Having a Sexual Photo Shared Without Permission and Associated Health Risks: A Snapshot of Nonconsensual Sexting | Adolescent Medicine | JAMA Pediatrics | JAMA Network
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Research Letter
March 23, 2020

Having a Sexual Photo Shared Without Permission and Associated Health Risks: A Snapshot of Nonconsensual Sexting

Author Affiliations
  • 1Oak Ridge Institute for Science and Education, Atlanta, Georgia
  • 2Division of Adolescent and School Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
  • 3Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
JAMA Pediatr. 2020;174(6):618-619. doi:10.1001/jamapediatrics.2020.0028

Sexting (sending, receiving, or forwarding sexually explicit messages or photos through text messages or other electronic means)1 is an increasingly recognized adolescent health concern. Less is known about nonconsensual sexting, a range of behaviors and experiences including having a sexual photo shared without consent, a form of noncontact sexual violence.2 We examined prevalence of having a sexual photo shared without permission, including variation by demographics, and associations with interpersonal violence experiences, mental health and suicidality, and sexual risk behaviors.

Methods

We pooled data from 4 large urban school districts participating in the 2017 Youth Risk Behavior Survey (YRBS), which included an optional question assessing exposure to nonconsensual sexting. Each site’s data were weighted and then combined, yielding a representative sample of ninth- through twelfth-grade public high school students across sites. More information regarding YRBS methods can be found elsewhere.3 Each of these school districts reviewed and approved the YRBS using their local procedures. The national YRBS has been reviewed and approved by an institutional review board at the US Centers for Disease Control and Prevention. The data used in this study were approved by the US Centers for Disease Control and Prevention as research not involving identifiable human subjects. Consent of parents was obtained according to local procedures; in addition, all student participation was anonymous and voluntary.

Experience of nonconsensual sexting was assessed by asking, “During the past 30 days, has a revealing sexual photo of you been texted, emailed, or posted electronically without your permission?” (response options: “yes,” “no,” and “not sure”). Students who were “not sure” whether they had a sexual photo shared without their permission were excluded from analysis, leaving an analytic sample of 8660 students. Associations between experiencing nonconsensual sexting and health risk indicators of lifetime and past-year interpersonal violence experiences, past-year mental health and suicidality, and lifetime, past 3 months, and at-last-sex sexual behaviors were examined. Sociodemographic variables included sex, grade, race/ethnicity, and sexual identity (heterosexual, gay/lesbian/bisexual, or not sure). We examined sex differences in having a sexual photo shared without permission using a χ2 test and calculated sex-stratified prevalence of experiencing nonconsensual sexting by other demographic characteristics using χ2 statistics to identify overall differences. We fit logistic regression models to produce sex-stratified adjusted prevalence ratios for each health risk indicator, adjusting for demographics and site. Statistical tests were considered significant if P was less than .05 or if the 95% confidence interval did not include 1.0. All P values were 2-tailed.

Results

Prevalence of having a sexual photo shared without permission in the past 30 days was 5.7% (95% CI, 4.7-7.0) for boys and 4.8% (95% CI, 3.7-6.1) for girls (P = .23). Lesbian, gay, and bisexual boys (17.6%; 95% CI, 11.1-26.8) and girls (7.4%; 95% CI, 5.2-10.5) had a higher prevalence of having a sexual photo shared without permission compared with heterosexual students (P = .004 and P = .02, respectively; Table 1).

Table 1.  Prevalence of Having a Sexual Photo Shared Without Permission in Past 30 Days by Grade, Race/Ethnicity, and Sexual Identity in Selected US School Districts, 2017
Prevalence of Having a Sexual Photo Shared Without Permission in Past 30 Days by Grade, Race/Ethnicity, and Sexual Identity in Selected US School Districts, 2017

For both boys and girls, each interpersonal violence, mental health, and suicidality indicator was significantly associated with having a sexual photo shared without permission (Table 2). Some sexual behaviors were positively associated with having a sexual photo shared without permission; other associations were null.

Table 2.  Adjusted Prevalence Ratios for Interpersonal Violence Experiences, Mental Health and Suicidality Indicators, and Sexual Behaviors by Having a Sexual Photo Shared Without Permission in Selected US School Districts, 2017
Adjusted Prevalence Ratios for Interpersonal Violence Experiences, Mental Health and Suicidality Indicators, and Sexual Behaviors by Having a Sexual Photo Shared Without Permission in Selected US School Districts, 2017

Discussion

The prevalence of nonconsensual sexting is notable, particularly because the survey was limited to experiences within the past month; lifetime experience is likely higher. Having a sexual photo shared without permission was associated with all interpersonal violence experiences examined as well as persistent feelings of sadness or hopelessness and suicidality, aligning with studies documenting associations between nonconsensual sexting and mental health and violence.4,5

Our study has limitations. Data are from 4 US school districts and may not represent other settings or generalize to out-of-school youths. Data are cross-sectional and cannot establish causality. Future research should explicitly address consent in sexting. A multifaceted approach involving parents, clinicians, and schools is likely warranted to address nonconsensual sexting. The US Centers for Disease Control and Prevention outlines several strategies for sexual violence prevention,6 which can include school-based programs addressing nonconsensual sexting in educational content and teaching refusal skills and bystander intervention.

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Article Information

Corresponding Author: Sanjana Pampati, MPH, Division of Adolescent and School Health, US Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS US8-1, Atlanta, GA 30329-4027 (mix2@cdc.gov).

Accepted for Publication: August 25, 2019.

Published Online: March 23, 2020. doi:10.1001/jamapediatrics.2020.0028

Author Contributions: Ms Pampati had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Pampati, Lowry, Rasberry, Steiner.

Drafting of the manuscript: Pampati, Moreno, Steiner.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Pampati, Steiner.

Administrative, technical, or material support: Rasberry.

Supervision: Moreno, Rasberry, Steiner.

Conflict of Interest Disclosures: None reported.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention.

References
1.
Klettke  B, Hallford  DJ, Mellor  DJ.  Sexting prevalence and correlates: a systematic literature review.   Clin Psychol Rev. 2014;34(1):44-53. doi:10.1016/j.cpr.2013.10.007PubMedGoogle ScholarCrossref
2.
Basile  KC, Smith  SG, Breiding  M, Black  MC, Mahendra  RR.  Sexual Violence Surveillance: Uniform Definitions and Recommended Data Elements, Version 2.0. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2014.
3.
Kann  L, McManus  T, Harris  WA,  et al.  Youth risk behavior surveillance: United States, 2017.   MMWR Surveill Summ. 2018;67(8):1-114. doi:10.15585/mmwr.ss6708a1PubMedGoogle ScholarCrossref
4.
Klettke  B, Hallford  DJ, Clancy  E, Mellor  DJ, Toumbourou  JW.  Sexting and psychological distress: the role of unwanted and coerced sexts.   Cyberpsychol Behav Soc Netw. 2019;22(4):237-242. doi:10.1089/cyber.2018.0291PubMedGoogle ScholarCrossref
5.
Frankel  AS, Bass  SB, Patterson  F, Dai  T, Brown  D.  Sexting, risk behavior, and mental health in adolescents: an examination of 2015 Pennsylvania Youth Risk Behavior Survey data.   J Sch Health. 2018;88(3):190-199. doi:10.1111/josh.12596PubMedGoogle ScholarCrossref
6.
Basile  KC, DeGue  S, Jones  K,  et al.  STOP SV: A Technical Package to Prevent Sexual Violence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2016.
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