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Letters / Journal of Adolescent Health 57 (2015) 126e129
widespread action among all relevant parties, focusing not just on the young adult years themselves but also on the transitions into and out of this important period of life.
UW LEAH (Leadership of Education in Adolescent Health) Seattle Children’s and the University of Washington Seattle, Washington UW Department of Pediatrics Seattle Children’s and the University of Washington Seattle, Washington
Acknowledgments The authors acknowledge the members of the Institute of Medicine and National Research Council Committee on Improving the Health, Safety, and Well-Being of Young Adults for their contribution to the report on which the commentary and this letter are based. The report was commissioned by the Health Resources and Services Administration and the Office of the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services, the Robert Wood Johnson Foundation, The Annie E. Casey Foundation, and the Department of Defense. Clare Stroud, Ph.D. Institute of Medicine Washington, DC Leslie R. Walker, M.D. Division of Adolescent Medicine Department of Pediatrics University of Washington/Seattle Children’s Hospital Seattle, Washington
Maryann Davis, Ph.D. Department of Psychiatry University of Massachusetts Medical School Worcester, Massachusetts Charles E. Irwin, Jr., M.D. Division of Adolescent and Young Adult Medicine Department of Pediatrics UCSF Benioff Children’s Hospital/University of California, San Francisco San Francisco, California
References [1] Stroud C, Walker LR, Davis M, Irwin Jr CE. Investing in the health and wellbeing of young adults. J Adolesc Health 2015;56:127e9. [2] To access these resources, see www.GotTransition.org. [3] Institute of Medicine and National Research Council. Investing in the health and well-being of young adults. Washington, DC: The National Academies Press; 2015.
It’s More Than Just “Sext”dA Brief Discussion on Sexting Activity Among Teens To the Editor: “Sexting” is a hot topic in the area of adolescent health. Ybarra and Mitchell [1] in their article, “Sexting and Its Relation to Sexual Activity and Sexual Risk Behavior in a National Survey of Adolescents,” suggest that sexting is related to behaviors indicative of psychosocial challenge and risky sexual behavior for some youth. Significant findings include a higher frequency of sexting among females and lesbian, gay, bisexual (LGB) youth. Additionally, a greater number of past-year sex partners and a greater odds of depression and substance abuse were found among teens who sext. Their work contributes to the growing literature in the area of sexting and provokes further discussion. In their study, “sexting” is defined as “sending or showing someone sexual pictures of yourself nude or nearly nude.” The definition also includes sending sexually suggestive messages [2e4]. The study reports that 7% of teens, aged 13e18 years, admitted to sexting. Expanding their definition may have revealed a higher prevalence of sexting activity among teens. For example, a study on teen sexting included “sexually explicit messages” in the definition and determined 15% prevalence [3]. Findings related to LGB populations are consistent with previous studies on sexting; however, transgender youth were not included. An earlier study found a significant association between sexting and risky sexual behaviors in lesbian, gay, bisexual, and transgender youth [3]. The inclusion of transgender
youth in Ybarra and Mitchell’s study may have yielded similar findings and revealed associations between sexting and psychosocial issues, such as depression and suicidal ideation because of the mental health disparities seen in transgender youth [5]. Nonetheless, a novel study of sexting among transgender and gender nonconforming youth will further contribute to existing literature. Although the study was indicative of sexual activity and risky sexual behaviors, it would be interesting to determine predictive outcomes of sexting. One study suggests that sexting may precede sexual intercourse [6]. The predictive value of a sexting history may inform sex education and HEEADSSS (Home, Education & Employment, Eating, Activities, Drugs, Sexuality, Suicide/Depression, and Safety) assessments [7]. Moreover, discussions between pediatricians and teens about sexting may indicate risky sexual behaviors and a number of psychosocial issues such as depression, anxiety, and low self-esteem that may be further addressed. Sexting is a behavior that will likely continue and expand with technological advances. Addressing risky sexual behaviors and psychological symptoms associated with sexting through education and guidance will promote wellness and responsibility within adolescent populations. Jeffrey Eugene
Letters / Journal of Adolescent Health 57 (2015) 126e129
Department of Community Health and Preventive Medicine Morehouse School of Medicine Atlanta, Georgia References [1] Ybarra ML, Mitchell KJ. “Sexting” and its relation to sexual activity and sexual risk behavior in a national survey of adolescents. J Adolesc Health 2014;55:757e64. [2] “Sexting”. Merriam-Webster, Inc. 2015. Available at: http://www.merriam -webster.com/dictionary/sexting. Accessed February 20, 2015.
