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Sexually Explicit Cell Phone Messaging Associated With Sexual Risk Among Adolescents
 

Sexually Explicit Cell Phone Messaging Associated With Sexual Risk Among Adolescents

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Sexually Explicit Cell Phone Messaging Associated With Sexual Risk Among Adolescents

Sexually Explicit Cell Phone Messaging Associated With Sexual Risk Among Adolescents

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    Sexually Explicit Cell Phone Messaging Associated With Sexual Risk Among Adolescents Sexually Explicit Cell Phone Messaging Associated With Sexual Risk Among Adolescents Document Transcript

    • Sexually Explicit Cell Phone Messaging Associated With Sexual Risk Among AdolescentsEric Rice, Harmony Rhoades, Hailey Winetrobe, Monica Sanchez, Jorge Montoya, Aaron Plant and Timothy Kordic Pediatrics; originally published online September 17, 2012; DOI: 10.1542/peds.2012-0021The online version of this article, along with updated information and services, is located on the World Wide Web at: http://pediatrics.aappublications.org/content/early/2012/09/12/peds.2012-0021 PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2012 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275. Downloaded from pediatrics.aappublications.org by guest on September 21, 2012
    • ARTICLESexually Explicit Cell Phone Messaging AssociatedWith Sexual Risk Among AdolescentsAUTHORS: Eric Rice, PhD,a Harmony Rhoades, PhD,a Hailey WHAT’S KNOWN ON THIS SUBJECT: Sending and receivingWinetrobe, MPH,a Monica Sanchez, MA,b Jorge Montoya, sexually explicit picture and text messages via cell phonePhD,c Aaron Plant, MPH,c and Timothy Kordic, MAd (ie, “sexting”) among adolescents is publicized as a societalaSchool of Social Work, University of Southern California, Los and public health concern, yet it is unknown whether sexting isAngeles, California; bDepartment of Psychology, Clark University, associated with physical sexual activity or sexual risk behavior.Worcester, Massachusetts; cSentient Research, Los Angeles,California; and dLos Angeles Unified School District, Los Angeles,California WHAT THIS STUDY ADDS: This study is the first to examine sexting among a probability sample of adolescents and found that sextingKEY WORDSsexual risk behavior, adolescents, HIV, sexting, technology is associated with sexual activity, sexual risk behavior, and knowing other person(s) who have sent a sext.ABBREVIATIONSCI—confidence intervalLAUSD—Los Angeles Unified School DistrictLGBTQ—lesbian, gay, bisexual, transgender, questioning/unsureOR—odds ratioSTIs—sexually transmitted infectionsYRBS—Youth Risk Behavior Survey abstractwww.pediatrics.org/cgi/doi/10.1542/peds.2012-0021 OBJECTIVES: Sexting (sending/receiving sexually explicit texts anddoi:10.1542/peds.2012-0021 images via cell phone) may be associated with sexual healthAccepted for publication May 21, 2012 consequences among adolescents. However, to date, no publishedAddress correspondence to Eric Rice, PhD, School of Social Work, data from a probability-based sample has examined associationsUniversity of Southern California, 1149 South Hill St, Suite 360, between sexting and sexual activity.Los Angeles, CA 90015. E-mail: ericr@usc.edu METHODS: A probability sample of 1839 students was collected along-PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). side the 2011 Youth Risk Behavior Survey in Los Angeles high schools.Copyright © 2012 by the American Academy of Pediatrics Logistic regressions were used to assess the correlates of sexting be-FINANCIAL DISCLOSURE: The authors have indicated they have havior and associations between sexting and sexual risk-taking.no financial relationships relevant to this article to disclose. RESULTS: Fifteen percent of adolescents with cell phone accessFUNDING: Data collection was supported by the Centers forDisease Control and Prevention (award 5U87DP001201-04). reported sexting, and 54% reported knowing someone who had sent a sext. Adolescents whose peers sexted were more likely to sext them- selves (odds ratio [OR] = 16.87, 95% confidence interval [CI]: 9.62– 29.59). Adolescents who themselves sexted were more likely to report being sexually active (OR = 7.17, 95% CI: 