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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

In most of the episodes, the person responsible – when it was not the respondent – was someone the young person knew. Adults were involved in a minority of the incidents, and they were all young adults aged 18-21 years. An aggravating component, such as alcohol or drug use, was involved in 31% of incidents. "The most commonly reported reason for incidents was ‘romance as part of an existing relationship’; pranks and jokes; or trying to start a relationship," wrote Dr. Mitchell and her associates at Crimes Against Children Research Center at the University of New Hampshire in Durham.

Twenty-one percent of the respondents who appeared in or created images said they were very or extremely upset, embarrassed or afraid, as did 25% who received sexting images.

"Our findings also raise the question of how sexting should be defined. As is often the case with popularly-inspired neologisms, the term sexting may be fatally compromised by its multiple and expansive colloquial use," the researchers noted. "Clearly, for many youth nude or nearly nude encompasses pictures that do not show naked breasts or genitals. Researchers and clinicians need to directly ask about the content of images."

Furthermore, "sexting may not indicate a dramatic change in youth risk taking or youth sexual behavior. It may just make some of that behavior more visible to adults and other authorities," they said.

In terms of disclosure, 28% of youth who appeared in or created sexting images and 28% who received images "either reported incidents to an authority (such as a parent, teacher, or police) or an authority found out in some other way," the researchers said.

Police Cases of Sexting

In the second study, Janis Wolak, J.D., and her coinvestigators at the Crimes Against Children Research Center empirically examined police-investigated sexting cases based on data gathered from interviews with investigators about a nationally representative sample of 675 sexting cases in 2008 and 2009 (Pediatrics 2011 Dec. 5 [doi: 10.1542/peds.2011-2242]).

The data about sexting cases were collected as part of the Third National Juvenile Online Victimization Study, which is a stratified national sample of 2,712 law enforcement agencies. The agencies were asked by mail if they had handled sexting cases from 2008 or 2009. Detailed telephone interviews were then conducted about specific cases. In addition, interviewers wrote narrative descriptions of cases.

Again, because the term "sexting" is imprecise in its meaning, the researchers used a more specific expression – youth-produced sexual images. Specifically, the agencies were asked if they handled any cases from 2008 or 2009 that involved sexual images created by minors (age 17 or younger) and if these images were or could have been considered child pornography under the statutes of the local jurisdiction.

U.S. law enforcement agencies handled an estimated 3,477 cases of youth-produced sexual images during this time period; approximately 2,291 law enforcement agencies saw at least one such case during that time.

Of cases known to police, 36% involved adults. In 50% of the cases, the offenders were young adults (aged 18-24 years). A total of 38% involved adults aged at least 25 years. In 10% of cases, the adults were 18- or 19-year-old high school students who legitimately belonged to adolescent peer groups that included minors. The remainder of cases were of a mixed nature.

"Estimates of youth involved in sexting vary considerably depending on what activities are included in the concept of sexting."

Thirty-one percent of youth-only cases involved nonconsensual, malicious, exploitative, or criminal behavior. Among these cases, 19% involved criminal behavior in addition to the creation, dissemination, or possession of sexual images – such as blackmail or sexually abusing a younger minor. The most prevalent factor in these cases was the distribution of images without consent (57%).

The remaining cases (33%) were termed experimental. Thirty-two percent of experimental cases occurred in romantic relationships (10% of total cases), while the majority (57%) of cases involved sexual attention-seeking (19% of total cases). The rest (11%) were incidents with no apparent sexual motivation.

When adults were involved, arrests occurred in 62% of cases. Arrests occurred in 36% of youth-only aggravated cases; 5% of youth-only aggravated offenders (n = 10) were subjected to sex offender registration. In the experimental cases, 18% involved an arrest.

"The diversity of cases identified in the study clearly undermines some reports that suggest sexting is relatively harmless or confined to dating behavior. Only 10% of cases involved images created for or sent to established adolescent girlfriends or boyfriends. At the other extreme, youth-produced sexual images played a role in criminal sexual relationships between adult sex offenders and minors. Such cases can be challenging to pediatricians, parents, and authorities because underage victims may have strong attachments to adult offenders and may not perceive themselves as having been victimized. To manage these cases effectively, clinicians must be sensitive to the perceptions of victims and not assume that youth will be eager to cooperate or see the situation as criminal," the authors wrote.

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