Introduction

The lives of young people are saturated with misleading media content [1, 2], potentially contributing to negative individual and public health outcomes. Although experts have expended considerable effort to reduce adolescents’ substance use and improve their health-related decision-making, significant portions of media programming and advertising consumed by young people contain glamorized, fictionalized portrayals of sex, alcohol, tobacco, and other substances [3]. As young people’s use of media has migrated from traditional media to digital and social media, so have marketing tactics and media-based displays of risky behavior [4–6].

Given the ability of digital and social media to provide largely unimpeded access to an overabundance of misleading and unsafe media content, health experts and others have expressed concerns over the role of media-message exposure in young people’s decision-making. Scholars have examined relationships of media consumption to negative health-related outcomes in a variety of contexts including alcohol abuse [7–9], tobacco use [10–12], substance use [13], and sexual decision-making [14–18] among other topics. While not conclusive, a variety of empirical research provides strong evidence supporting the negative influence of media exposure on young-peoples’ decision-making and behaviors [3, 13, 15]. Research findings emphasize the need for interventions that can disrupt the flow of incorrect and overly idealized messages about substance use to adolescents and increase their ability to detect and use correct, realistic information. As a result, many experts have examined media literacy as a potentially effective way to equip young people with critical-thinking skills necessary to distinguish truthful information from unhealthy or deceptive information.

The Influence of Media Exposure on Tobacco, Alcohol, and Other Substances

Despite over 50 years of warning about the dangers of smoking, nearly 42 million adults and more than 3.5 million middle and high school students smoke cigarettes; smoking kills nearly 500,000 people in the USA each year [19]. Aggressive and misleading marketing tactics used by cigarette manufacturers including advertising and related promotional efforts contribute significantly to first-time smoking by adolescents and young adults, and their nicotine addiction keeps them smoking [19]. Most tobacco users start before they are 18 years of age and many die prematurely as a result of their tobacco use [19]. Cigarette manufacturers target their advertising to young people. Longitudinal research by Hanewinkle and colleagues [11] using an ad-exposure measure that included frequency and cued-brand recall indicates that cigarette advertising associates with initiation of smoking, even after controlling for established risk factors. In addition, analyses indicated that the association between tobacco advertising and smoking initiation was specific to tobacco marketing and not simply a marker of adolescent receptivity to marketing more broadly.

Hanewinkle and colleagues suggest that the aspirational images used in tobacco advertising are purposefully selected to appeal to young people because the images associate tobacco use with desirable characteristics such as masculinity, independence, or sex appeal. Consistent with this perspective, research by Scull and colleagues [20] indicates that wishful identification with and perceived similarity to models used in tobacco and alcohol advertising associates with adolescents’ actual and future substance-use intentions. Adolescents’ identification with and perceived similarity to movie stars and other media personalities may also explain the influence of movie portrayals of smoking on young people’s tobacco use. Specifically, research by Dal Cin et al. [10] indicates that exposure to smoking in movies predicts an increased rate of smoking initiation while longitudinal research by Primack and colleagues [12] found that adolescents’ early exposure to smoking in movies associated with a 73 % increase in established smoking—a greater influence on adolescents’ smoking than even parent, sibling, or peer smoking.

Similarly, research indicates that young people’s exposure to advertising and digital-marketing tactics associates with an increase in their drinking and problematic drinking behavior [7, 9, 21, 22]. Abusive drinking is an epidemic among American college students, and alcohol abuse among adolescents and young adults poses a considerable public health concern. The results of a nationally representative survey of high school students indicates that more than 65 % of high school students in the USA have had a drink with nearly 35 % categorized as current drinkers and nearly 21 % having engaged in recent binge drinking. At US colleges and universities, 80 % of all underage students drink [23], and each year, alcohol is a factor in nearly 600,000 college student injuries and more than 1800 student deaths [24]. Part of the blame for the high number of negative outcomes associated with college student drinking is attributable to students’ binge drinking (consumption of >4/5 drinks per occasion for females/males). Research indicates that 44 % of college students binge drink [23], and among student and nonstudent members of the general population, those aged 18–24 consume an average of 9.5 drinks while binge drinking—the highest rate of consumption among any population subgroup [17, 25].

