Resources

  1. Madigan S, Van Ouytsel J, Temple JR. Nonconsensual Sexting and the Role of Sex Differences—Reply. JAMA Pediatr. 2018;172(9):890–891. doi:10.1001/jamapediatrics.2018.1951
  2. Madigan S, Ly A, Rash CL, Van Ouytsel J, Temple JR. Prevalence of Multiple Forms of Sexting Behavior Among Youth: A Systematic Review and Meta-analysis. JAMA Pediatr. 2018;172(4):327–335. doi:10.1001/jamapediatrics.2017.5314
  3. Moreno MA. What Parents Need to Know About Sexting. JAMA Pediatr. 2018;172(4):400. doi:10.1001/jamapediatrics.2017.5745
  4. Reed E, Salazar M, Raj A. Nonconsensual Sexting and the Role of Sex Differences. JAMA Pediatr. 2018;172(9):890. doi:10.1001/jamapediatrics.2018.1948



Transcript

Dr. Frank Domino:

You're seeing Madison, a 15-year-old female, for her well child exam. Before the visit, Madison's mother Emma pulls you aside to talk to you about a concern. Emma tells you she picked up Madison's phone, which was sitting on the counter, and looked through her texts. She saw something that she thought was rather obscene, and is now concerned. When Emma discussed this with Madison, Madison became angry and defensive, and accused her mother of invading her privacy. Emma is clearly upset by this and asked you what to do about this behavior? Is her daughter at risk? And what should they both do?

Hi, this is Frank Domino, Professor of Family Medicine and Community Health at the University of Massachusetts Medical School. And joining me today to discuss sexting in the teen population is Dr. Susan Feeney, Assistant Professor and Coordinator of the Family Nurse Practitioner Track at the University of Massachusetts Medical School's Graduate School of Nursing. Thanks for coming today, Susan.

Susan Feeney:

My pleasure, Frank.

Dr. Domino:

Wow. So, I see teens all the time in the office, and this is quite concerning. Can you tell us a little bit about what sexting is, and what's the risk associated with it?

Susan Feeney:

Well, sexting, there's been some evolution of the term. Originally, it was sending or receiving nude or semi-nude photos of yourself through a digital means. Now, it is not just sending nude or semi-nude photos, it's also videos and explicit behavior or explicit language or messaging. There was a recent meta-analysis done looking at research that goes back to 2009 all the way to 2016, and as you can imagine, there's been quite an evolution in this behavior, because from 2009 we've seen an explosion in the use of cellular phones, smartphones. So in 2009, most of this behavior was done online, and so it was pretty limited, although it wasn't a minimal amount of kids doing this. But now it appears to be a sizable amount of tweens and teens, who are sharing these kinds of photos and messages data. So right now what they're saying according to this meta-analysis, is that basically, the mean for kids sending a sext is almost 15% of that age group. So this would be somewhere between 10 and 18 years of age. And then for the mean for receiving is about 27%, and then the mean for forwarding a sext, which is what a text that has this data in it, without consent, so non-consensual forwarding of this, is 12%. And the mean for having one of your sext text sent without your consent is about 8.5%.

Dr. Domino:

Wow.

Susan Feeney:

So it's stunning. It's quite amazing how that has increased. And the idea is the reason it's increased is the use of cellular phones.

Dr. Domino:

It's really remarkable those numbers. You think about one in six have sent something, and one in four have received something in that age group.

Susan Feeney:

Yeah.

Dr. Domino:

I guess it's my age that surprises me. I just inherently think that seems like a bad idea, yet between 10 and 18, we know that impulsivity is rather high and thinking clearly. So, what are some strategies to address this behavior? How do we discuss this with our teens?

Susan Feeney:

Well, it was interesting from the meta-analysis. What they said is that maybe some of this is just normative sexual exploration in the digital age, which as an old lady, this kind of took me back a bit. But that it could correlate with sexual identity, because it does seem, when you look at the prevalence of use, it can start as early as 10. But it does seem to correlate with pubescent change of... 10 or three or four. But the risks are significant in that it really goes around to the non-consensual sharing, is that there is an association with harassment, cyber bullying, that there has been exploitation.

Dr. Domino:

Really?

Susan Feeney:

Oh yeah, there's stories of kids who've been sort of forced into becoming sexually active because this has been held over their head. And they say it in extreme cases, it could even be associated with suicidal ideation and behavior. And we've seen an uptick in this recently, so associated with cyber bullying. So it's not a trivial thing. I think what we need to do is... This is really being identified as a public health concern, and it needs to be addressed both with our parents and with our teens, along with everything else we need to talk to them about risky behavior.

We know that kids who do behave... Use the sexting, it seems to be correlated with earlier sexual behavior, so to have that discussion with them. But also to start... Because of the cellphone use, there was a recent study in 2016, that showed the average age for a cellphone access and use, it was 10.3 years.

Dr. Domino:

Wow.

Susan Feeney:

And that's a concern that if these kids have this phone and maybe they'll start receiving some of these things, unasked for, that puts them at risk. And a younger child is clearly more vulnerable for exploitation than an older child. So, I think it means we have to have discussions with our parents fairly early, like when are you going to give your kids a phone? And understand that there are risks here. And then with our teens and tweens, obviously starting at 10 or older, the risk of sending, in that if you send something, it's not private. You've basically given away that access, you've let people, they can do whatever they want with it, and that puts you at risk. And if you forward something, even though you think it might be funny or well they've given me permission, you don't have a right to forward that. And that that is a form of a... Really a form of a crime in a sense, that you're sharing intimate data. So these are tough conversations, but we have to have them.

Dr. Domino:

Well, it certainly seems like with Madison, we need to make it very clear that if you receive something you should delete it, you shouldn't forward it.

Susan Feeney:

Right.

Dr. Domino:

I like the thought that they should be made aware of that forwarding something you receive has possibly criminal potential. And so it's not innocuous. What advice are we gonna give Madison's Mom Emma today, what can we help her with?

Susan Feeney:

I think we can give her some resources, there are some apps that have some parental controls on it. It's tough, Madison's 15, so that a really tough age. But also to encourage her to have an open conversation, she can say, "Yes. I looked at your phone. And yes, that is an invasion of privacy. However, you are under age and my role is to protect you. And here are my concerns, my concerns is that you could be exploited and that you are vulnerable to exploitation." 'Cause I don't think that's something that they're gonna think about. And that would be the tact I would take when talking to Madison, is that this is not a harmless behavior, because once you share these photos, you have opened yourself up to potential exploitation, and a real risk to your mental health.

Dr. Domino:

And your future.

Susan Feeney:

Yeah, right.

Dr. Domino:

No, I agree. Well, thank you, Susan. This is a really important topic. It does add more to our teen visits than we probably would prefer, but it's so important that I think it's right up there with seatbelts and substance abuse.

Susan Feeney:

Right. Sort of took my breath away, but it definitely needs to be included in our care.

Dr. Domino:

Great. Thanks again.

Susan Feeney:

My pleasure.

Dr. Domino:

Practice pointer: Sexting behavior is on the increase in teens, the risks associated with it are higher chance of increased sexual behavior and non-consensual sharing of digital data, both are worrisome in the pre-teen, teen and early adulthood populations. Join us next time when we talk about the role of de-prescribing with our senior citizen patients.