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Teen 'Sexting' Estimates Vary Widely

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How to Handle Sexting in the Office

Pediatricians will likely face the issue of "sexting" in their office practices. A sufficient number of teenagers are sending by text message nude, nearly nude or provocative pictures – often of themselves – to their friends.


Dr. Michael Jellinek

Pediatricians will be asked by parents what they should do if they discover that their teenagers have sexted. Teenagers may mention, ask, or complain about sexting during a visit. Less commonly, schools or even the police may be involved and may even be the source of questions. Texting messages and/or images is a frequent and common activity by most teenagers. Teenagers often do not have the best judgment and typically do pranks, jostle for social status, act impulsively, or demonstrate a deeper problem in a number of areas. Therefore, it is not surprising that a topic as meaningful and developmentally relevant as an adolescent’s sexuality and relationships quickly becomes part of a texting habit and culture.

Adolescent sexuality is a common concern and routine part of primary care. Sexting is obviously a new feature because it is now technologically feasible and so easily done. As is the case with other adolescent sexual and general behavior, the pediatrician has to understand the context of sexting to determine whether it merits counseling or is part of a potentially high-risk activity.

Some questions to consider: How old is the teenager? Clearly a young teenager being more explicit is of greater concern then a college student. However, a preteen sexting a new boyfriend or girlfriend may simply be immature and naive. What is the social context? Is the sexting part of what could be seen as exploration and experimentation between two adolescents in an increasingly close relationship that is age appropriate – between equals who are sensitive to privacy? Or is there a dynamic of unequal power involved? For example, does the teenager sending the text feel coerced by a partner who is threatening to end the relationship, has control in some way over the relationship, is older, or is an adult? Or is the teen sexting to impress or obtain some kind of leverage in the relationship? What is the meaning of the sexting and what does the behavior imply in her or his life? Is the teenager who sexted vulnerable because of low self-esteem or depression, or in the context of alcohol or substance use? Has the image been unexpectedly shown to others? How many, and under what circumstances? What has been the consequence, intentional or unintentional? Are there family conflicts that are driving the teenager to "leave" home emotionally, rebel against over-control, or take risks? Could or has the activity crossed the line of legality, as in blackmail, bullying, child pornography, or prostitution?

Pediatricians often have to assess adolescent behavior in the context of the teenager’s overall functioning in the family, with friends, in school, with activities, and their mood. Clearly, if sexting is an isolated lapse of judgment in a new, equal relationship, simply suggesting that caution be taken – given the ease of digital spread – may be all that is indicated. If sexting is part of low self-esteem, repeated poor judgment, frequent risk taking, poor choices in relationships, and poor overall functioning, then sexting becomes another key indicator requiring a comprehensive mental health consultation.

Most sexting involves a small percentage of adolescents and should be seen as a variation of normal or a minor risk factor to be followed. However, sexting also can indicate real vulnerability to power relationships, reflect low self-esteem and high risk, indicate poor judgment, or be part of illegal, abusive situations.

Pediatricians might want to be attuned to sexting and include some counseling about electronic media in their individual sessions with teenagers. In addition, they should be prepared to counsel parents in digital media literacy. This new high-tech aspect of primary care includes an awareness of excessive use of computers that over time substantially interferes with life tasks (playing of video games, social media), sexting, and whatever comes next!

Adolescents communicate their emerging identity, their self-esteem, the quality of their relationships, and their mental health through their interaction with the world and the choices they make. Electronic communication is another window into that emerging identity.

Michael S. Jellinek, M.D., is professor of psychiatry and of pediatrics at Harvard Medical School, Boston. He is also president of Newton (Mass.) Wellesley Hospital. He said he had no relevant disclosures.


 

FROM PEDIATRICS

Sexting among children and adolescents appears to be far more variable and less explicit than previously thought, based on the results of two studies published online Dec. 5 in Pediatrics. Sexting is defined broadly as the transmission via cell phone, the Internet, and other electronic media of sexual images.

In a survey, 149 of 1,560 young people (9.6%) reported appearing in, creating, or receiving nude or nearly nude images in the previous year.

© Mariusz Blach - Fotolia.com

Two separate studies have shown that the number of teens involved in ‘sexting,’ and the explicitness of texts and pictures sent, fluctuates.

"This study reveals that estimates of youth involved in sexting vary considerably depending on what activities are included in the concept of sexting. The percentage of youth who have, in the past year, appeared in or created sexually explicit sexual images that potentially violate child pornography laws is low (1%). But if sexting is defined as appearing in, creating, or receiving sexually suggestive rather than explicit images, the survey reveals 9.6% of youth who used the Internet in the past year [were] involved in this way," Kimberly J. Mitchell, Ph.D., and her coinvestigators wrote (Pediatrics 2011 Dec. 5 [doi: 10.1542/peds.2011-1730]).

Dr. Mitchell and her associates used data from the third Youth Internet Safety Survey (YISS-3) on sexting, among other technology-based problems. Data collection occurred between August 2010 and January 2011. YISS-3 was conducted via telephone surveys with a national sample of youth Internet users aged 10-17 years.

A national survey research firm conducted the sampling, screening, and telephone interviews. The main sample was drawn from a national sample of households with telephones developed by random digit dialing. At the end of data collection, 45 interviews had been completed by cell phone in addition to 1,515 landline interviews, resulting in a total sample size of 1,560. Eligible respondents were children and adolescents who had used the Internet at least once a month for the previous 6 months.

Interviewers first asked to speak with the adult who was most familiar with that child’s Internet use, and after receiving informed consent, interviewers asked a series of questions about Internet use. Then the interviewer requested permission to interview the child or teen. Interviewers told parents that the youth interview would be confidential and would include questions about "sexual material your child may have seen on the Internet."

Adolescents were asked five screener questions about three types of sexting involvement: receiving "nude or nearly nude" images; forwarding or posting such images; and appearing in or creating such images. Follow-up questions gathered details, including the content of the nude or nearly nude images. The screeners asked:

– Has anyone ever sent you nude or nearly nude pictures or videos of kids who were under the age of 18 years that someone else took?

– Have you ever forwarded or posted any nude or nearly nude pictures or videos of other kids who were under the age of 18 that someone else took?

– Have you ever taken nude or nearly nude pictures or videos of yourself?

– Has someone else ever taken nude or nearly nude pictures or videos of you?

– Have you ever taken nude or nearly nude pictures or videos of other kids who were under the age of 18?

When a young person responded positively to one of these questions, the interviewers asked if the incident occurred in the past year. Interviewers then asked extensive follow-up questions about up to two unique sexting episodes in the past year.

"Sexting may not indicate a dramatic change in ... youth sexual behavior. It may just make some of that behavior more visible."

Of those individuals who reported involvement in sexting, 39 (2.5%) appeared in or created images and 110 participants (7.1%) received images but did not appear in or create them. Of the 39 young people who appeared in or created images, 61% were girls, 72% were 16 or 17 years of age, and 6% were 10-12 years of age. Most adolescents created images of themselves (1.8% of total sample). Some were photographed by someone else (0.3%); and some photographed other young people (0.4%).

Of the 110 young people who received images but did not appear in or create them, 56% were girls, 55% were aged 16 or 17 years, and none were younger than 12 years.

One of the goals of this study was to determine how adolescents define "nude" or "nearly nude." Participants were asked whether the images "showed breasts, genitals, or someone’s bottom." Only 21 (54%) of the young people who appeared in or created images reported pictures that met these criteria; the same was true for 84% of the 110 youth who received images.

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