5.01–10.25). Nonheterosexual students were more likely to report sexting (OR = 2.74, 95% CI: 1.86– 4.04), sexual activity (OR = 1.52, 95% CI: 1.07–2.15), and unprotected sex at last sexual encounter (OR = 1.84, 95% CI: 1.17–2.89). CONCLUSIONS: Sexting, rather than functioning as an alternative to “real world” sexual risk behavior, appears to be part of a cluster of risky sexual behaviors among adolescents. We recommend that clinicians discuss sexting as an adolescent-friendly way of engaging patients in conversations about sexual activity, prevention of sexually transmitted infections, and unwanted pregnancy. We further recommend that discussion about sexting and its associated risk behavior be included in school-based sexual health curricula. Pediatrics 2012;130:667–673PEDIATRICS Volume 130, Number 4, October 2012 667 Downloaded from pediatrics.aappublications.org by guest on September 21, 2012
    • “Sexting,” which refers to the sending themselves, whereas 15% reported “online” and was not associated withor receiving of sexually explicit mate- receiving such a photograph or vid- physical sex risk behavior. Some ado-rial (including written messages and eo of someone they knew.2 Among lescents perceive that sexting is a saferimages) via cell phone, is a relatively high school students surveyed in the substitute to real life sexual activity,2new phenomenon that has received Northeastern United States, 15% had but others suggest that sexting may beincreased attention in recent years, as received sexts containing nude photos viewed as a future expectation for en-instances of sexting are publicized and and 32% knew someone who had par- gaging in sexual intercourse.8associated with a variety of legal and ticipated in this type of sexting.7 In Much of the research on sexting hassocial/behavioral consequences.1–4 The a sample of teenagers surveyed on the focused on the sending and receivingauthors of a recent nationally repre- Internet in 2008, 20% of teenagers of sexually explicit images and textssentative study suggest that the outcry reported sending nude or seminude via cell phone. Few studies have collect-over sexting is unnecessary, as they photographs of themselves, and 39% ed data on the perceptions of peer en-found only 2.5% of 10- to 17-year-olds reported sending sexually suggestive gagement in such practices. Yet, decadesreported sending sexually explicit text, E-mail, or instant messages.8 of school-based research on adolescentsphotos.5 However, sexting cannot be Although the exchange of sexually ex- have repeatedly demonstrated that ado-discounted as a potentially risky be- plicit content is not a new phenomenon, lescents’ perceptions of the norms andhavior solely on the basis of being a technological advances have expanded values of their peers are strongly asso-relatively low probability event. Very the availability of this material and ciated with their risk-taking and antiso-little is known about the possible weakened restrictions on access to cial behaviors.13–18 It is important that wehealth consequences related to sexting such content (ie, age verification). Sexts examine not only the rates of sexting, butamong adolescents. In a study of young differ from other types of sexually ex- that we understand how such behaviorsHispanic women at a university in the plicit material because of the ease with are tied to adolescents’ perceptions ofsouthern United States, engaging in which an individual can create and the sexting behaviors of their peers orsexting was related to unprotected widely distribute material via portable other persons whom they know.sex.6 To fully understand the potential digital devices. Particularly problem- This study examined both the correlatesnegative consequences of sexting, it is atic is the ability of persons under the of sexting (including perceived peerandnecessary to know whether sexting is age of consent to create and receive others’ sexting behavior) and the associ-associated with physical sexual be- such materials, given the widespread ation of sexting with physical sexual riskhavior that may put young people at use of cell phones and other portable behavior among a representative proba-risk for HIV, other sexually transmitted digital devices among the “Facebook bility sample of