Int J Adolesc Med Health 2020; ▪▪▪(▪▪▪): 20200037

Ayesha Tahir, Lubna Ansari Baig and Zaeema Ahmer*

Does watching violent electronic and social media

content lead to increased levels of aggression? A
survey among adolescents in an urban slum of
metropolitan Karachi
https://doi.org/10.1515/ijamh-2020-0037 Conclusions: The usage of violent content on social and
Received February 27, 2020; accepted June 18, 2020; published online electronic media was popular among adolescents, and
August 24, 2020
produced negative effects on the behavior of adolescents.
Measures should be taken to introduce media literacy of
Abstract
the children in Pakistan, especially in the peri-urban
Objectives: Increased levels of aggression and desensiti- slums.
zation of adolescents has been witnessed as a result of Keywords: adolescent health; level of aggression; media
exposure to violent social/electronic media content. It is exposure.
imperative for policymakers to study such behavioral
outcomes in order to make sound policies regarding media
literacy. The objective of the study therefore was to assess
relationship between violent electronic/social media
Introduction
exposure and level of aggression.
Recent advancements in media science and technology
Methods: A cross sectional study was conducted among
includes television, movies, radio, video games, cell
adolescents aged 9–19 years in peri-urban slum of Karachi.
phones, i-pods, iPhones etc. [1–3]. This digital revolution
Content-based Media Exposure scale and Buss and Perry
has a potential influence on the social development and
questionnaire, internationally validated tools were used to
behavior of adolescents. Also the choice for viewing the
collect data. Level of aggression was the main outcome
type of media channel depends on their future aspirations
variable which was analyzed.
[1].
Results: Four hundred and twenty-two adolescents
Literature supports that increasing media usage by
participated in the survey. Usage of television was signif-
adolescents causes increased exposure to the violent con-
icantly higher in the younger age group whereas the effect
tent in media. Also increased violent media usage has
of watching violent content among the adolescents varied.
triggered aggressive behavior development over the de-
It was observed that 153 (36.3%) respondents felt stressed
cades [1, 2].
and 24 (5.7%) felt aggressive after watching violent content
Evidence from previous studies has shown effective
on electronic and social media. The contents showing
role of media in enhancing interpersonal skills and
people who fight (39.6 ± 5.6, p-value<0.05), who steal
improving access to global information [1, 4, 5]. However,
(39.5 ± 7.5, p-value=<0.05) and destroyed someone else’s
many studies conducted in developed and developing
belongings (40.6 ± 7.6, p-value=<0.05) had a significant
countries have established potential negative impact of
effect on the level of aggression. Regression analysis pre-
media use, particularly when associated with exposure to
dicted a strong positive association of exposure of violent
violent content [1, 4, 6, 7]. Adolescents’ spending pro-
content with level of aggression ( β=0.43).
longed hours on screen watching violent content can also
have an effect on their concentration and interpersonal
*Corresponding author: Zaeema Ahmer, APPNA Institute of Public
interactions resulting in decreased pro-social behavior.
Health, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan, There is loss of empathy and they may experience a change
E-mail: zaeema.ahmer@jsmu.edu.pk. https://orcid.org/0000-0002- in cognitive and social behavior towards violence [5].
4457-6699 Pakistan is a developing country, consisting of more
Ayesha Tahir, United Medical and Dental College, Karachi, Sindh, than 65% youth in its population, out of which around 30%
Pakistan
are adolescents [8]. (Pakistan Demographic and Health
Lubna Ansari Baig, APPNA Institute of Public Health, Jinnah Sindh
Medical University, Karachi, Sindh, Pakistan Survey 2017–18). Socioeconomic and cultural context
2 Tahir et al.: Violent media content and levels of aggression

