Is sexual content in new media linked to sexual risk behaviour in young people? A systematic review and meta-analysisLucy Watchirs Smith A K , Bette Liu B , Louisa Degenhardt C , Juliet Richters B , George Patton D E , Handan Wand A , Donna Cross F , Jane S. Hocking G , S. Rachel Skinner H , Spring Cooper I , Catharine Lumby A J , John M. Kaldor A and Rebecca Guy A
A Kirby Institute, Wallace Wurth Building, University of New South Wales, NSW 2052, Australia.
B School of Public Health and Community Medicine, Samuels Building, University of New South Wales, NSW 2052, Australia.
C National Drug and Alcohol Research Centre (NDARC), University of New South Wales, 22–32 King Street, Randwick, NSW 2031, Australia.
D Department of Paediatrics, University of Melbourne, Royal Children’s Hospital, 50 Flemington Road, Parkville, Vic. 3052, Australia.
E Centre for Adolescent Health, Royal Children’s Hospital, Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, Vic. 3052, Australia.
F Telethon Kids Institute, 100 Roberts Road, Subiaco, WA 6008, Australia.
G Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 3/207 Bouverie Street, Carlton, Vic. 3010, Australia.
H Discipline of Child and Adolescent Health, University of Sydney, Children’s Hospital Westmead, 212 Hawkesbury Road, Westmead, NSW 2145, Australia.
I School of Public Health, City University of New York, 55 W 125th Street, New York, NY 10027, USA.
J Department of Media, Music, Communication and Cultural Studies, Faculty of Arts, Building Y3A, Macquarie University Hadenfeld Avenue, North Ryde, NSW 2109, Australia.
K Corresponding author. Email: email@example.com
Sexual Health 13(6) 501-515 https://doi.org/10.1071/SH16037
Submitted: 13 March 2016 Accepted: 6 June 2016 Published: 11 August 2016
Background: Social networking and digital media increasingly have an impact on the lives of young people. We undertook a systematic review and meta-analysis of studies that examined the relationship between exposure to sexually explicit websites (SEWs) and ‘sexting’ (i.e. sending semi-nude or nude photos from a mobile phone) and the sexual attitudes and practices of young people. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement, Medline, EMBASE and PsycINFO were searched for papers that described the statistical association between viewing SEWs or sexting by young people (defined as 10–24 years) and their sexual attitudes and behaviours. Results: Fourteen studies, all cross-sectional in design, met the inclusion criteria. Six studies (10 352 participants) examined young people’s exposure to SEWs and eight (10 429 participants) examined sexting. There was substantial variation across studies in exposure and outcome definitions. Meta-analyses found that SEW exposure was correlated with condomless sexual intercourse (odds ratio (OR) 1.23, 95% confidence interval (CI): 1.08–1.38, two studies); sexting was correlated with ever having had sexual intercourse (OR 5.58, 95% CI: 4.46–6.71, five studies), recent sexual activity (OR 4.79, 95% CI: 3.55–6.04, two studies), alcohol and other drug use before sexual intercourse (OR 2.65, 95% CI: 1.99–3.32, two studies) and multiple recent sexual partners (OR 2.79, 95% CI: 1.95–3.63, two studies). Most studies had limited adjustment for important potential confounders. Conclusions: Cross-sectional studies show a strong association between self-reported exposure to sexual content in new media and sexual behaviours in young people. Longitudinal studies would provide a greater opportunity to adjust for confounding, and better insight into the causal pathways underlying the observed associations.
References Rideout VJ, Foehr UG, Roberts DF. Generation M2 media in the lives of 8- to 18-year-olds. Menlo Park: Henry J. Kaiser Family Foundation; 2010.
 File T, Ryan C. Computer and Internet Use in the United States: 2013 Washington, United States Census Bureau; 2014. Available from: http://www.census.gov/content/dam/Census/library/publications/2014/acs/acs-28.pdf [verified 2015 19 May 2015].
 Madden M, Cortesi S, Gasser U, Lenhart A, Duggan M. Parents, teens and online privacy. Washington, DC: Pew Research Centre; 2012.
 Lenhart A. Teens, smartphones & texting. Washington, D.C.: Pew Internet and American life project; 2012.
 Boyd D. It’s complicated: the social lives of networked teens. New Haven and London: Yale University Press; 2014.
 Ito M, Horst H, Bittanti M, Boyd D, Herr-Stephenson B, Lange PG, et al. Living and learning with new media: summary of findings from the digital youth project. Chicago: MacArthur Foundation; 2008.
 Buckingham D. After the death of childhood: growing up in the age of electronic media. Cambridge: Polity; 2000.