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[3] Rice E, Rhoades H, Winetrobe H, et al. Sexually explicit cell phone messaging associated with sexual risk among adolescents. Pediatrics 2012;130: 667e73. [4] Katzman DK. Sexting: Keeping teens safe and responsible in a technologically savvy world. Paediatric Child Health 2010;15:41e2. [5] Reisner SL, Vetters R, Leclerc M, et al. Mental health of transgender youth in care at an adolescent urban community health center: A matched retrospective cohort study. J Adolesc Health 2015;56:274e9. [6] Temple JR, Choi H. Longitudinal association between teen sexting and sexual behavior. Pediatrics 2014;134:e1287e92. [7] Klein DA, Goldenring JM, Adelman WP. HEEADSSS 3.0: The psychosocial interview for adolescents updated for a new century fueled by media. Contemp Pediatr. Available at: http://contemporarypediatrics.modernmedicine. com; 2014. Accessed February 20, 2015.
The Authors Reply: We appreciate Eugene’s letter in response to our recent article about the psychosocial and behavioral characteristics associated with “sexting” in adolescence. We agree that our study adds to the handful of national studies documenting the limited scope of adolescent sexting. Indeed, our prevalence rate, 7% [1], is similar to national studies of Mitchell et al. [2] and Lenhart [3], which used comparable definitions of sexting. These studies also report fewer than 10% of adolescents engaging in the behavior. Moreover, Mitchell et al. found that when the definition is restricted to instances where youth create or appear in pictures or videos that are sexually explicit, that is when naked breasts, genitals, or bottoms are shown, the rate of sexting falls to 1%. To clarify for our readers, our measure included sexually explicit messages but only in instances that involved sexual pictures of oneself nude or nearly nude. We also applaud the Eugene’s call to increase the inclusion of transgender youth in adolescent health studies. We caution researchers, however, that combining gender minority (e.g., transgender) youth with sexual minority (e.g., lesbian, gay, bisexual) youth as one monolithic group in analyses (i.e., lesbian, gay, bisexual, and transgender [LGBT] vs. non-LGBT) conflates sexual and gender identity. The two identities are distinct in a way that is critical for health researchers to understand: Although sexual identity refers to one’s sexual attractions, gender identity refers to one’s innate feeling of being a “man” or a “woman.” Some youth identify with more than one or no gender as well. Like nontransgender people, transgender people can be same-sex attracted, opposite-sex attracted, or dually attracted; their sexual identity is not predicated by their gender identity. To not acknowledge this difference, particularly in studies about youth sexuality, could potentially reify ongoing conflation of the two. For an example of how gender and sexual identities can be included in the same study, please see Mitchell et al.’s examination of sexual harassment [4]. We agree too that longitudinal studies of sexting could prove useful, particularly in understanding what the behavior may portend for some youth. That said, for some young people, sexting may predict sexual debut in the same way that kissing does. Sexting behavior in and of itself does not necessarily denote risk. As Eugene notes, instead of seeing it
Conflicts of Interest: The authors have no conflicts of interest to declare. Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute of Child Health and Human Development.
as a reason for grave concern, sexting that comes to the attention of adults working with youth could be instead seen as an important entry into a larger discussion with youth about healthy sexuality, sexual expression, and what that means for them. Acknowledgments The authors thank the entire study team from the Center for Innovative Public Health Research, the University of New Hampshire, the Gay, Lesbian & Straight Education Network, Latrobe University, and Harris Interactive, who contributed to the planning and implementation of the study. The authors also thank the study participants for their time and willingness to participate in this study. Funding Sources This work was supported by Award Number R01 HD057191 from the National Institute of Child Health and Human Development. Michele L. Ybarra, M.P.H., Ph.D. Center for Innovative Public Health Research San Clemente, California Kimberly J. Mitchell, Ph.D. Crimes Against Children Research Center University of New Hampshire Durham, New Hampshire References [1] Ybarra ML, Mitchell KJ. “Sexting” and its relation to sexual activity and sexual risk behavior in a national survey of adolescents. J Adolesc Health 2014;55:757e64. [2] Mitchell KJ, Finkelhor D, Jones LM, Wolak J. Prevalence and characteristics of youth sexting: A national study. Pediatrics 2012;129:13e20. [3] Lenhart A. Teens and sexting. Washington, D.C.: Pew Internet & American Life Project; 2009. Available at: http://www.pewinternet.org/Reports/2009/ Teens-and-Sexting.aspx. Accessed May 10, 2015. [4] Mitchell KJ, Ybarra ML, Korchmaros J. Sexual harassment among adolescents of different sexual orientations and gender identities. Child Abuse Negl 2014;38:280e95.