along with poor literacy rates in the country increase Media violence
Desensitization
vulnerability of its youth, particularly adolescents’ towards Procedure Exposure to initially violent
stimuli
harmful exposure to violent media transmissions and its
associated social and behavioral outcomes. Pakistan
through Pakistan Electronic Media Regulatory Authority
(PEMRA) has been putting in more efforts for the control Desensitization Decreased level of
Fear/Anxiety Reactions
and prevention of media violence. According to PEMRA Effect
to Violence
rules 2009: “No program shall be aired containing any-
thing which tends to glorify crime or criminals” [9].
Cognitive & Decreased Increased Decreased
All the researches from Karachi and other parts of Affective attention to Belief that Negative Attitude
Pakistan focused on the exposure to violent content Outcome Violent Violence is towards Violence
Events Normative
through news channels. The study conducted by Imtiaz F.
et al. in Karachi, on a sample of 634 adolescents, showed
that news channels do exaggerate the information [10].
Daredia KMA et al. in their study, conducted in Karachi,
showed that, dramatic breaking news should be controlled Increased Aggression
Behavioral
and not be utilized for increasing the viewership, instead Higher likelihood of initiating aggression
Outcomes
should be very gentle [11]. Although the relationship be- More sever level of aggression
tween electronic media exposure and aggressive behavior
in viewers has been studied for many years, research Figure 1: Conceptual model for this study.
regarding violent media content on social media is lacking.
This becomes even more important factor to study in light
affect the behavior by increasing the level of aggression.
of the lawlessness and frequent crimes rampant in the city.
Refer to Figure 1.
Present study focused on broadcast of violent content not
only in news and electronic media but also in other types of
programs on social media as well. Methods
The aim of this study was therefore to identify the level
of aggression among adolescents after being exposed to This study was conducted in urban slum of Karachi, located in Bin
violent content in an urban slum of Karachi. We also Qasim Town. In Bin Qasim town, a large proportion of its population
lives in slum areas. It was a descriptive cross sectional study. All
determined the usage of violent content on social/elec-
children and adolescents were from age 9–19 years, living in the peri-
tronic media among these adolescents. Additionally the urban slum of Karachi, who were exposed to electronic/social media.
aim was also to explore how adolescents felt when viewing World Health Organization has defined adolescence as the age group
violent media content. between 10 and 19 years of age of either sex i.e., male and female [13].
The theoretical frame work from Bushman and Ander- Adolescents who did not give written informed assent were
son explained that, the exposure to violent stimuli elimi- excluded. Also respondents were enquired whether they were taking
treatment from a psychiatrist currently or in the past 6 months or were
nates the initial anxious response to violent content [12].
taking any medications for mental illness. Any affirmative responses
This actually means desensitization, causing decreased were excluded as they could be negatively influenced by violent media
responsiveness towards violent incident and increased level content and thus be confounders. Sample size was calculated using
of acceptance to violence as normative belief. This in turn OpenEpi for proportion. With the frequency of 50% at a Confidence
results in increased level of aggressive behavior and Level of 95% and Precision of 5% the minimum calculated sample size
was 384. After adjustment of 10% non-response rate we obtained a
decreased empathy.
final sample size of 422.
The conceptual framework for this study was adapted Non-probability, proportionate quota sampling was applied to
from Bushman and Anderson [12]. Exposure to violent me- select girls and boys in defined age groups from the community. Ad-
dia content can affect the behavior of the adolescents living olescents of either sex were approached personally on the streets and
in the urban slum of Karachi. When adolescents are exposed in their houses, after acquiring their informed assent.
to violent media repeatedly, desensitization to the violent Survey was conducted with adolescents using structured
questionnaire and information collected regarding socio-
content can occur. Due to this phenomenon, they start
demographic characteristics and exposure to violence through
believing that violence is a normal thing and will not take it electronic/social media. Section A contained questions related to
as a bad or obnoxious exposure. This may result in sociodemographic variables like age, gender, job status, education
decreased attention towards violent events. This can in turn, etc. Additionally an item also enquired regarding one’s feeling upon
 Tahir et al.: Violent media content and levels of aggression 3

