen to

critique and analyze by students should be done in future. Does the developer of a curriculum

chose the media examples to show students or does the instructor? What considerations for age,

race, socioeconomic status, gender identity, and culture are considered when choosing relevant

and meaningful media for students?

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