Media Aware – High School (MA-HS)

About the program

MA-HS is a web-based, comprehensive Sexual Health Education (SHE) program for high school students that uses a Media Literacy Education (MLE) approach. It is a developmentally appropriate adaptation of Media Aware - Young Adult, aimed at ages 18+ shown to reduce risky sexual behaviour and improve other sexual health outcomes (Scull et al., 2018).

MA-HS is designed to provide high school students with sexual health knowledge, media literacy skills, and healthy decision-making skills regarding sexual activity and relationships. MA-HS consists of four highly interactive, self-paced modules, each designed to be completed within one traditional class period.

Who does it work for?

MA-HS is designed for high school students aged 13-17. MA-HS has only been evaluated in the USA. A randomized control trial (Scull et al., 2021) was conducted with 331 participants (166 in the intervention group and 165 in the control group).

The study recruited students from a large high school in the USA. Just over half the students in both intervention and control conditions were male and an average of 14 years old. Most students in both conditions were white and non-Hispanic. Most students in both intervention and control conditions reported having no sexual experience (83% and 84% respectively)

MA-HS has not been evaluated in Australia or with Aboriginal Australians.

What outcomes does it contribute to?

Positive outcomes:

• MA-HS participants reported increased intentions to communicate about sexual health with parents, partners, and medical professionals
• MA-HS participants were less likely to believe that teen sexual activity and was normative (teen sex descriptive norms)
• MA-HS participants were less likely to believe that risky sexual activity and was normative (risky sex subjective norms)
• MA-HS participants reported being less willing to “hook up” when they did not necessarily want to “hook up”
• MA-HS participants reported being less willing to have unprotected sex
• MA-HS participants’ measures of the perceived realism of media messages were lower, they were less likely to perceive similarity to media messages and they were more likely to think critically about advertisements (improved cognitive elaboration).

No effect:

• The program had no effect on participants’ refusal efficacy (refusing sexual activity)
• The program had no effect on participants’ acceptance of dating violence.
• The program had no effect on participants’ intentions to have sex (teen sexual intentions)
• The program had no effect on participants’ intentions to use contraceptives or protection for sexual activity.
• The program had no effect on participants’ communication efficacy
• The program had no effect on participants’ acceptance of gender role stereotypes
• The program had no effect on participants’ acceptance of rape myths
• The program had no effect on participants’ scepticism of media messages about sex and substance use.

How effective is it?

Overall, MA-HS had mixed effects on client outcomes.

How strong is the evidence?

Mixed research evidence (with no adverse effects):

• At least one high-quality randomised controlled trial (RCT)/quasi-experimental design (QED) study reports statistically significant positive effects for at least one outcome, AND
• An equal number or more RCT/QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND
• No RCT/QED studies show statistically significant adverse effects.

How is it implemented?

MA-HS is delivered over the course of 4 health classes (one module per class), completed privately by each student online. The program uses text-based narration, streaming media examples, videos, animations, and interactivities to present course content. There are many opportunities for students to analyse media messages and receive automatic feedback on their responses. This may include medically accurate and developmentally appropriate health information and resources and/or peer videos that includes a group of diverse high school students discussing their answers to the media message deconstructions or thoughts surrounding the health topics at hand.

Module 1: Students set personal goals related to school success and health. Students identify media as influential sources of health information in their lives and are provided with tools to critically analyse media messages. Students examine gender role stereotypes, the realism and implied messages in media, and healthy and unhealthy relationships.

Module 2: Students identify the ways in which media may promote and/or normalize substance use, sexual assault, and dating violence and learn more advanced message analysis to redress inaccurate norms. Students are introduced to the concept of consent, are taught to recognize when consent is needed, when consent cannot be given, and learn and practice bystander intervention skills.

Module 3: Students analyse media messages with a focus on how media messages frequently omit information or provide misinformation about the use of contraception/protection. Students learn about FDA-approved methods of contraception and methods of protection against sexually transmitted infections, differentiating between perfect and typical use.

Module 4: Students analyse media messages with a focus on how infrequently communication is portrayed prior to sexual activity. Students learn skills needed to have effective sexual health conversations with trusted adults, romantic partners, and medical professionals – including sexual refusal and contraception negotiation skills. Students get skills-based practice in applying techniques, reflect on personal goals, and create a plan for their future.

How much does it cost?

The costs for MA-HS were not reported in the study.

What else should I consider?

While the program was designed to be non-heteronormative (e.g., inclusion of gender-neutral names, pronouns, and images), it does not explicitly discuss sexual orientation or gender identity. It is essential that sexual health programming discusses these topics in a factual, affirming, and inclusive manner. Future work should expand program content.

MA-HS did not have an outlet for students to have questions answered as they completed the program. This is another avenue for future adaptation of the program.

Where does the evidence come from?

1 RCT conducted in the USA with a sample of 331 people (Scull et al., 2021).

Further resources

Scull, T, Malik, C, Morrison, A, & Keefe, E 2021, ‘Promoting Sexual Health in High School: A Feasibility Study of A Web-based Media Literacy Education Program’, Journal of Health Communication, vol. 26, pp. 147-160, DOI 10.1080/10810730.2021.1893868.

The following studies are particularly relevant to the program:

Rothman, EF, Adhia, A, Christensen, TT, Paruk, J, Alder, J, & Daley, N 2018, ‘A pornography literacy class for youth: results of a feasibility and efficacy pilot study’, American Journal of Sexuality Education, vol. 13, pp. 1–17, DOI 10.1080/15546128.2018.1437100

Scull, TM, Malik, CV, & Kupersmidt, JB 2014, ‘A media literacy education approach to teaching adolescents comprehensive sexual health education.’ Journal of Media Literacy Education, 6(1), 1–14, https://digitalcommons.uri.edu/jmle/.

Scull, TM, Kupersmidt, JB, Malik, CV, & Morgan-Lopez, AA 2018, ‘Using media literacy education for adolescent sexual health promotion in middle school: Randomized control trial of media aware’, Journal of Health Communication, vol. 23, pp. 1051-1063, DOI 10.1080/ 10810730.2018.1548669