watching violent media content. Participants had to respond by with more males in younger age groups (p=0.04). The fe-
answering one of the four options: feeling stressed, aggressive, male respondents were significantly more educated
feeling of crying or no feeling at all. Section B was based on Content-
compared to males (p<0.05). There was no significant dif-
based Media Exposure scale (C-ME), which is a 21 item, five point
Likert type scale [14]. It is an internationally validated scale, used for ference in job status. Please refer to Table 1.
assessing the antisocial and neutral media content. For this study,
after pretesting, this scale was adapted and adjusted. Questions
related to sex and drug abuse were left out keeping in mind the Use of electronic devices among
religious and cultural sensitivities of the community. The adapted
version had 10 questions. It was used to measure the level of expo- adolescents
sure to the electronic/social media regardless of the place and time of
the availability. It had good reliability for our study population There was no significant difference in the usage of televi-
(Cronbach Alpha value: 0.77). Participants were asked about the sion among age groups, gender, education or job status.
number of times they were exposed to a particular type of electronic/
However, there was a significant difference in the usage of
social media content from never to very often. Highest total score for
10 items was 50 and lowest was 10. all types of cell phones on the basis of gender (p=0.05), age
The level of aggression among adolescents was assessed as an group (p=0.0001) and education status (p=0.0001). Refer
outcome variable using Buss and Perry questionnaire for aggression to Table 2.
assessment in Section C of the questionnaire [15]. A validation study
conducted in Pakistan upon children showed significant reliability of
the Urdu translated versions with Alpha value of 0.93 [16]. Buss and Effect of watching violent content on
Perry questionnaire is a five point Likert scale with 12-items which
examines various expressions of aggression to determine level of respondents
aggression. It is designed to assess four major attributes of aggression
through aggression scale; Physical Aggression (PA), Verbal Aggres- The effect of watching violent content on the participants
sion (VA), Anger (A) and Hostility (H). Each item had its own struc- was varied. Out of 422 respondents, 153 (36.3%) felt
tured scoring system. During this study participants were asked to rate
stressed, 130 (30.8%) cried and 115 (27.3%) had no feelings
themselves for given items. The total score for aggression level was
for the violent content. However, a small proportion 24
calculated by adding score for each individual item in the question-
naire. The maximum score was 60 and the minimum score was 12. (5.7%) felt aggressive.
Data collection process was directly supervised by the principal
investigator. Data was jointly collected by PI and trained data
collectors. Relationship between content based-media
The collected data was analyzed using SPSS version 22. exposure and level of aggression
Descriptive statistics were run and frequencies were calculated for
socio-demographic characteristics, violent media transmission and
exposure to violent content through electronic/social media and fre- Relationship between Content based media exposure
quency for level of aggression. Analysis of variance (ANOVA) was and level of aggression was measured using Pearson
performed to find out the relationship between exposure to various
types of violent content and level of aggressive. Post hoc comparison Table : Demographic characteristics of the respondents (n=).
within the five levels of exposure scale was performed using Bonfer-
roni test. Linear regression was applied to identify the association of Gender p-
violent contents media exposure on level of aggression of the Value
Males Females
adolescents.
Informed consent was taken from adolescents of 18–19 years. n % n %
Assent forms were signed by the children’s parents aged 9–17 years. Age
Prior approval from community leaders was obtained to ensure their (–)  .%  .% .
cooperation with research team. All information gathered was kept (–)  .%  .%
confidential with access limited to authorized personnel only. Inter- Education
view codes were assigned to the participants. Ethical approval for the Uneducated  .%  .% .
proposed study was obtained from Institutional Review Board of Jin- Primary (–)  .%  .%
nah Sindh Medical University, Karachi. Secondary (–)  .%  .%
Intermediate (–)  .%  .%
Job status
Private job  .%  .% .
Results Daily wages  .%  .%
Skilled workers  .%  .%
Not employed (including  .%  .%
There were 47% males and 53% females in this study. There
students)
was a significant difference of participants observed in age,
4 Tahir et al.: Violent media content and levels of aggression

Table : Use of Electronic Devices among respondents.