high school students. Toinfections (STIs), and/or unwanted generation.”9 Moreover, this activity the best of our knowledge, no previouspregnancy. Data that include youth of can result in charges of child pornog- research has examined whether sextingvarying gender, racial/ethnic back- raphy, even if the picture-senders are is associated with physical sexual behav-ground, and sexuality is critical to an- ,18 years of age.10 Sexting may be ior or sexual risk-taking in a represen-swering these questions. particularly detrimental for adolescent tative probability sample of adolescentsThere has been variation across studies populations because of the likelihood across genders, racial/ethnic groups, andas to the operational definition of that sexually explicit material will be sexual orientations.sexting, resulting in discrepancies in quickly shared throughout young people’sreported rates of sexting behavior, in technologically active social groups.4,11 METHODSaddition to differences driven by study Sexting may be another means of We distributed a supplemental ques-design and target population. In some adolescents exploring their sexuality, tionnaire in conjunction with the 2011studies the focus was on the sending of engaging in sexual experimentation, administration of the Centers for Dis-nude or semi-nude photos and videos, identity and self-development, and de- ease Control and Prevention’s Youthin others it was the sending of sexually termining his or her moral and sexual Risk Behavior Survey (YRBS) in the Losexplicit text messages, whereas others values.3,11,12 Sexting itself does not Angeles Unified School District (LAUSD)included both. A 2009 nationally rep- pose a direct risk for transmission of high schools. The supplemental studyresentative survey found that 4% of 12- STIs or unwanted pregnancy, and was approved by the LAUSD Healthto 17-year-olds who owned their own could, in fact, be considered a “safe” Education Programs, as is requiredcell phone reported sending a nude or alternative to actual sexual behavior, if by the Cooperative Agreement withnearly nude photograph or video of sexting behavior remained strictly the Centers for Disease Control and668 RICE et al Downloaded from pediatrics.aappublications.org by guest on September 21, 2012
    • ARTICLEPrevention, Division of Adolescent TABLE 1 Individual Characteristics and Cell persons’ sexting behavior, personal Phone Use of Los Angeles UnifiedSchool Health. The data analysis was School District High School sexting behavior, and sexual riskgranted an exemption from review by Students, Los Angeles, CA, 2011 behaviors are reported in Table 2.the University of Southern California (N = 1839)Institutional Review Board. Weighted Unweighted Statistical Analysis % nThe YRBS at LAUSD is conducted in 2 Three logistic regression models were What is your sex? conducted with SAS 9.2 (SAS Institute,steps. First, schools within the district Female 48.14 901are selected with a probability pro- Male 51.86 925 Inc, Cary, NC) to assess associationsportional to their student enrollment. Missing 13 with personal sexting, history of sexual What race or ethnic activity, and unprotected sex at lastSecond, classes within schools are se- background do you mostlected with equal probability. All students closely identify with? sexual encounter. The first 2 modelsin grades 9 through 12 are eligible, in- American Indian or Alaska 0.29 18 were restricted to the subsample ofcluding those in special education clas- Native adolescents who reported having any Asian 3.82 96ses or who have low English-language access to a cell phone (n = 1714; in- Black/African American 11.75 80proficiency. Of the 2425 LAUSD students Latino/Hispanic 71.52 1315 dividual model n’s are lower, becausesampled for the YRBS, 2105 completed Native Hawaiian or Other 2.65 35 of missing cases within the independentthe YRBS (87%); of those, 1853 completed Pacific Islander variables). The first model assesses White 8.75 103the supplemental questionnaire (88%), Multiple races/Ethnicity 1.23 126 associations with demographics, peers’/with a response rate of 76% of the overall Missing 66 other persons’ sexting behavior, and How old are you? personal sexting behavior. Becausesample (1853 of the 2425). Students 12 0.10 3older than 