Alcohol is the principal substance featured in television programs, many of which portray alcohol use as normative [3]. In addition, young people are exposed to large amounts of alcohol advertising [26] which associates with increases in the initiation of drinking and higher levels of alcohol consumption [7, 22]. Research by Siegel and colleagues [21] found evidence of a robust relationship between underage youth exposure to alcohol-brand advertising and the prevalence of past 30-day brand consumption. Study participants were more than five times more likely to consume brands advertised on national television indicating advertising influence on brand choice among young people who consume alcohol. In addition, research by Primack and colleagues [13] found independent links between adolescents’ exposure to movies and their use of alcohol, and adolescents’ exposure to music and their use of marijuana. At the collegiate level, students’ exposure to online and digital alcohol-marketing tactics such as immersive environments and alcohol-themed games and wallpapers associates with higher levels of consumption and problem drinking behaviors [9]. How do media portrayals influence drinking among young people?

As Scull and coauthors [20] note, media messages concerning alcohol and other substances present their use as normative in fictitious portrayals that are exciting, glamorous, and typically free of negative consequences. Storylines show substance use as a good way to fit in with others, relax after a hard day at work, or relieve stress. Ultimately, media play an important socializing role in shaping adolescents’ attitudes toward alcohol and other substances [3], and young people’s positive affect toward highly desirable media portrayals may circumvent more logical aspects of their decision-making [27•]. In fact, research indicates that young people’s exposure to alcoholic-beverage advertising and their positive affect toward those ads influence under-aged drinking and the emergence of alcohol-related problems later in adolescence [8]. In light of the influence of media messages on young peoples’ substance use, researchers have recommended media literacy—which includes educating young people about media to enable and encourage their critical processing of media messages—as a way to forestall negative media effects on substance-related attitudes and behaviors [8, 20].

Media Literacy’s Role in Reducing the Influence of Misleading Media Messages

To create persuasive messages that sell alcoholic beverages, tobacco, and related products, marketers rely on attractive images and well-targeted social cues that associate desirable characteristics and consumption with resulting social rewards. Advertising for tobacco relies on purposefully selected aspirational images, for example, that are especially appealing to young people because the images associate tobacco use with desirable characteristics such as masculinity, independence, or sex appeal [11]. Similarly, alcohol advertising succeeds by relying on creative advertising appeals and enticing characters, action, and music [28]. Even when marketing messages contain obviously fictitious storylines and events, research has shown that young people develop an appreciation for and assign meanings to messages concerning alcohol that, while often incorrect, affect their appreciation for alcohol and actual drinking behavior [29, 30]. Ultimately, these techniques impact the thinking of young people, positively predisposing them to the consumption of alcohol and tobacco.

As a result, many experts have recommended media literacy as a potentially effective way to equip young people with critical-thinking skills and help negate the influence of unhealthy or deceptive information contained in many media messages [3, 11, 20, 31–33]. While scholars have yet to settle on a specific definition, media literacy generally refers to an individual’s ability to access, analyze, evaluate, and communicate messages using a wide range of communication tools and forms [34•]. Typically, media literacy education helps increase individuals’ skepticism toward media messages by strengthening their critical-thinking skills and facilitating their reflective, logic-based information processing to diminish the unhealthy impact of media messages [27•, 35, 36]. As a result, the objective of media literacy education programs is to help individuals—most commonly adolescents—develop the proficiencies needed to evaluate the veracity of media messages and use them effectively in decision-making [3].

Media-literate individuals possess capabilities that develop with maturation, such as the cognitive sophistication necessary to control attentional processes, relevant competencies resulting from vicarious and/or personally experienced learning, and the skills necessary to apply competencies as appropriate [37, 38]. The successful acquisition of health information, for example, requires individuals to access appropriate information sources and assess the credibility of claims and assertions regarding health threats and treatment—skills that are a major contributor to self-efficacy [39]. Decision-making is a learned skill, and scholars suggest that adolescents who improve their critical-thinking abilities tend to make better, healthier decisions [40, 41]. These adolescents will have an improved ability to understand and deconstruct media messages as well as a better understanding of the varied intentions of message producers. This will help produce skepticism toward media messages and more realistic expectancies in young people [27•].

