Abstract
This study examines the prevalence of adolescents who have had sexual photos shared without permission, including variation by demographics, and associations with interpersonal violence experiences, mental health and suicidality, and sexual risk behaviors.
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.
| Demographic Characteristic | Had a Sexual Photo Shared Without Permission, % (95% CI)a | |||
|---|---|---|---|---|
| Boys | Girls | |||
| Yes (n = 226) | No (n = 3904) | Yes (n = 210) | No (n = 4241) | |
| Total | 5.7 (4.7-7.0) | 94.3 (93.0-95.3) | 4.8 (3.7-6.1) | 95.2 (93.9-96.3) |
| Grade | ||||
| 9th | 5.9 (4.3-8.2) | 94.1 (91.8-95.7) | 6.3 (3.8-10.2) | 93.7 (89.8-96.2) |
| 10th | 4.3 (2.7-6.8) | 95.7 (93.2-97.3) | 4.6 (3.1-6.9) | 95.4 (93.1-96.9) |
| 11th | 6.3 (4.4-8.9) | 93.7 (91.1-95.6) | 4.3 (2.5-7.3) | 95.7 (92.7-97.5) |
| 12th | 6.3 (4.1-9.4) | 93.7 (90.6-95.9) | 3.5 (2.3-5.5) | 96.5 (94.5-97.7) |
| Race/ethnicity | ||||
| White | 6.2 (4.1-9.2) | 93.8 (90.8-95.9) | 5.9 (3.8-8.9) | 94.1 (91.1-96.2) |
| Black | 5.9 (4.3-8.2) | 94.1 (91.8-95.7) | 4.7 (3.2-6.8) | 95.3 (93.2-96.8) |
| Hispanic | 4.0 (2.7-5.8) | 96.0 (94.2-97.3) | 4.8 (3.5-6.5) | 95.2 (93.5-96.5) |
| Other | 3.6 (2.0-6.6) | 96.4 (93.4-98.0) | 2.9 (1.9-4.5) | 97.1 (95.5-98.1) |
| Sexual identity | ||||
| Heterosexual | 4.1 (3.2-5.1) | 95.9 (94.9-96.8) | 3.9 (2.7-5.6) | 96.1 (94.4-97.3) |
| Gay/lesbian/bisexual | 17.6 (11.1-26.8) | 82.4 (73.2-88.9) | 7.4 (5.2-10.5) | 92.6 (89.5-94.8) |
| Unsure | 10.8 (5.0-21.8) | 89.2 (78.2-95.0) | 8.1 (4.2-15.1) | 91.9 (84.9-95.8) |
Sample number is unweighted; percentage is weighted.
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.
| Health Risk Indicators | APR (95% CI)a | |
|---|---|---|
| Boys | Girls | |
| Interpersonal violence experiences | ||
| Forced sexual intercourse, ever | 7.73 (5.01-11.91) | 4.35 (3.35-5.66) |
| Sexual dating violence, past 12 mob | 6.78 (3.91-11.77) | 3.97 (2.54-6.21) |
| Physical dating violence, past 12 mob | 3.16 (1.91-5.20) | 5.65 (3.70-8.64) |
| Bullied on school property, past 12 mo | 2.73 (1.85-4.01) | 2.31 (1.78-2.99) |
| Electronically bullied, past 12 mo | 5.00 (3.23-7.74) | 2.86 (2.19-3.74) |
| Mental health and suicidality | ||
| Persistent feelings of sadness or hopelessness, past 12 mo | 2.45 (1.86-3.24) | 1.56 (1.32-1.85) |
| Seriously considered attempting suicide, past 12 mo | 4.39 (3.37-5.73) | 2.11 (1.54-2.89) |
| Attempted suicide, past 12 mo | 2.12 (1.37-3.27) | 1.94 (1.26-2.96) |
| Sexual behavior | ||
| Had sexual intercourse, ever | 1.82 (1.47-2.27) | 1.66 (1.25-2.20) |
| Currently sexually activec,d | 1.23 (0.96-1.57) | 1.20 (1.06-1.35) |
| Did not use condom at last intercoursec | 1.53 (1.13-2.09) | 1.34 (0.96-1.87) |
| Had ≥4 lifetime sexual partnersc | 1.88 (1.17-3.03) | 3.62 (2.48-5.27) |
| Used alcohol or drugs before last sexual intercoursec | 1.73 (0.95-3.13) | 2.43 (1.50-3.94) |
Abbreviation: APR, adjusted prevalence ratio.
Adjusted models controlled for grade, race/ethnicity, sexual identity, and site, comparing the prevalence of the health risk among those who had a sexual photo shared without permission with those who did not have a sexual photo shared without permission.
Among students who dated or went out with someone during the past 12 months.
Among those who reported ever having sexual intercourse.
Sexual intercourse during the past 3 months.
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.
References
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