TV n= (%) p-Value Android n= (%) Tablet n= (%) IPhone n= (%) No access n= (%) p-Value

Gender
Males  (%) .  (%)  (%)  (%)  (%) .
Females  (%)  (%)  (%)  (%)  (%)
Age
– years  (%) .  (%)  (%)  (%)  (%) .
– years  (%)  (%)  (%)  (%)  (%)
Education
Uneducated  (%) .  (%)  (%)  (%)  (%) .
Primary  (%)  (%)  (%)  (%)  (%)
Intermediate  (%)  (%)  (%)  (%)  (%)
Secondary  (%)  (%)  (%)  (%)  (%)
Job status
Private job  (%) .  (%)  (%)  (%)  (%) .
Daily wages  (%)  (%)  (%)  (%)  (%)
Skilled worker  (%)  (%)  (%)  (%)  (%)
Not employed  (%)  (%)  (%)  (%)  (%)

Table : Effect of Content based media exposure on level of

correlation. Results showed a positive association between aggression score.
the two variables (r=0.43, p-value of <0.05.)
Type of content Level of Aggression score p*-
exposure Mean ± S.D. Value

People who fight Never . ± . .

Relationship of aggression score with
Incidentally . ± .
watching violent content on electronic media Some times . ± .
Often . ± .
There was a significant association between exposure to Very often . ± .
the content with people who fight and aggression score of People who steal Never . . .
Incidentally . ± .
adolescents. [F(4,417)=18.9, p-value=0.0001]. Post hoc
Sometimes . ± .
comparison within the five levels of exposure scale was Often . ± .
performed using Bonferroni, which indicated that those Very often . ± .
respondents who were watching the content with people People who destroy Never . ± . .
who fight very often (39.6 ± 5.6) were more likely to get someone else’s Incidentally . ± .
belongings Some times . ± .
higher aggression score as compared to those who were
Often . ± .
sometimes incidentally or never exposed to the content. Very often . ± .
Participants who watched content showing people
*ANOVA used for identifying the statistically significant results.
stealing also showed significant association with aggres-
sion score. [F(4,417)=10, p-value=0.0001]. Exposure level of
very often, showed more aggression score (39.5 ± 7.5) as Regression analysis
compared to those who were sometimes incidentally or
never exposed to the content. Effect of content based media exposure on aggression of
Respondents who were exposed to watching the con- adolescents
tent with destruction of others property, also had a sig-
nificant association with aggression score [F(4,417)=12.4, To predict the effect of content based media exposure on
p-value=0.0001]. Bonferroni indicated significant effect on level of aggression of the adolescents, linear regression
the people who watched content with destruction of others was performed. The results showed that with one unit in-
property very often (40.6 ± 7.6) as compared to those who crease in exposure score there was a 0.43 unit increase in
were sometimes, incidentally or never exposed to the level of aggression. It showed a strong positive association
content. Refer to Table 3. between exposure and aggression (R2=0.55).
 Tahir et al.: Violent media content and levels of aggression 5