The influence of media literacy education should be most evident through assessments of individuals’ beliefs related to decision-making processes because an increased understanding of media messages should alter their decision-making influence [42]. Media literacy evaluations typically rely on concepts and constructs from social cognitive theory [43], expectancy theory [44], and theories of heuristic and systematic message processing [45]. These concepts and related constructs are associated with the Message Interpretation Process (MIP) Model—consistent with the Integrative Model of Behavioral Prediction [46]—because it treats decision-making as a process of message evaluation and understanding rather than as a simple response to message stimuli [37, 47].

Scholars have conducted a number of reviews concerning media literacy and related topics [48, 49, 50•, 51]. In their meta-analysis of media literacy research, Jeong and colleagues [50•] concluded that media literacy interventions typically produce effects on outcomes they classify as either media relevant or behavior relevant. Media-relevant outcomes include measures of media-based knowledge and individuals’ understanding of the persuasive intent of advertising, awareness of media influence, their skepticism toward media messages, and the like. Behavior-relevant outcomes include individuals’ normative perceptions of behavior, expectancies and attitudes toward engaging in behaviors, and perceived self-efficacy to perform behaviors such as refusing tobacco or alcohol. Jeong and colleagues [50•] indicate that media literacy programs generally are effective as interventions producing desired outcomes on most media- and behavior-relevant outcomes, although the authors suggest media literacy education may have greater effects on media-relevant outcomes than on behavior-relevant outcomes. These authors suggest that media literacy curricula can successfully equip people to resist potentially harmful message effects.

Consistent with this perspective, public health advocates and others generally suggest that media literacy education provides a valuable strategy for substance-abuse prevention. Research concerning antismoking media literacy educational programs indicates that media literacy programs can provide significant benefits including increasing knowledge, correcting misperceptions regarding peers’ norms, increasing critical thinking and skepticism, and increasing perceived efficacy [20, 31, 33, 42, 47, 52, 53]. In a comparison of a media literacy-based antismoking education program to a typical antismoking educational program, for example, Primack and colleagues [33] found that students in the media-literacy program experienced improved media literacy skills and normative understanding related to smoking when compared to other participants in the typical program. Consistent with these findings, participants in evaluations of media literacy education commonly report increased perceptions of self-efficacy to resist media-message influence and control their choices [42, 47, 53].

Qualitative analyses of media literacy programming indicate that students consider media literacy programming to be a positive and compelling experience [54]. Other participants note the lack of veracity of tobacco advertising, the failure of tobacco producers to provide truthful, health-related information and express greater suspicion toward the tobacco industry [55]. Even while students report they appreciate and benefit from media literacy education, they also may continue to express an appreciation for clever commercial advertising [55]. In addition, in at least one study, participants in a media-literacy intervention were no more likely to suggest that they might change their health-related behavior than participants in a traditional antismoking program [54]. Even so, media literacy programs have shown an ability not only to increase participants’ self efficacy but also to demonstrate links to behavioral outcomes. For example, boys in one media-literacy program expressed less interest in alcohol-branded merchandise than control-group participants as a result of their participation [53]. More significantly, the results of a survey of 3600 college students by Primack and colleagues [54] indicated that higher media literacy concerning smoking independently associated with lower incidence of current smoking.

Caveats Regarding the Evaluation of Media Literacy Programs

Media literacy is not a panacea for an unhealthy, manipulative message environment, and the successful evaluation of media literacy programming requires a clear understanding the needs of the individuals receiving a curriculum and also the specific, intended outcomes of the curriculum. Most adolescents are awash in sexualized media content, advertising for harmful substances, music with violent or highly sexualized themes and the like. As a result, it is important for researchers conducting evaluation work to keep distinctions clear between what amounts to a manipulation check for a media literacy program (e.g., did participants learn media literacy content or principles?) and the outcomes or effects of media literacy education which tend to be reflected in changes in participants’ attitudes, beliefs, and behaviors attributable to media literacy education.

As part of this process, researchers should be aware of the potential for bias in measurement in media literacy evaluation. In particular, the National Association for Media Literacy Education (NAMLE) notes that media literacy is about teaching skills for good decision-making and avoiding presumptions concerning what participants should determine as a “right” or “correct” decision. In addition, it is useful to keep distinctions clear between critical thinking (the process of critically evaluating messages) and skepticism (the results of critical thinking). In this context, skepticism typically refers to an individual’s potentially malleable state of disbelief that preserves openness to new information, while cynicism refers to a more intransigent state of disbelief generally closed to new information. Ultimately, media-literate information consumers likely will be motivated to consult multiple sources of information to weigh their veracity and seek reliability among information sources.

