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Contributing studies are sorted in reverse chronological order. JAMA Pediatr. Question Is youth sexting associated with sexual behaviors and mental health? The associations between sexting and multiple sexual partners, drug use, smoking, and internalizing problems were stronger in younger compared with older adolescents. Meaning of this study suggest that sexting is associated with various sexual behaviors and mental health risk factors; moving forward, education campaigns should focus on providing youth with comprehensive information about sexting and digital citizenship.

Importance Sexting is the exchange of sexual messages, photographs, or videos via technological devices and is common and increasing among youth. Although various studies have examined the association between sexting, sexual behaviors, and mental health, are mixed.

Objective To provide a meta-analytic synthesis of studies examining the associations between sexting, sexual behavior, and mental health using sex, age, publication date, and study methodological quality as moderators. Study Selection Studies were included if participants were younger than 18 years and an association between sexting and sexual behaviors or mental health risk factors was examined.

Data Extraction and Synthesis All relevant data were extracted by sextig forum independent reviewers. Random-effects meta-analyses were used to derive odds ratios ORs. The mean range age was ificant associations were observed between sexting and sexual activity 16 studies; OR, 3. Moderator analyses revealed that associations between sexting, sexual behavior, and mental health factors were stronger in younger compared to older adolescents. Conclusions and Relevance of this meta-analysis suggest that sexting is sextig forum with sexual behavior and mental health difficulties, especially in younger adolescents.

Longitudinal research is needed to assess directionality of effects and to analyze the mechanisms by which sexting and its correlates are related. Educational campaigns to raise awareness of digital health, safety, and security are needed to help youth navigate their personal, social, and sexual development in a technological world. It has been 10 years since the advent of sexting research, and, during this time, sexting has moved into mainstream culture. Sexting is the exchange of sexual messages, photos, or videos via technological devices.

Although the prevalence of youth sexting is now more definitive, research on the types of risks associated with sexting is not. Various studies have found associations between sexting and increased sexual activity, substance use, delinquency, and internalizing problems such as depression and anxiety 6 - 9 ; however, other studies indicate no associations between sexting and these behaviors. With a decade of research now in hand, enough data exist to resolve discrepancies via a meta-analysis. Although several literature reviews have compiled reports of sexting and its correlates, none has focused exclusively on adolescents, 1213 nor to our knowledge has a meta-analytic synthesis been conducted.

The primary aim of this meta-analysis is to provide clarity to otherwise incongruentby compiling and organizing sexting and associated variables into a synthesized analysis. A secondary aim is to identify potential methodological and sample characteristic moderators that may explain between-study variability. The current analysis will examine sex as a moderator, as studies have shown that female adolescents who sext are more likely to experience adverse health consequences than male adolescents. Given the rapid increase in technology use across the last decade, publication date is examined as a moderator, and owing to variation in the methodological rigor across studies, method quality will also be assessed to determine if it predicts between-study variability.

Sexting has emerged as a relatively recent cultural phenomenon; as such, no universal definition of sexting has been used consistently within the literature. Studies range in their definition of the context, content, and format of sexting. Context specificities of sexting include distinctions between sending, receiving, requesting, and forwarding sexts.

Participants consented to take part in the original studies. were limited to publications between sextig forum Figure 1. The concept of sexting was captured by searching numerous text word phrases, using both adjacency operators and truncation to capture variations in spelling and phrasing eTable 1 in the Supplement. The concept of adolescents was searched using text words, database-specific sextig forum headings, and age limits, when available. Synonymous terms were first combined with the Boolean OR. These 2 concepts were then combined with the Boolean AND.

Studies were included if they met the following inclusion criteria: 1 examined an association between sexting and 1 or more sexual behavior s or mental health risk factor s ; 2 assessed participants younger than the mean age of 18 years; 3 provided sufficient information to allow for effect size calculation; and 4 was available in English.

Two coders C. A standard data extraction form was used to code study variables and effect sizes. In the case that a study stratified by context sent or a mix of sent and receivedthe present analysis prioritized associations based on sent over other types of messages, because 1 only 5 included studies assessed other sexting types in isolation 926 - sextig forum and thus there were insufficient data to conduct moderator analyses based on the type of sexting behaviors; and 2 an individual may receive a sext without wanting one; therefore, sending sexts is seen as more conceptually related to taking a risk than receiving a sext.

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In terms of the content of sexting, we prioritized images or videos over text message, because picture and video sexts may have more punitive and negative social consequences for adolescents compared with word-only texts. We also extracted child age and sex percent of the sample who were femaleas well as publication date, to determine if these potential moderators explained between-study variability. When there were multiple publications based on 1 data set, each data set was only represented once by selecting the study with the largest sample size and most comprehensive data extraction information.

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Each study underwent a methods appraisal to ensure quality and validity of included findings. A 9-point assessment scale, developed based on meta-analyses, 30 - 32 was used to evaluate studies. Each criterion was given a score of 0 No or 1 Yesand scores were summed for a total quality score out of a possible 9, with higher scores indicating better quality eTable 2 in the Supplement. Consistent with research, scores of 1 to 2 were considered low quality, 3 to 5 were of moderate quality, and 6 to 9 were high-quality studies.

Analyses were conducted using Comprehensive Meta-Analysis software version 3. Operating on the assumption that all studies possess unique population parameters, effect-size calculations were based on random-effects modeling using the DerSimonian and Laird estimator. The Q statistic indicates whether study variability is greater than sampling error; if ificant, moderator variables should be examined.