18 were removed from our 13 0.81 15 only 12 students who reported sextinganalyses, yielding a final sample of 14 26.29 499 also reported not knowing peers/other1839 students. Data were weighted 15 32.77 585 persons who sext, peer/other person 16 21.75 390 sexting was dropped from subsequentwith respect to race/ethnicity to reflect 17 14.88 272the demographic distribution of stu- 18 3.39 64 models in favor of retaining personaldents attending LAUSD. The sample de- Missing 11 sexting. The second model thus assesses What do you consider your the associations among demographics,mographic profile is presented in Table 1. sexual orientation? Homosexual 1.90 27 personal sexting behavior, and lifetime (Gay or Lesbian) history of sexual intercourse (ie, everMeasures Bisexual 7.00 117 having had oral, vaginal, or anal sex). Heterosexual (Straight) 86.97 1578It is important to note that the sup- The third model is restricted to ado- Transgender 0.54 8plemental questionnaire and the YRBS Questioning/ Unsure 3.58 59 lescents with cell phone access whocould not be linked, as both ques- Missing 50 reported ever having had sex (n = 616tionnaires were anonymous and did not after the exclusion of missing cases),include identifiers. As such, we asked and examines associations among de-students to answer demographic ques- Native Hawaiian or other Pacific Is- mographics, personal sexting, and un-tions a second time, including age, race/ lander, (6) White.” Sexual orientation protected sex at last intercourse.ethnicity, and gender (see Table 1). was assessed with the following item:LAUSD has a disproportionate racial/ “What do you consider your sexual RESULTSethnic minority student population, and orientation? (Please choose the bestbeing a large, urban school district, answer for you): (1) Homosexual (Gay Descriptive Statisticsit was important to investigate poten- or Lesbian), (2) Bisexual, (3) Hetero- The overall sample (n = 1839) was 52%tial racial disparities with health be- sexual (Straight), (4) Transgender, (5) male, mostly Latino/Hispanic (72%),haviors. Students self-reported their Questioning/Unsure.” A subsequent followed by Black/African Americanrace/ethnicity with the following ques- dichotomous variable that contrasts (12%), and white (9%). Most (96%)tion and subsequent response options: heterosexual to lesbian, gay, bisex- were between 14- and 17-years-old,“What race or ethnic background do you ual, transgender, or questioning/unsure most (87%) identified as heterosexual,most closely identify with? (Check all (LGBTQ) students was created by col- and nearly 75% reported owning a cellthat apply): (1) American Indian or lapsing all nonheterosexual responses. phone and using it every day. More thanAlaska Native, (2) Asian, (3) Black or Af- The exact wording of items regard- 15% of respondents with cell phonesrican American, (4) Hispanic/Latino, (5) ing cell phone access, peer or other reported ever sending a “sexuallyPEDIATRICS Volume 130, Number 4, October 2012 669 Downloaded from pediatrics.aappublications.org by guest on September 21, 2012
    • TABLE 2 Cell Phone Use and Sexual Behaviors of Los Angeles Unified School District High School have had unprotected sex at last sexual Students, Los Angeles, CA, 2011 (N = 1839) encounter (OR = 1.84; 95% CI: 1.17– Weighted % Unweighted n 2.89). Participants who had sent sexu-Pick the sentence that best describes your cell phone access: ally explicit cell phone messages or I have my own cell phone and use it every day 74.94 1357 I have my own cell phone, but no minutes 3.55 62 photos were statistically significantly I share a cell phone with a friend 0.81 15 more likely to have ever engaged in I don’t have my own cell phone, but I can borrow one from 15.54 280 sexual intercourse (OR = 7.17; 95% CI: a friend or other people 5.01–10.25), and exhibited a trend to- I don’t have a cell phone and I cannot borrow one 5.16 99 Missing 26 ward unprotected sex during their lastDo you know anyone who has sent a sexually explicit message or sexual encounter (OR = 1.41; 95% CI: photo of themselves by cell phone? 