and well-being of children and youth
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Boy: feelin hot 2nite need 2 cu
Girl: k wanna c some pics ?
Girl: What’s up?
Boy: I am feeling hot tonight. I need to see you.
Girl: O.K. Do you want to see some pictures?
What are these teens texting about? What ‘pics’ (pictures) are these teens referring to? These teens are ‘sexting’. Sexting is the term used to describe sending and receiving sexually explicit messages, or nude or seminude photographs or videos electronically (primarily between cell phones, but can occur between any media-sharing device or technology – ie, e-mail or the Internet). Sexting has been a recognized occurrence for several years and is a global practice among teens and young adults. Despite its prevalence, we know very little about this phenomenon. This is partly because technology is changing rapidly, making it difficult to study. A PubMed search revealed that ‘sexting’ is nonexistent in the research literature. In fact, a search for “sexting” on PubMed generated the following result: “Your search for sexting retrieved no results”.
In an effort to better understand the practice of sexting, the American National Campaign to Prevent Teen and Unplanned Pregnancy, and CosmoGirl.com commissioned a survey  of teens and young adults to explore electronic activity. They surveyed 1280 young people – 653 teens (ages 13 to 19 years) and 627 young adults (ages 20 to 26 years) – about sexting during the fall of 2008. This study reported data on teens and young adults separately. According to the survey, one in five teens had sent or posted nude or seminude pictures or videos of themselves. Sexually suggestive messages (sent by text, e-mail or instant messaging) were even more prevalent than sexually suggestive images, with 39% of all teens sending or posting sexually suggestive messages and 48% of teens having received such messages. Approximately 71% of teen girls and 67% of teen boys who had sent or posted sexually suggestive content reported that they had sent or posted this content to boyfriends/girlfriends, and 21% of teen girls and 39% of teen boys reported that they had sent material to individuals they wanted to ‘hook up’ with. Forty-four per cent of teen girls and 36% of teen boys said that it is common for sexually suggestive text messages, and nude or seminude photographs to be shared with people other than the intended recipients. Teens admitted that sending or posting sexually suggestive content has an impact on their behaviour; 22% were more likely to use sexually suggestive words and images in text messages than in face-to-face communications, 38% admitted that exchanging sexually suggestive content makes dating or ‘hooking up’ with others more likely, and 29% of teens believed that it increases the likelihood that the parties involved will date or ‘hook up’. The most common reason for male and female teens to send sexually suggestive content was that it was regarded as a ‘fun or flirtatious’ activity.
Why might teens be involved in sexting? Adolescence is an important time for the development of identity and independence. This period is characterized by an increased ability to reason abstractly; the development of a sense of perspective, compromise and limit setting; a greater need for privacy; the emergence of sexual feelings and sexual experimentation; and the development of one’s own value system and refinement of moral and sexual values . Some experimentation and self-discovery occur through texting or sexting. Texting is a skill that allows teens to be sociable and interact with others, while providing distance from personal contact. Texting provides an electronic medium that allows teens to conceal who they are while expressing themselves and fostering personal relationships that might not otherwise occur face-to-face. For instance, shy, lonely and anxious people tend to find texting to be a less stressful and more comfortable way to express themselves, and an easier way to develop friendships than by a direct encounter . Peer pressure and peer expectations may play a role in why teens are sexting. According to the study mentioned above , 51% of teen girls felt pressure from teen boys to send ‘sexy’ messages. Further, 23% of teen girls and 24% of teen boys reported that they were pressured by friends to send or post sexual content. Although it can be challenging for teens to resist peer pressure, they should be encouraged not to do anything that makes them feel uncomfortable, even in cyberspace. Teens need to feel empowered to say ‘no’ to any request to send suggestive text, photographs or videos. We still have much to learn about where sexting behaviour comes from.
The obvious danger associated with sexting is that the material can be easily and widely disseminated. Once the message or image is in cyberspace, the sender loses control over the material and cannot assume that it will remain private . Teens need to understand that nothing in cyberspace ever really gets deleted. Friends, enemies, parents, teachers, coaches, police, strangers, sexual predators and potential employers may receive or find past postings. Even if the teen deletes the text or image, it can be copied and sent/posted elsewhere. Another important issue to consider is that the recipient’s reaction to these messages may not be what the sender had originally intended it to be. For instance, four of 10 teen girls who had sent sexually suggestive content did so as a ‘joke’, and one-third of teen boys believe that girls who send such content are expecting to date or ‘hook up’ in real life . There are social, psychological and legal consequences to taking, sending or forwarding sexually suggestive images. Teens need to be aware that they can be arrested, charged and convicted for possessing and distributing child pornography, even when the pornography they are sending is of themselves . Unlike other countries, to date, no charges have been laid in connection with sexting in Canada. The bottom line is that nothing is anonymous in cyberspace.
In this digital world, parents need to become more knowledgeable about the technologies their children are using. They also need to be aware that many teens are sexting . Parents should be encouraged to ask their children, in a developmentally appropriate manner, what they know about sexting. Children and young teens with cell phones may not have heard the term ‘sexting’. Therefore, parents can open discussion with them about sending or receiving pictures of naked kids, teens or adults. Further, parents can teach children that text messages should never contain pictures of kids, teens or adults with their clothes off or kissing or touching each other in a manner that makes the child feel uncomfortable. Regardless of age or developmental stage, it is important to listen to the teen’s understanding of the issues, and then provide accurate and developmentally appropriate information. Parents need to have discussions with their child about safe and responsible online and cell phone activity. Parents need to reinforce that messages or pictures they send on their cell phones or online are not private or anonymous. Parents need to be transparent and explain to their teen that they will monitor online and cell phone activities, including who their kids are spending time with online and on the phone. As with other adolescent behaviours, parents should communicate to their teen what they consider to be responsible electronic messaging behaviours. Parents can help teens identify the possible consequences of behaviours, such as sexting, to help them come to their own conclusions about the potential outcomes of their actions. Schools may be another resource to help educate parents, teachers and students about the risks and consequences of their online and cell phone behaviours .
Health care professionals caring for teens should recognize that sexting is a public health issue. Health care professionals need to become better informed about the issue so that they can comfortably include questions about sexting in their teen health visits, and integrate discussions on safe and responsible online and cell phone activity. Using the HEADSS (Home, Education, Activities, Drugs, Sex and sexuality, and Suicide and mood) interview strategy can help health care professionals to organize their questions so that they can better explore the many issues that relate to sexting . Most importantly, health care professionals need to speak with teens and their families about the risks and potential consequences of sexting. Addressing these issues may prevent a teen from finding him- or herself in a compromising position.
Technology is here to stay and is evolving rapidly – children and teens will continue to use the current and new technologies. Health care professionals and parents need to develop novel approaches to keeping children digitally safe and responsible while influencing positive behaviours and good judgment in this technologically savvy world. We must do everything possible to prevent teens from making a mistake that could alter their life forever.
Members: Franziska Baltzer MD; April Elliott MD; Johanne Harvey MD; Debra K Katzman MD; Stan Lipnowski MD (board representative); Jorge Pinzon MD (Chair)
Principal author: Debra K Katzman MD
Disclaimer: The recommendations in this position statement do not indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate. Internet addresses are current at time of publication.