Entertainment Education: Its Role in Reducing Teen Pregnancy

Books are my first media love, but at times I can definitely be a screen media junkie. I still drop Mean Girls references even though the movie is a decade old because I know the limit on those references does not exist. I will also admit that I once watched five straight hours of Community on Hulu Plus. So even though the reality TV show 16 and Pregnant aired on MTV is not my idea of “quality entertainment,” I am not surprised at the recent findings from the National Bureau of Economic Research that highlighted the show’s contribution to lower teen pregnancy rates. According to the report, 16 and Pregnant increased the number of searches and tweets about birth control and abortion, which the authors argue ultimately led to a 5.7 percent reduction in teen births in the 18 months after it was introduced.

Fusing information and entertainment is not a new idea. (You don’t really think Aesop was inserting those morals for fun, do you?) Entertainment education through TV and radio has been used as a health-communication tool since the 1960s to promote everything from family planning to vaccine utilization. In South Africa, the television drama Tsha Tsha significantly increased condom use and HIV testing while decreasing the stigma associated with HIV/AIDS. Similarly, a radio drama in Nepal helped train health workers to improve health care delivery. While entire entertainment-education programs are rare in the United States, there have been small examples of its use. Who can forget the Friends episode when Ross and Joey learned the effectiveness rate for condoms? (In case you missed that episode, they’re not 100 percent effective at preventing pregnancy. The CDC reports condoms are 82 percent effective as typically used by males, though it can be higher with correct use.) One study showed that youth recalled the information, and those who spoke with parents reported learning about condoms from the episode. But apart from these historical and international examples, there are elements of 16 and Pregnant that give it some credibility as a form of entertainment education.

Just as romantic comedies have two people who hate each other ending up in love, entertainment education has its own “formula.” Here’s how 16 and Pregnant fits:

1. Engaging its intended audience. Producers of programs intending to change health behaviors will tell you the importance of recruitment and retention. It is one of the basic criteria for program evaluation. Programs cannot influence behavior if people don’t spend time with their message. Adolescents spend a lot of time using media, with 12- to 17-year-olds logging 112 video hours per month, the majority of which are on TV. Think of the number of messages you could share in 112 hours.
2. Having relatable characters. One of the key principles of entertainment education comes from Alfred Bandura’s social cognitive theory, which states that people can learn by observing others’ experiences. While reality TV stars may go through a bit more antics than the rest of us, the point of the genre is that these shows are peeking into the lives of regular people. What’s more relatable than that?
3. Changing specific knowledge and attitudes. Many health-behavior change theories include some form of changing knowledge and attitudes—namely that people can’t change behaviors unless they know what steps to take and believe that change is beneficial to them. Research shows that ambivalence regarding pregnancy is one of the challenges teen pregnancy prevention specialists face. Studies on entertainment education, as well as studies on media’s overall effects on issues like body image, gun violence, and sexuality, show that media extensively shape what we know and how we view the world in both good ways and bad. Those effects are further compounded when taking into account the norms set and reinforced through social media. When you look at the discussion guides for 16 and Pregnant, the episodes cover some pretty hard realities about teen pregnancy and the responsibilities involved. Discussing and advocating these norms is a necessary part of behavior change.

While there are elements that research suggests could contribute to 16 and Pregnant’s positive impact, there is still more that can be done to improve its capabilities as a form of entertainment education. For one, the show lacks racial and ethnic diversity, perhaps missing an opportunity to reach some populations of teens at higher risk of pregnancy. Additionally, because the show focuses on teens who ultimately become pregnant, there’s less modeling of behaviors to prevent pregnancy, which would support the transition from knowledge and attitudes to actual practice. Fortunately, other entertainment education shows are working to fill this void. East Los High, a new drama series airing on Hulu, tracks the relationships, sexual decisions, and their consequences of several Latino teens in East Los Angeles. The shows’ developers have created a social media site that lets audience members further engage with the characters and learn about other health topics, such as healthy eating. It is already generating a following and fostering discussions among its audience. As these projects continue to develop, it is important that we also assess their impact to strengthen our understanding, especially as they incorporate new strategies like social media.

The takeaway from findings like those recently published about 16 and Pregnant is that our interventions don’t always have to look like traditional interventions. It is possible to innovate, and when we use all the avenues available to us, we can have great impacts. Case in point: my second week as a teaching fellow, three of my students walked up to me and said that I looked like Annie from Bad Girls Club, a reality TV show on the Oxygen Network. If youth are going to spend time watching these shows, shouldn’t we be figuring out how to use them to their advantage?