0.97–2.04) (Table 3). No 46.31 843 Yes 53.69 933 Missing 63 DISCUSSIONHave you ever sent a sexually explicit message or photo of yourself by cell phone? (Restricted to participants who have There are several important results to access to a cell phone; n = 1714) No 84.56 1426 emerge from this study. First, among Yes 15.44 228 the students with access to a cell phone Missing 60 (N = 1714), 15% reported sexting. ThisHave you ever had sexual intercourse (vaginal, anal, or oral sex)? percentage is comparable to recent (Restricted to participants who have access to a cell phone; n = 1714) work that also included the sending No 58.77 1003 and receiving of explicit text messages Yes 41.23 660 in the operational definition of sexting.7 Missing 51The last time you had sexual intercourse, did you or your partner However, this result is contrary to re- use a condom? (Restricted to sexually active participants who cent work that focused on the sending have access to a cell phone; n = 660) and receiving of naked photos.5 Per- No 36.27 238 Yes 63.73 417 centage disparities most likely reflect Missing 5 differences in sexting definitions and sample ages. Our study defined sexting as images or text messages, ratherexplicit message or photo” of them- themselves, compared with those stu- than just images, and included ages 12selves by cell phone, whereas 54% of dents who did not know someone who to 18 (versus 10–17 in the nationallythe total sample reported knowing sexted (OR = 16.87; 95% CI: 9.62–29.59) representative study, which found lowersomeone who has ever sent a sext. (Table 3). rates of sexting).5 Moreover, our sampleFewer than half of respondents with is of high school students in the LAUSDcell phones (41%) had ever had vagi- Sexting, Sexual Activity, and system, and urban youth in Southernnal, anal, or oral sex, and 64% of those Unprotected Sex California may be different from youthrespondents used a condom the last Models 2 and 3 examine the correlates in other regions of the country, or youthtime they had sex (Tables 1 and 2). of being sexually active and, among from suburban or rural settings. those who are sexually active, having Second, more than half of the studentsCorrelates of Sexting had unprotected sex at the last sexual reported knowing at least 1 personIn the first model regarding individual encounter. Older students were more whom they know who engaged insextingbehavior, older(odds ratio [OR] = likely to have had sex (OR = 1.65; 95% CI: sexting. This rate is somewhat higher1.17; 95% confidence interval [CI]: 1.02– 1.49–1.82), and to have had un- than was found in other work7; although1.33) and African American (OR = 2.75; protected sex at last sexual encounter the findings rely on perceptions of peer95% CI: 1.86–4.06) students were more (OR = 1.18; 95% CI: 1.02–1.36). Boys behavior and not necessarily observedlikely to send sexually explicit text were more likely to have had sex (OR = behavior. Additionally, knowing some-messages or photographs, as were 1.74, 95% CI: 1.39–2.19) and less likely one who sexted was strongly associ-LGBTQ adolescents (OR = 2.74; 95% CI: to have had unprotected sex (OR = 0.54; ated with an individual’s own sexting1.86–4.04). Students who knew some- 95% CI: 0.38–0.76). LGBTQ students behavior. Sexting thus falls in line withone who had sent a sext were nearly 17 were more likely to both have had sex many other health-related behaviors intimes more likely to have sent a sext (OR = 1.52; 95% CI: 1.07–2.15), and to which adolescents who engage in such670 RICE et al Downloaded from pediatrics.aappublications.org by guest on September 21, 2012
    • ARTICLETABLE 3 Logistic Regressions of Sexting Behaviors: Cell Phone Using LAUSD High School Students anal/vaginal sex), which may vary Los Angeles, CA, 2011 widely among adolescents. We asked Personal Sexting Sexually Active Unprotected Sex at only about the sending of sexts, and n = 1578 n = 1536 Last Intercourse n = 616 receipt of sexts might be associated with dissimilar factors. Further, as OR 95% CI OR 95% CI OR 95% CI previously mentioned, these findingsAge 1.17 1.02 1.33 ** 1.65 1.49 1.82 *** 1.18 1.02 1.36 ** may not be generalizable to otherMale 1.28 0.94 1.74 1.74 1.39 2.19 *** 0.54 0.38 0.76 **Race/Ethnicity (Hispanic/ school populations. Despite these lim- Latino = 0) itations, this study finds an importantBlack/African American 2.75 1.86 4.06 *** 1.11 0.76 1.63 1.08 0.66 1.78 association between sexting, sexualWhite 