Effect of exposure to different types of contents on significantly to the prediction, p<0.05. It was found that
aggression score of adolescents exposure to content in which people fight significantly
predicted aggressive behavior (β=1.6, p<0.05), as did
Linear regression was applied to identify the effect of exposure to content with people who steal (β=1.3, p<0.05),
exposure to various forms of violent contents on level of exposure to content with people who destroyed someone
aggression of the adolescents. The results indicated four else’s belongings ( β=2.0, p<0.05) and exposure to dead
main predictors which had the highest effect on the level of bodies on electronic media (β=<1, p<0.05).
aggression (p-value <0.05). These included contents
related to people fighting, stealing, destroying someone
else’s belongings and watching dead bodies. Refer to
Discussion
Table 4.
This was the first study of its kind in Karachi, to assess the
Prediction model association between the level of aggression and exposure
to violent electronic and social media among adolescents.
A multiple regression was run to predict aggression score Adolescents felt more stressed when exposed to violent
based on content of exposure showing; people who fight, electronic and social media content. There was a positive
people who steal, people who destroy someone else’s association of content-based media exposure and level of
belongings and dead bodies. These variables predicted a aggression among adolescents.
statistically significant aggression score, [F(4,417)=30.83, It was observed that watching violent content was
p-value <0.05, R2=0.23]. All four variables added inducing stress among the study participants. This is in line
with a study conducted by Busching et al. in 2015, which
reported exposure to violent media caused stress among
Table : Multiple Linear Regression analysis of watching violent
electronic and social media content on aggression score.
study participants, decreased their empathy and increased
their vulnerability towards aggressive behavior [17]. The
Exposure factors Unstandard- Sig. % CI study conducted in 2006 by Funk JB discussed similar
ized findings [18]. Results from the study conducted in Multan
coefficients also reports desensitization due to excessive exposure to
B Std. p- Lower Upper violent news [19].
Error Value bound bound This study indicated a moderate positive association
(Constant) . . . . . between content based media exposure and level of
Watch people who . . . . . aggression among adolescents. Participants who watched
fight? contents with people fighting very often were most likely to
Watch people who . . . . . behave aggressively. These results were in concordance
steal?
with a number of studies including the conference paper
Watch people who . . . . .
destroy someone
presented in 2006 [11, 17, 18, 20]. Funk, Jeanne B. reported
else’s belongings? that being exposed to violence on media can lead to
Watch dead body . . . −. . aggressive behavior in adolescents [18]. Adolescents who
Watch emotionally . . . −. . were exposed to the content showing robberies, felt
sensitive contents aggressive too. As per observational-learning theory,
in news
portrayal of violence made the viewers believe that react-
Watch political talk . . . −. .
shows? ing aggressively in response to perception of any offense is
Watch shows with . . . −. . acceptable.
people crying over Participants showed higher level of aggression if they
dead body? watched more frequent social/electronic media content
Watch the news about . . . −. .
with people destroying someone else’s belongings. Con-
mass protest/Pub-
lic protest?
tents showing perpetrators damaging cars, houses, and
Watch people who do −. . . −. . vehicles could be very disturbing, especially with regards
physical violence to contextual factors. This can have more serious effects if
Watch people who −. . . −. . the viewers are young audience with sudden exposure to
shoot at another violent media content. Additionally it is known that par-
person?
ents can play an important role in mitigating the somewhat
6 Tahir et al.: Violent media content and levels of aggression
negative effects of violent media [22]. However, since our
target population was from a peri-urban slum, where ma-
jority of the population belonged to a lower socioeconomic
class, hence importance of educating parents about the
risks associated with watching violent media content and
subsequent reduction techniques cannot be overly
emphasized. It was also observed that participants who
watched news on TV about victims of property crime were
most affected by fear of crime [5]. This in turn led to
aggressive behavior as well.
Multilinear regression predicted the effect of various
exposure contents on the level of aggression among ado-
lescents. A strong positive association was observed. This
result is similar to the meta-analysis conducted by Craig A.
Anderson, to check the association of extended television
viewing of violent content and increasing level of aggres-
sion of 381 studies on violent video games and 37 indi-
vidual studies on violent media exposure and hostile
appraisals [21].
This study produced significant knowledge about the
magnitude of social/electronic media violent content
exposure among adolescents and the relationship between
their aggressive behavior and exposure to violent content.
Electronic and social media showing contents with fights,
stealing, dead body and people belongings being
destroyed should be removed or have some sort of re-
strictions for the adolescents being exposed to it. This
study can be used as a platform for further research in this
field, in Pakistan. Focus should be on the media literacy of
the children, when they are still young. It is recommended
that media literacy programs should be introduced for the
adolescents. Proper utilization of the social media can
affect the behavioral outcomes of the adolescents of these
areas.
The strengths of the study include using the results of
this study to formulate policies for transmission of violent
content and also creating awareness among adolescents
about the potential adverse effects of transmission of vio-
lent media content through electronic/social media. Limi-
tations of the study included the generalizability to urban
adolescents as the target population belonged to peri-
urban slum of bin Qasim town. This study was limited to
only one peri-urban slum, to get a better picture of the
situation more multicenter studies should be conducted.
As the study design was cross sectional, it was not possible;
to assess the effect of prolonged violent media exposure.
Conclusions
It was found that level of aggression was directly propor-
tional to exposure of types of violent media content. The
usage of violent content on electronic/social media was
quite prevalent. Females were more exposed to the violent
content through Television, while males through cell
phones. The exposure to violent electronic and social me-
dia does produce a negative effect on the behavior of ad-
olescents. Further investigation should be done, to study
the impact on adolescents’ negative behavior.
Research funding: This research was supported by the
Jinnah Sindh Medical University, Thesis grant.
Author contributions: All authors have accepted
responsibility for the entire content of this manuscript
and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all
individuals included in this study.
Ethical approval: Ethical approval for the proposed study
was obtained from Institutional Review Board of Jinnah
Sindh Medical University, Karachi.
References
1. Brown JD, Bobkowski PS. Older and newer media: patterns of use
and effects on adolescents’ health and well-being. J Res Adolesc
2011;21:95–113.
2. Heusman LR. The impact of electronic media violence: scientific
theory and research. J Adolesc Health 2007;41:1–12.
3. Tahir M, Shafi B. The impact of electronic media on youth
behavior regarding informal education in peshawar. Kpk 2015;05:
349–58.
4. Gentile DA, Bushman BJ. Reassessing media violence effects
using a risk and resilience approach to understanding
aggression. Psychol Pop Media Cult 2012;1:138–51.
5. Weitzer R, Kubrin CE. Breaking news: how local TV news and real-
world conditions affect fear of crime. Justice Q 2004;21:497–520.
6. Anderson CA, Bushman BJ. The effects of media violence on
society. Science 2002;295:2377–9.
7. Strasburger VC, Hogan MJ. Children, adolescents, and the media.
Pediatrics 2013;132:958–61.
8. National Institute of Population Studies (NIPS) [Pakistan] and
ICF. Pakistan Demographic and Health Survey 2017-18.
Islamabad, Pakistan, and Rockville, Maryland, USA: NIPS and
ICF; 2019.
9. Authority R. Pakistan electronic media regulatory authority;
Islamabad: Government of Pakistan, 12th December; 2009.
10. Imtiaz F, Ellahi N, Zaidi YH. Impact of media on social behavior of
individuals living in Karachi. Int J Endorsing Health Sci Res 2015;
3:24.
11. Ali Daredia KM, Zehra N, Rasheed S. Psychological effects of
viewing News channels among adult population of Karachi. Pak J
Med Dentistry 2013;2:24–32.
12. Bushman BJ, Anderson CA. Comfortably Numb desensitizing
effects of violent media on helping others. Psychol Sci 2009;20:
273–7.
13. World Health Organization. Adolescents: health risks and
solutions. Fact Sheet 2018.