In addition, some media literacy-based experiments and intervention evaluations have provided counter-intuitive results, apparently increasing some detrimental attitudes and behaviors in addition to improving beneficial ones [42, 47]. Some scholars have suggested this occurs if material is not carefully matched to the developmental sophistication of children or if researchers do not pretest materials interactively [56]. Also, Nathanson [57] has suggested that media literacy interventions can have unintended effects among lighter viewers if they are drawn to the novelty of material they have not seen before.

These are important considerations and deserving of more study as researchers continue to examine the efficacy of media literacy education. One issue requiring additional research is the potential role measurement or analysis may play in identifying “boomerang” effects [56, 58]. Research concerning participants’ reports of increased message desirability as a result of media literacy training, for example, appeared to indicate a boomerang effect. This created a need to consider whether participants’ responses to media literacy training reflected an improved awareness of message-design techniques—and therefore, a successful intervention—rather than a confusing or problematic outcome. In an analysis of data from two media literacy evaluations [27•], results indicated no boomerang effect after all: even though desirability levels had not decreased, the media literacy treatments had negated the effect of perceived desirability on participants’ attitudes and reduced the effect of desirability on participants’ expectancies. In addition, the treatment reduced the effect of desirability on participants’ efficacy in one study. Ultimately, these results supported what the researchers deemed the “double-edged desirability hypotheses,” that media literacy education can diminish the influence of desirable but glamorized, fictionalized media messages whether or not it decreases people’s message affinity [27•].

The limits of media literacy also need more investigation. Theorizing about media literacy tends to assume that media-literate individuals process messages at a deeper level of involvement than less media-literate individuals do [59]. Yet research on processing of media messages indicates that individuals have a limited capacity for message processing and that message designers can take advantage of these limitations [60]. For example, individuals may recall content without recalling the source of the information or the context surrounding the content, putting them at risk for believing inaccurate or untruthful content. Because people cannot apply deep levels of dispassionate cognitive involvement to every media encounter, it will be important to study the intersections of active and automatic processing for more and less media-literate individuals, such as to determine the extent to which more media-literate individuals may have increased levels of processing effectiveness. Similarly, more study is needed regarding the extent to which media literacy skills taught in a general context or to a particular context such as nutrition, violence, body image or sex can and will be applied by individuals to other contexts such as substance use. The ability and likelihood to do so may depend on developmental maturity, cognitive involvement, and other factors such as sociocultural development. Related to these points, researchers need to examine the developmental, sociocultural, and environmental conditions under which individuals gain more or less from media literacy education. Some studies, for example, have found that those who have less media literacy knowledge or are younger and presumably less cognitively developed may gain more from media literacy intervention [29] but it seems likely that different aspects of or levels of sophistication concerning media literacy education will be most appropriate for different developmental and cultural situations.

In terms of future research, it will be important for scholars to continue working to both understand message receivers’ decision-making processes and to test and refine media construct measurement and evaluation of media literacy. One of the biggest limitations of previous media literacy evaluations has been the cross-sectional nature of evaluation data which makes it impossible to draw conclusions about causality. In addition, evaluation findings typically are limited to single samples (e.g., college students or adolescents in a single state or region). Because decision-making models typically hypothesize that media message interpretations contribute to decisions over time, it is important for researchers to replicate and extend evaluation studies in a longitudinal, repeated-measures design.

Conclusion

Currently, the preponderance of research evidence indicates that media literacy education has tremendous potential in substance-abuse and other forms of health programming. Research findings indicate that those who receive media literacy education can gain increased knowledge of media, advertising, and specific health-related topics such as smoking or alcohol consumption. In addition, media literacy training can provide an improved understanding of persuasive intent of advertising, improved critical-thinking skills, and greater resistance toward advertising influences, correction of norms misperceptions, increased skepticism and critical-thinking skills, and increased efficacy to control their choices related to substance use. In order to more fully realize the benefits of media literacy, researchers must continue working to answer existing questions and extend the methods they use to include longitudinal, repeated-measures research designs. This will allow health-promotion experts to tailor media literacy programs to the specific needs of audience members and take full advantage of the benefits media literacy training provides.