Letters / Journal of Adolescent Health 57 (2015) 126e129
widespread action among all relevant parties, focusing not just on the young adult years themselves but also on the transitions into and out of this important period of life.
UW LEAH (Leadership of Education in Adolescent Health) Seattle Children’s and the University of Washington Seattle, Washington UW Department of Pediatrics Seattle Children’s and the University of Washington Seattle, Washington
Acknowledgments The authors acknowledge the members of the Institute of Medicine and National Research Council Committee on Improving the Health, Safety, and Well-Being of Young Adults for their contribution to the report on which the commentary and this letter are based. The report was commissioned by the Health Resources and Services Administration and the Office of the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services, the Robert Wood Johnson Foundation, The Annie E. Casey Foundation, and the Department of Defense. Clare Stroud, Ph.D. Institute of Medicine Washington, DC Leslie R. Walker, M.D. Division of Adolescent Medicine Department of Pediatrics University of Washington/Seattle Children’s Hospital Seattle, Washington
Maryann Davis, Ph.D. Department of Psychiatry University of Massachusetts Medical School Worcester, Massachusetts Charles E. Irwin, Jr., M.D. Division of Adolescent and Young Adult Medicine Department of Pediatrics UCSF Benioff Children’s Hospital/University of California, San Francisco San Francisco, California
References [1] Stroud C, Walker LR, Davis M, Irwin Jr CE. Investing in the health and wellbeing of young adults. J Adolesc Health 2015;56:127e9. [2] To access these resources, see www.GotTransition.org. [3] Institute of Medicine and National Research Council. Investing in the health and well-being of young adults. Washington, DC: The National Academies Press; 2015.
It’s More Than Just “Sext”dA Brief Discussion on Sexting Activity Among Teens To the Editor: “Sexting” is a hot topic in the area of adolescent health. Ybarra and Mitchell [1] in their article, “Sexting and Its Relation to Sexual Activity and Sexual Risk Behavior in a National Survey of Adolescents,” suggest that sexting is related to behaviors indicative of psychosocial challenge and risky sexual behavior for some youth. Significant findings include a higher frequency of sexting among females and lesbian, gay, bisexual (LGB) youth. Additionally, a greater number of past-year sex partners and a greater odds of depression and substance abuse were found among teens who sext. Their work contributes to the growing literature in the area of sexting and provokes further discussion. In their study, “sexting” is defined as “sending or showing someone sexual pictures of yourself nude or nearly nude.” The definition also includes sending sexually suggestive messages [2e4]. The study reports that 7% of teens, aged 13e18 years, admitted to sexting. Expanding their definition may have revealed a higher prevalence of sexting activity among teens. For example, a study on teen sexting included “sexually explicit messages” in the definition and determined 15% prevalence [3]. Findings related to LGB populations are consistent with previous studies on sexting; however, transgender youth were not included. An earlier study found a significant association between sexting and risky sexual behaviors in lesbian, gay, bisexual, and transgender youth [3]. The inclusion of transgender
youth in Ybarra and Mitchell’s study may have yielded similar findings and revealed associations between sexting and psychosocial issues, such as depression and suicidal ideation because of the mental health disparities seen in transgender youth [5]. Nonetheless, a novel study of sexting among transgender and gender nonconforming youth will further contribute to existing literature. Although the study was indicative of sexual activity and risky sexual behaviors, it would be interesting to determine predictive outcomes of sexting. One study suggests that sexting may precede sexual intercourse [6]. The predictive value of a sexting history may inform sex education and HEEADSSS (Home, Education & Employment, Eating, Activities, Drugs, Sexuality, Suicide/Depression, and Safety) assessments [7]. Moreover, discussions between pediatricians and teens about sexting may indicate risky sexual behaviors and a number of psychosocial issues such as depression, anxiety, and low self-esteem that may be further addressed. Sexting is a behavior that will likely continue and expand with technological advances. Addressing risky sexual behaviors and psychological symptoms associated with sexting through education and guidance will promote wellness and responsibility within adolescent populations. Jeffrey Eugene
Letters / Journal of Adolescent Health 57 (2015) 126e129
Department of Community Health and Preventive Medicine Morehouse School of Medicine Atlanta, Georgia References [1] Ybarra ML, Mitchell KJ. “Sexting” and its relation to sexual activity and sexual risk behavior in a national survey of adolescents. J Adolesc Health 2014;55:757e64. [2] “Sexting”. Merriam-Webster, Inc. 2015. Available at: http://www.merriam -webster.com/dictionary/sexting. Accessed February 20, 2015.