1.44 0.86 2.39 0.91 0.61 1.36 1.20 0.67 2.16Other race/ethnicity 1.55 0.89 2.71 0.58 0.37 0.90 ** 1.02 0.50 2.06 activity, and a trend toward unprotec-Sexuality (LGBTQ = 1) 2.74 1.86 4.04 *** 1.52 1.07 2.15 ** 1.84 1.17 2.89 *** ted sex in this population.Know someone who sexts 16.87 9.62 29.59 *** (Yes = 1)Personal sexting (Yes = 1) 7.17 5.01 10.25 *** 1.41 0.97 2.04 * Implications22 Log 1356.30 2084.08 833.43Pseudo R-Square 0.16 0.18 0.05 As this is a cross-sectional study with* P , .10. a sample of Los Angeles adolescents,** P , .05. research is needed with national*** P , .01. samples of adolescents and through prospective studies. Diary studiesbehaviors typically report that their Limitations measuring adolescent sexting (ie, fre-peers do so as well.13–18 Because ado- As with any study, there are several quency, with whom, picture versus text,lescent behavior is strongly tied to limitations. Because of the causality and so forth) and sexual behavior (ie,the perceptions of normative behavior limitations inherent in cross-sectional frequency, with whom, type of sex,among their peers, these findings sug- studies, we are unable to conclude condom use, and so forth) may helpgest that sexting, and associated sexual that sending sexts causes one to en- determine causation between sextingrisk behavior, may be fueled by the gage in sexual activity or engage in and sexual risk behavior. Furthermore,perception that sexting is normative. unsafe sex practices. The examination clarifications of “sexually explicit” andThird, and most importantly, these data of the correlates of sexting is limited differentiations between sending andreveal that sexting is associated with because we did not explore the reasons receiving sexts should be assessed inphysical sexual risk taking. Unlike work for sexting; doing so might shed light on future studies.that has suggested that sexting is a low- the causal relationship between sexting Clinician-based, school-based, and cell-risk, or healthy alternative to sexual and sexual risk behavior. As with all phone–based programs targetingrisk taking,2,11,12 we find that there is self-reported data, there is the possi- adolescents may mitigate the potentiala clustering of sexual risk behaviors, bility of both under- and overreporting negative health consequences of sext-which includes sexting. Sexting was of sexting and risk behaviors. How- ing and sexual risk behavior by dis-statistically significantly associated ever, because this was an anonymous cussing age-appropriate preventionwith sexual activity and showed a near- questionnaire, social desirability biases messages, such as safer sex and usingsignificant trend with reports of unsafe may have been reduced. Furthermore, condoms, within the context of ado-sex (ie, not using a condom at last in- we did not delineate between sending lescent technology use. We recognizetercourse). Moreover, certain pop- text-based versus picture-based sexts, that health care professionals haveulations of adolescents were more and we are unable to determine if limited time to discuss potential risklikely to sext in this study, including there are differences in associated behavior. Inquiring about patient in-Black/African American and LGBTQ behaviors between these 2 types of volvement in sexting behavior instudents. The findings with respect messages. We did not define “sexually a nonjudgmental manner may createto LGBTQ students are particularly explicit” content; as such, respondents a lead-in for the patient and clinician toalarming as these youth are more may have had varying interpreta- discuss sexual risk behavior. To facili-likely to be involved in sexting, to be tions of what constitutes sexually ex- tate discussions of sexual behaviorsexually active, and to engage in unsafe plicit images or messages. We also with young people of diverse sexualsex and thus are at increased risk for did not differentiate between specific orientations, we encourage health carethe transmission of HIV and other STIs. types of sexual activity (ie, oral versus professionals to use gender-neutralPEDIATRICS Volume 130, Number 4, October 2012 671 Downloaded from pediatrics.aappublications.org by guest on September 21, 2012
