Home and child safety on reality television

HEALTH EDUCATION RESEARCH

Vol.24 no.1 2009 Pages 49–53 Advance Access publication 23 January 2008

Home and child safety on reality television

Jennifer A. Manganello1* and Lara B. McKenzie2 Abstract

1

Department of Health Policy, Management & Behavior, School of Public Health, University at Albany, SUNY, One University Place, Rensselaer, NY 12144, USA and 2College of Medicine, The Ohio State University, Department of Pediatrics, Research Institute at Nationwide Children’s Hospital, Center for Injury Research and Policy, 700 Children’s Drive, Columbus, OH 43205, USA *Correspondence to: J. A. Manganello. E-mail: [email protected]

Introduction Injuries are the leading cause of death for children and adolescents aged 1–21 years in the United States [1]. There are many safety practices (e.g. use of countermeasures such as smoke alarms and cabinet latches) that can reduce or prevent injuries to children. There are also behaviors or products that can increase the chance of injury (e.g. crib bumpers, long window blind cords), and thus, people are encouraged to avoid using such products. These and other injury prevention countermeasures recommended by the National Center for Injury Prevention and Control [2] and the American Academy of Pediatrics (AAP) [3, 4] are not consistently or properly utilized, especially by those from low-income groups [5–8]. Known, effective countermeasures or safety practices, such as the use of working smoke alarms [9], poison storage devices [4] and carbon monoxide (CO) detectors [10] when properly implemented, can reduce or prevent injuries. The ability to influence the adoption and continued use of safety practices is a key factor in preventing child injuries. For example, proper installation and correct placement of smoke alarms can lower the risk of death by providing an early warning of house fires. Parents or other adults are generally the ones responsible for overseeing safety practices for children and homes. The average American watches >4 hours of television each day [11], and

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Injuries, many of which occur at home, are the leading cause of death for children. With such an extensive problem, it is natural to look for outlets such as mass media to reach large numbers of families with educational messages about safety and injury prevention. Mass media has been widely used to educate people about health issues. While studies have examined the portrayal of topics such as substance use and sexual behavior, no study has looked at media content about home and child safety practices. A pilot study with a sample of 10 television shows about home renovation, children or families was examined using content analysis for the presence or absence of home and child safety practices and products and discussion of injury topics. Most practices, like checking the water temperature when bathing a child or having smoke alarms, were never discussed or shown. Results suggest these shows provide information about home or family life, but few role models are shown offering information or examples of safe practices. Promoting safety information in these television programs may be a potentially important way to educate a large

number of people, and feasibility of adding safety information to such shows should be explored.

J. A. Manganello and L. B. McKenzie

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could help prevent injuries, that suggests these programs do not routinely offer information concerning behaviors that could potentially be life saving. Understanding the effects of the content of such programs is important to determine whether the media is another factor that influences safety behavior. The first step in assessing whether media messages about safety practices can influence and potentially educate viewers is to understand what messages (if any) about these practices appear on television. The goal of this pilot study is to provide details about safety practices shown on a sample of reality television programs airing in the United States that focus on home and family life. We specifically chose reality programs. These shows often go into more detail about the characteristics of homes due to the focus on home renovation or family life. We also considered that viewers might be more influenced by home safety shown on programs with real-life families rather than scripted dramas or sitcoms.

Methods Two research assistants analyzed a sample of reality television shows focusing on home renovation, children or families that were airing during April and May of 2006 (Table I). Although this sample does not include all of the reality shows related to home and family programs, it represents a reasonable overview of some of the programs that

Table I. Television shows used in the content analysis Title

Channel

Extreme Makeover: Home Edition Supernanny Wife Swap Decorating Cents Designer’s Challenge Room By Room Baby Story Bringing Home Baby Surviving Motherhood Trading Spaces