129
[3] Rice E, Rhoades H, Winetrobe H, et al. Sexually explicit cell phone messaging associated with sexual risk among adolescents. Pediatrics 2012;130: 667e73. [4] Katzman DK. Sexting: Keeping teens safe and responsible in a technologically savvy world. Paediatric Child Health 2010;15:41e2. [5] Reisner SL, Vetters R, Leclerc M, et al. Mental health of transgender youth in care at an adolescent urban community health center: A matched retrospective cohort study. J Adolesc Health 2015;56:274e9. [6] Temple JR, Choi H. Longitudinal association between teen sexting and sexual behavior. Pediatrics 2014;134:e1287e92. [7] Klein DA, Goldenring JM, Adelman WP. HEEADSSS 3.0: The psychosocial interview for adolescents updated for a new century fueled by media. Contemp Pediatr. Available at: http://contemporarypediatrics.modernmedicine. com; 2014. Accessed February 20, 2015.
The Authors Reply: We appreciate Eugene’s letter in response to our recent article about the psychosocial and behavioral characteristics associated with “sexting” in adolescence. We agree that our study adds to the handful of national studies documenting the limited scope of adolescent sexting. Indeed, our prevalence rate, 7% [1], is similar to national studies of Mitchell et al. [2] and Lenhart [3], which used comparable definitions of sexting. These studies also report fewer than 10% of adolescents engaging in the behavior. Moreover, Mitchell et al. found that when the definition is restricted to instances where youth create or appear in pictures or videos that are sexually explicit, that is when naked breasts, genitals, or bottoms are shown, the rate of sexting falls to 1%. To clarify for our readers, our measure included sexually explicit messages but only in instances that involved sexual pictures of oneself nude or nearly nude. We also applaud the Eugene’s call to increase the inclusion of transgender youth in adolescent health studies. We caution researchers, however, that combining gender minority (e.g., transgender) youth with sexual minority (e.g., lesbian, gay, bisexual) youth as one monolithic group in analyses (i.e., lesbian, gay, bisexual, and transgender [LGBT] vs. non-LGBT) conflates sexual and gender identity. The two identities are distinct in a way that is critical for health researchers to understand: Although sexual identity refers to one’s sexual attractions, gender identity refers to one’s innate feeling of being a “man” or a “woman.” Some youth identify with more than one or no gender as well. Like nontransgender people, transgender people can be same-sex attracted, opposite-sex attracted, or dually attracted; their sexual identity is not predicated by their gender identity. To not acknowledge this difference, particularly in studies about youth sexuality, could potentially reify ongoing conflation of the two. For an example of how gender and sexual identities can be included in the same study, please see Mitchell et al.’s examination of sexual harassment [4]. We agree too that longitudinal studies of sexting could prove useful, particularly in understanding what the behavior may portend for some youth. That said, for some young people, sexting may predict sexual debut in the same way that kissing does. Sexting behavior in and of itself does not necessarily denote risk. As Eugene notes, instead of seeing it
Conflicts of Interest: The authors have no conflicts of interest to declare. Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute of Child Health and Human Development.
as a reason for grave concern, sexting that comes to the attention of adults working with youth could be instead seen as an important entry into a larger discussion with youth about healthy sexuality, sexual expression, and what that means for them. Acknowledgments The authors thank the entire study team from the Center for Innovative Public Health Research, the University of New Hampshire, the Gay, Lesbian & Straight Education Network, Latrobe University, and Harris Interactive, who contributed to the planning and implementation of the study. The authors also thank the study participants for their time and willingness to participate in this study. Funding Sources This work was supported by Award Number R01 HD057191 from the National Institute of Child Health and Human Development. Michele L. Ybarra, M.P.H., Ph.D. Center for Innovative Public Health Research San Clemente, California Kimberly J. Mitchell, Ph.D. Crimes Against Children Research Center University of New Hampshire Durham, New Hampshire References [1] Ybarra ML, Mitchell KJ. “Sexting” and its relation to sexual activity and sexual risk behavior in a national survey of adolescents. J Adolesc Health 2014;55:757e64. [2] Mitchell KJ, Finkelhor D, Jones LM, Wolak J. Prevalence and characteristics of youth sexting: A national study. Pediatrics 2012;129:13e20. [3] Lenhart A. Teens and sexting. Washington, D.C.: Pew Internet & American Life Project; 2009. Available at: http://www.pewinternet.org/Reports/2009/ Teens-and-Sexting.aspx. Accessed May 10, 2015. [4] Mitchell KJ, Ybarra ML, Korchmaros J. Sexual harassment among adolescents of different sexual orientations and gender identities. Child Abuse Negl 2014;38:280e95.