Egger test 36 and review of forest plots were used to assess publication bias. Of nonoverlapping articles, were excluded through abstract review. Subsequent full-text review of studies identified 26 studies that met inclusion criteria. Three studies 37 - 39 were eliminated from analyses owing to low methodological quality; thus 23 studies met full inclusion criteria for the meta-analytic synthesis.

Of the included studies, 1 study used a longitudinal de. All other included studies either used a cross-sectional de or analyzed cross-sectional data from an ongoing longitudinal study. The mean age range of participants was Two of the studies 8. of meta-analyses for each sexual behavior and mental health factor are presented below. The mean pooled effect size is provided, followed by of publication bias and moderator analyses. Unless otherwise sextig forum, moderators examined in each meta-analysis were age, sex percentage female sextig forum, publication date, and methodological quality score.

A random-effects meta-analysis produced a ificant combined effect size OR of 3. Odds ratios greater than 3. No publication bias was suggested. Only study methodological quality emerged as a ificant moderator. For every 0. Five studies participants examined the association between sexting and having multiple sexual partners, and the pooled effect size was ificant sextig forum an OR of 5. There was no indication of publication bias. Age emerged as a ificant moderator of between-study variability: for every 0. Being male was also a ificant moderator: for every 2. Six studies participants examined the association between sexting and lack of contraception use, and the pooled effect size was ificant, with an OR of 2.

No publication bias was detected. No moderators were detected. Three studies participants report on sexting and delinquency, with a ificant pooled effect size OR, 2. There was no evidence of publication bias. Moderator analyses were not conducted owing to insufficient sample size. Age emerged as a ificant moderator: for every 0. Five studies participants examined associations between youth sexting and drug use, and the pooled effect size was ificant, with an OR of 3. Age was a ificant moderator: for every 0. Youth sexting and its potential risks have grabbed the attention of parents, educators, health practitioners, and the public at large.

reveal that sexual behaviors and mental health factors are implicated to a greater extent in youth who are sexting. Sexting youth, relative to their sextig forum counterparts, are more likely to use substances, experience anxiety, depression, and delinquency, and to engage in sexual activity, sex with multiple partners, and lack of contraception use.

These findings, together with research suggesting that approximately 1 in 4 youth are sexting, 3 imply that discussions regarding sexual health and education between parents, teachers, and youth should include digital health and citizenship. Sexual activity, although associated with risks such as sexually transmitted infections STIs 59 and pregnancy, 16 is not an inherently dangerous or delinquent behavior among youth.

Sexual exploration at various points in development is normative and can be indicative of healthy exploration and positive relationship building. However, an important finding to emerge from this study is that the associations between sexting and having multiple partners, experiencing internalizing problems, and engaging in smoking and drug use were stronger in younger compared with older adolescents. Although sexual exploration becomes an increasingly normative part of development as adolescents age 48 sextig forum, 60 ; it is possible that younger adolescents may be more susceptible to risks associated with sexting owing to their relative immaturity compared with older adolescents.

A span as short as 3 years within the adolescent period could reflect a difference between the onset of puberty and advanced sexual, physical, and cognitive maturation. Furthermore, younger adolescents may be more vulnerable to online dangers such as sextortion being blackmailed to send nude photos, or money to prevent their pictures being posted online 62 and may be at risk of experiencing the negative outcomes that can accompany sexual behavior at an early age, such as teen pregnancy, or sexually transmitted infections, as younger adolescents are less likely than older adolescents to get tested for sexually transmitted infections.

Sex moderated the association between sexting and having multiple sexual partners, such that the association was stronger among male than female adolescents. Given that sex differences are not found with respect to actual sexting behavior in youth, 3 the weaker association between sexting and having multiple sexual partners seen in female adolescents may be owing to the cultural emphasis placed on the negative sexual, social, and psychological consequences of female sexuality, 1466 leading female adolescents to engage in, and report, fewer sexual encounters relative to male adolescents.

The differing strengths of the association between sexting and having multiple sexual partners may therefore be associated with social mores, which normalize male sexual exploits and lead to male individuals having or reporting a greater of sexual partners overall. One possible mediating variable linking sexting to sexual behaviors and mental health risks is intention. Youth may sext with relatively harmless intentions of sexual exploration or intimacy building; such intentions are normative developmental occurrences in adolescence. However, in the case that harmless intentions result in harmful or unwanted outcomes, the likelihood of internalizing problems may increase.

For example, youth may sext with the intention of building intimacy; however, when intimacy does not sextig forum, emotional distress or disappointment ensues. For example, the environmental disinhibitory effect of alcohol and drugs may contribute to a greater tendency to engage in sexting and other risky behaviors eg, drunk texting, lack of contraception use.

A common conclusion in sexting-related research is that education is fundamental to minimizing risk. Although these are legitimate risks that must be addressed, research shows that youth are already aware that sexting is risky 7273 ; therefore, several additional strategies may be needed. Open and frequent conversations with youth about sexual behavior and digital citizenship ie, how to be safe, legal, and ethical in their online lives may be essential to safeguarding youth. It is also important to discuss the emotional and legal ramifications of sending or forwarding sexts without consent, which is reportedly occurring in 1 of 8 youth.

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