ABC ABC ABC HGTV HGTV HGTV TLC TLC TLC TLC


television, including reality TV, has the potential to influence knowledge, attitudes and behavior [12]. For example, one study found that a Friends episode provided education about the use and effectiveness of condoms [13]. Another study found that television had an influence on people’s perceptions about doctors [14]. A study examining health story lines in the show ER found that people seemed to learn about emergency contraception and human papillomavirus after watching episodes featuring these topics [15]. Different theories have been used to explain how television and other mass media can influence people. For instance, Cultivation Theory suggests that people who watch a lot of television develop a view of the real world that is similar to what they see in the media [16]. Social Cognitive Theory explains how people can be influenced by those they admire, including television personalities, and strive to imitate their behavior [17]. Additional theories can also be used to explain the pathways through which people can be influenced by mass media, including television. While television can influence people according to the above theories, it can also serve as a valuable method of educating people who may not receive information about health issues from other sources. Adults with lower education levels were more likely to get nutrition information from doctors, neighbors and television than adults with higher education levels [18]. Television can potentially have an important influence on educating people who may not be able to access information in other places, such as the Internet, or those who live in areas with limited services and resources. No study has previously linked television exposure with home and child safety practices. This is an important area to understand given the extensive use of mass media and the fact that injuries are the leading cause of death among youth in the United States. If no unsafe practices are shown (meaning, the display of behaviors that could result in injury), that would be a positive finding, indicating that people are not exposed to such messages in these programs. Alternately, if no safe practices are shown, such as the use of smoke alarms, that

Home and child safety on television Table II. Number and percent of safety practices depicted across all 28 television episodes Discussed Shown Safe practices Home safety (n = 43 homes) Smoke alarms 0 (0%) CO detectors 0 (0%) Asbestos 1 (2%) Lead 1 (2%) Fire extinguishers 0 (0%) Gate/fence around pool (n = 5) — Child safety (n = 30 homes) Safe poison storage 0 (0%) Low water temperature on heater 0 (0%) Shortening window blind cords 0 (0%) Cabinet safety locks 0 (0%) Electrical outlet covers 0 (0%) Stair gates 0 (0%) Window guards > first floor (n = 21) 0 (0%) Check bath temperature (n = 2) 0 (0%) Unsafe practices Crib safety (n = 6) Crib near window 0 (0%) Crib bumper 1 (17%)

a b

1 (2%) 1 (2%) 0 (0%) 1 (20%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)

1 (17%) 2 (33%)

a Data is not presented since this variable had low reliability. However, only one home clearly showed smoke alarms. b Data is not presented since this variable had low reliability. However, only one home clearly showed CO detectors.

ers, while showing the use of a crib bumper would be a negative model. Coders also assessed whether any children appeared on the programs. Estimating exact ages can be difficult; therefore, it is common practice to use broad age categories. Coders indicated whether babies ( 0.70) was obtained on almost all variables (average 0.94, range 0.06–1.0). Two variables with low reliabilities, presence of a smoke alarm and presence of a CO detector, were excluded from analysis. The coders agreed in all except one 51


consistently depict home and family life. We looked at the websites for ABC, CBS, NBC and FOX to search for any relevant shows. We also looked at programs on TLC and HGTV, since those channels have many shows that focus on home renovation and families. Once we developed a list of reality programs airing on these channels, we excluded shows that never or rarely depict home renovation of homes or rooms where children live, which was determined by reviewing episode descriptions on the show website. We also did not include shows that were not airing at the time of our data collection, including Nanny 911. We taped three consecutive episodes starting the week of 22 April (29 May for Surviving Motherhood, a new show). Shows airing weekly were taped during the regular airtime, while shows airing daily were taped on Thursdays. Wife Swap and Supernanny did not air during the third week of taping. This resulted in a total of 28 episodes. We used the entire episode and each home depicted in the show as the units of analysis for our study. Some variables, such as main topic of the show, were assessed at the program level. Since many shows featured more than one home or family, we considered each home or family a separate unit of analysis. Thus, we did not examine use of smoke alarms out of the 28 shows, but instead, out of the 43 homes depicted in the 28 episodes. This sample size is reasonable for a pilot study and is similar to the sample size of other published content analysis studies [19–21]. The content analysis examined presence or absence of safety products or discussion of injury topics. The list of safety practices and related products recommended by the AAP for child and home safety appear in Table II. Coders noted the presence or absence of practices or safety products shown or discussed. For instance, if a coder saw a crib bumper used, they would mark that a bumper was seen. When discussion about a safety product or injury topic occurred, the coder made note of the content of the discussion. While some products or practices can be considered positive, others can be considered negative. For instance, showing the use of a smoke alarm would be a positive model for view-

J. A. Manganello and L. B. McKenzie case (simple agreement 93%) where one coder could not tell whether it was a smoke alarm or CO detector that was shown, and this was enough to lower the reliability of the variable. Stata 8.2 was used to calculate reliability and analyze data [22].