    • language that does not presume het- safety (http://www.aap.org/en-us/about- including condom use, strategies forerosexuality when asking about the-aap/aap-press-room/news-features- maintaining healthy relationships, andpatients’ sexual behavior. For patients and-safety-tips/Pages/Talking-to-Kids-and- the importance of safeguarding one’swithout a history of sexual activity, Teens-About-Social-Media-and-Sexting. online identity can increase adoles-clinicians may discuss the role of aspx)4 and parents can access resour- cents’ understanding of healthy iden-sexting in future sexual behavior and ces for discussing safe cell phone use tities and behaviors, while alsoidentify concrete means to practice from the National Center for Missing preventing sexual risk among diversesafer sex. Engaging in such a conver- and Exploited Children’s NetSmartz populations, including racial/ethnicsation is applicable for adolescents of program (http://www.netsmartz.org/ minorities and LGBTQ adolescents. Ad-all sexual orientations; however, it may CellPhones).19 The National Campaign ditionally, emerging sexual health textbe even more important with sexual to Prevent Teen and Unplanned Preg- message programs targeting adoles-minority adolescents (LGBTQ), as these nancy also provides tips for parents, cents (eg, ISIS’ SexInfo, Hookup, andindividuals are more likely to be en- including learning about adolescents’ REALtalkDC) allow for repeated mes-gaging in both sexting and sexual risk Internet and cell phone use, and setting sages on topics such as HIV/STI testing,behavior, yet feel less comfortable rules about technology behavior. Al- safer sex practices, and sexting, to bedisclosing their sexual identity and though research has found that teens sent to large numbers of adolescentsbehavior to providers. We encourage whose parents look at their phones for low cost. Research suggests thatproviders to not only connect with were no more or less likely to partici- adolescents are receptive to theseLGBTQ youth about sexting, but to also pate in sexting, adolescents whose types of private, interactive, technology-stress the importance of protected sex, parents limited the number of texts based sexual health information dis-given their added vulnerability to STIs they were allowed to send were less semination programs.20 Future iter-and HIV. likely to sext.2 ations may consider presentingFurthermore, depending on the age of Public health messages regarding individually tailored messages pro-the patient, resources may be made sexting and sexual risk behaviors can moting sexual health and means foravailable to parents to inform them of also be carried into school-based sex- mitigating risk-taking behavior, in-the possible negative consequences of ual health education programs. Dis- cluding sexting. As new sexual healthsexting and sexual risk behavior and cussing with students the possible programs for adolescents are cre-how to best communicate this in- repercussions of sending sexually ex- ated or updated, sexting should beformation with their adolescents. The plicit material, the context of sexting considered within the context ofAmerican Academy of Pediatrics Web within other sexual behavior (ie, degree sexual exploration and sexual riskpage discusses sexting and online of risky behavior), safer sex practices taking.REFERENCES 1. Berry C. DA’s office raises awareness about social media on children, adolescents, Results from a Survey of Teens and Young ’sexting.’ The Berkshire Eagle. March 4, 2009. and families. Pediatrics. 2011;127(4):800– Adults. 2008. Available at: www.thenatio- 2. Lenhart A. Teens and Sexting: How and why 804 nalcampaign.org/sextech/pdf/sextech_ minor teens are sending sexually sugges- 5. Mitchell KJ, Finkelhor D, Jones LM, Wolak J. summary.pdf. 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    • ARTICLE12. Katzman D. Sexting: Keeping teens safe substance use. J Appl Psychol. 1991;76(2): smokers, triers, and regular smokers esti- and responsible in a technologically savvy 291–298 mates of cigarette-smoking prevalence— world. Paediatr Child Health (Oxford). 2010; 16. Marks G, Graham JW, Hansen WB. Social when do overestimations occur and by 15(1):41–45 projection and social conformity in ado- whom. J Appl Soc Psychol. 1988;18(7):537–13. Berndt TJ. Developmental-changes in con- lescent alcohol-use—a longitudinal analysis. 