14. den Hamer AH, Konijn EA, Plaisier XS, Keijer MG, Krabbendam LC,
Bushman BJ. The content-based media exposure scale (C-ME):
development and validation. Comput Human Behav 2017;72:
549–57.
15. Pechorro P, Barroso R, Poiares C, Oliveira JP, Torrealday O.
Validation of the Buss-perry aggression questionnaire-short form
among Portuguese juvenile delinquents. Int J Law Psychiatry
2016;44:75–80.
16. Iftikhar R, Malik F. Translation and validation of aggression
questionnaire in a Pakistani children cohort. Pak J Soc and Clin
Psychol. 2014;12:39–45.
17. Busching R, Allen J, Anderson C. Violent media content and
effects. Oxford research encyclopedia of communication.
New York: Oxford University Press; 2016.
18. Funk JB. Exposure to violent video games and desensitization to
violence in children and adolescents. In: Lect Notes Comput Sci
Tahir et al.: Violent media content and levels of aggression 7
(Including Subser Lect Notes Artif Intell Lect Notes
Bioinformatics) LNCS. Berlin, Heidelberg: Springer; 2006, vol
4161:pp. 96–102.
19. Bhatti MA, Ul Hassan AA. Psychological effects of TV News Violence
on youth: A Case Study of the Students of BahauddinZakariya
University, Multan. Pak J Soc Sci 2014;34:295–309.
20. Parkes A, Sweeting H, Wight D, Henderson M. Do television and
electronic games predict children’s psychosocial adjustment?
Longitudinal research using the UK Millennium Cohort Study.
Arch Dis Child 2013;98:341–8.
21. Anderson CA, Bushman BJ, Bartholow BD, Cantor J, Christakis D,
Coyne SM, et al. Screen violence and youth behavior. Pediatrics
2017;140:S142–7.
22. Nathanson AI. Identifying and explaining the relationship
between parental mediation and children’s aggression. Commun
Res 1999;26:124–43.