Results

Discussion While these shows may provide information about home or family life, there was little discussion or depiction of safe practices regarding children and homes. The absence of certain products, such as baby walkers or crib bumpers, was a good thing, since the use of these products is not recommended. However, failure to show behaviors such as smoke alarm use or safety gates suggests that more content could be included to provide discussion or depiction of recommended practices. While the main intent of such shows is to entertain viewers, it seems this could be an ideal forum for promoting correct safety practices and messages. Programs could incorporate comments about 52


Of the 28 television episodes coded, 14% focused on entire home renovation, 32% depicted room or other renovations around the house, 21% discussed pregnancy and 25% explored issues related to family life and child care. Seven percent were considered other topics. All were reality television programs. Of the 43 homes shown on the 28 episodes, 30 (70%) had babies or small children aged 1–12 years or both living in the home. Table II presents frequencies for safety practices shown in the programs. Most practices were never shown. Sample sizes are provided to indicate the proportion of the homes for which a particular behavior was relevant. For example, only six homes had a crib depicted, thus the sample size for the crib safety practices is six. The discussion and depiction of asbestos and lead occurred in the same episode of Extreme Home Makeover during the renovation of a home.

safe behavior, or provide Web links at the end of the program or on the show website with links to safety information. If television programs could incorporate illustrations or messages about safety practices, they could potentially educate a large number of people. While it is impractical to suggest that television programs should show stairs simply for the purpose of showing safety gates, it may not take much extra effort to show a safety gate being used for a stairway when depicting homes with small children. These television programs may also be used to help instruct adults regarding safe practices by showing depictions of unsafe practices, or highlighting correct safety practices. Incorporating popular shows into education programs [23] could potentially help engage participants. For instance, one could show clips of a show as part of an education session and comment on the positive and negative safety behaviors depicted. This is a small pilot study that did not examine all shows that could possibly have home safety messages. We used a small sample of programs, selecting the reality home design and renovation shows that were most likely to include homes with children living in them per descriptions of previous episodes. In addition, it is very difficult to assess exact ages of people, especially children, on television programs. In order to achieve a reasonable level of reliability among coders, age groups were coded, noting specific ages when mentioned in the dialog. Because of this coding method, we were unable to provide exact matches in some cases between safety practice age recommendations and age of children on the programs. However, the study provides an initial look at how the topics are portrayed on television, offering a starting point for more comprehensive future research. There are many factors that can influence parent safety practices with respect to home and child safety, including knowledge, attitudes, beliefs, financial resources and availability of safety products [24, 25]. Mass media, a potential influence on parent safety practices and behavior, is a factor that has not been examined in prior studies. Future research could examine a larger sample of programs and

Home and child safety on television focus more on parenting shows to provide a more comprehensive look at the depiction of safety practices in homes with children on television. Future research could also assess whether mass media use plays a role in knowledge, attitudes, beliefs and behavior regarding home and child safety. Practitioners could also develop and evaluate programs that incorporate mass media as an education tool to help people learn about behaviors to engage in and behaviors that should be avoided with respect to home safety.

We thank Kate Rose Bobseine and Dayna Maniccia for their assistance with coding the television programs. We also thank anonymous reviewers from Health Education Research for their comments.

Conﬂict of interest statement None declared. References 1. Centers for Disease Control and Prevention (National Vital Statistics System National Center for Health Statistics CDC). Downloadable Leading Causes Charts. Available at: http://www.cdc.gov/ncipc/osp/charts.htm. Accessed: 17 February 2005. 2. National Center for Injury Prevention and Control. Unintentional Injury Prevention. Available at: http://www.cdc.gov/ ncipc/duip/duip.htm. Accessed: 17 February 2005. 3. American Academy of Pediatrics. Children’s Health Topics: Safety and First Aid. Available at: http://www.aap.org/ healthtopics/safety.cfm. Accessed: 17 February 2005. 4. American Academy of Pediatrics. A Guide to Safety Counseling in Office Practice.Available at: www.aap.org/family/ tippmain.htm. Accessed: 18 July 2006. 5. Gielen AC, Wilson MEH, McDonald EM et al. Randomized trial of enhanced anticipatory guidance for injury prevention. Arch Pediatr Adolesc Med 2000;155(1), 42–9. 6. National Highway Traffic Safety Administration. Observed Patterns of Misuse of Child Safety Seats. Available at: http:// www.nhtsa.dot.gov/staticfiles/DOT/NHTSA/Communication %20&%20Consumer%20Information/Studies%20&%20 Reports/1996/tt133.pdf. Accessed: 3 January 2008. 7. McDonald E, Girasek D, Gielen AC. Home injuries. In: Liller K, (ed.), Injury Prevention for Children and Adolescents, Research, Practice, and Advocacy. Washington, DC: American Public Health Association, 2006, 123–62.

Received on September 11, 2006; accepted on November 20, 2007

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