551 formity to peers and parents. Dev Psychol. Pers Soc Psychol Bull. 1992;18(1):96–101 19. National Center for Missing and Exploited 1979;15(6):608–616 17. Prinstein MJ, Wang SS. False consensus Children. NetSmartz Workshop. Available at:14. Collins LM, Sussman S, Rauch JM, et al. and adolescent peer contagion: examining www.netsmartz.org/Parents. Accessed May Psychosocial predictors of young ado- discrepancies between perceptions and 10, 2012 lescent cigarette-smoking—a 16-month, actual reported levels of friends’ deviant 20. Selkie EM, Benson M, Moreno M. Adoles- 3-wave longitudinal-study. J Appl Psychol. and health risk behaviors. J Abnorm Child cents’ views regarding uses of social net- 1987;17(6):554–573 Psychol. 2005;33(3):293–306 working websites and text messaging for15. Graham JW, Marks G, Hansen WB. Social 18. Sussman S, Dent CW, Mestelrauch J, Johnson adolescent sexual health education. Am J influence processes affecting adolescent CA, Hansen WB, Flay BR. Adolescent non- Health Educ. 2011;42(4):205–212 GIVING YOUR GRILL THE BRUSH-OFF MAY NOT BE THE SAFEST THING TO DO: Summer is a time of sunshine, relaxation, and cooking outdoors. Hotdogs, hamburgers, and steaks are essential components of grilling, an all-American activity. Waiting for the food to cook, I tend not to worry about the grilled food causing any problems. However, an article published in a blog for The New York Times (Healthy Consumer: July 3, 2012) highlights how cleaning your grill before cooking might pose unanticipated health risks. In recent years, several reports have documented case series of diners who presented to the emergency de- partment with acute neck and abdominal pain shortly after eating home bar- beque. Imaging studies revealed that the cause of the pain was ingested grill brush bristles that became lodged in the neck, stomach, and intestines. All documented cases so far have involved bristles that became incorporated into the grilled meat. No individuals have died secondary to bristle ingestion, but several have needed uncomfortable invasive procedures to remove the foreign bodies. While emergency room staff are not strangers to individuals ingesting common household objects—keys, rings, and safety pins are among the countless items swallowed and extracted from patients—the dangers of scrubbing a grill with a metal brush before cooking are not well known. No one knows the rate at which these events occur. It is likely that many individuals ingest the bristles and pass them without symptoms. However, for those looking to minimize the risk, the author recommends grillers replace brushes regularly to decrease the risk of loose bristles finding their way into summer meals. Noted by Leah H. Carr, BS, MS-IIIPEDIATRICS Volume 130, Number 4, October 2012 673 Downloaded from pediatrics.aappublications.org by guest on September 21, 2012
    • Sexually Explicit Cell Phone Messaging Associated With Sexual Risk Among AdolescentsEric Rice, Harmony Rhoades, Hailey Winetrobe, Monica Sanchez, Jorge Montoya, Aaron Plant and Timothy Kordic Pediatrics; originally published online September 17, 2012; DOI: 10.1542/peds.2012-0021Updated Information & including high resolution figures, can be found at:Services http://pediatrics.aappublications.org/content/early/2012/09/12 /peds.2012-0021Subspecialty Collections This article, along with others on similar topics, appears in the following collection(s): Adolescent Medicine http://pediatrics.aappublications.org/cgi/collection/adolescent _medicinePermissions & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: http://pediatrics.aappublications.org/site/misc/Permissions.xh tmlReprints Information about ordering reprints can be found online: http://pediatrics.aappublications.org/site/misc/reprints.xhtmlPEDIATRICS is the official journal of the American Academy of Pediatrics. A monthlypublication, it has been published continuously since 1948. PEDIATRICS is owned, published,and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, ElkGrove Village, Illinois, 60007. Copyright © 2012 by the American Academy of Pediatrics. Allrights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275. Downloaded from pediatrics.aappublications.org by guest on September 21, 2012