 Lim MS, Vella A, Sacks-Davis R, Hellard ME. Young people’s comfort receiving sexual health information via social media and other sources. Int J STD AIDS 2014; 25 1003–8.
| Young people’s comfort receiving sexual health information via social media and other sources.CrossRef | 24616114PubMed |
 Ahern NR, Mechling B. Sexting: serious problems for youth. J Psychosoc Nurs Ment Health Serv 2013; 51 22–30.
| Sexting: serious problems for youth.CrossRef | 23668382PubMed |
 Owens EW, Behun RJ, Manning JC, Reid RC. The impact of internet pornography on adolescents: a review of the research. Sex Addict Compulsivity 2012; 19 99–122.
| The impact of internet pornography on adolescents: a review of the research.CrossRef |
 Rice E, Rhoades H, Winetrobe H, Sanchez M, Montoya J, Plant A, Kordic T. Sexually explicit cell phone messaging associated with sexual risk among adolescents. Pediatrics 2012; 130 667–73.
| Sexually explicit cell phone messaging associated with sexual risk among adolescents.CrossRef | 22987882PubMed |
 Martino SC, Collins RL, Kanouse DE, Elliott M, Berry SH. Social cognitive processes mediating the relationship between exposure to television’s sexual content and adolescents’ sexual behavior. J Pers Soc Psychol 2005; 89 914–24.
| Social cognitive processes mediating the relationship between exposure to television’s sexual content and adolescents’ sexual behavior.CrossRef | 16393024PubMed |
 Chandra A, Martino SC, Collins RL, Elliott MN, Berry SH, Kanouse DE, et al Does watching sex on television predict teen pregnancy? Findings from a national longitudinal survey of youth. Pediatrics 2008; 122 1047–54.
| Does watching sex on television predict teen pregnancy? Findings from a national longitudinal survey of youth.CrossRef | 18977986PubMed |
 Mitchell KJ, Finkelhor D, Jones LM, Wolak J. Prevalence and characteristics of youth sexting: a national study. Pediatrics 2012; 129 13–20.
| Prevalence and characteristics of youth sexting: a national study.CrossRef | 22144706PubMed |
 Temple JR, Paul JA, Van Den Berg P, Le VD, McElhany A, Temple BW. Teen sexting and its association with sexual behaviors. Arch Pediatr Adolesc Med 2012; 166 828–33.
| Teen sexting and its association with sexual behaviors.CrossRef | 22751805PubMed |
 Benotsch EG, Snipes DJ, Martin AM, Bull SS. Sexting, substance use, and sexual risk behavior in young adults. J Adolesc Health 2013; 52 307–13.
| Sexting, substance use, and sexual risk behavior in young adults.CrossRef | 23299017PubMed |
 Wolak J, Mitchell K, Finkelhor D. Unwanted and wanted exposure to online pornography in a national sample of youth Internet users. Pediatrics 2007; 119 247–57.
| Unwanted and wanted exposure to online pornography in a national sample of youth Internet users.CrossRef | 17272613PubMed |
 Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009; 62 1006–12.
| Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.CrossRef | 19631508PubMed |
 Wells GA, Brodsky L, O’Connell D, Shea B, Henry D, Mayank S, et al. An evaluation of the Newcastle Ottawa Scale: an assessment tool for evaluating the quality of non-randomized studies. XI Cochrane Colloquium. Barcelona: XI International Cochrane Colloquium Book of Abstracts; 2003 p. 26.
 Peter J, Valkenburg PM. Adolescents’ exposure to a sexualized media environment and their notions of women as sex objects. Sex Roles 2007; 56 381–95.
| Adolescents’ exposure to a sexualized media environment and their notions of women as sex objects.CrossRef |
 Peter J, Valkenburg PM. Adolescents’ exposure to sexually explicit online material and recreational attitudes toward sex. J Commun 2006; 56 639–60.
| Adolescents’ exposure to sexually explicit online material and recreational attitudes toward sex.CrossRef |
 Lo VH, Wei R. Exposure to Internet pornography and Taiwanese adolescents’ sexual attitudes and behavior. J Broadcast Electron 2005; 49 221–37.
| Exposure to Internet pornography and Taiwanese adolescents’ sexual attitudes and behavior.CrossRef |
 Braun-Courville DK, Rojas M. Exposure to sexually explicit web sites and adolescent sexual attitudes and behaviors. J Adolesc Health 2009; 45 156–62.
| Exposure to sexually explicit web sites and adolescent sexual attitudes and behaviors.CrossRef | 19628142PubMed |
 Luder MT, Pittet I, Berchtold A, Akre C, Michaud PA, Suris JC. Associations between online pornography and sexual behavior among adolescents: myth or reality? Arch Sex Behav 2011; 40 1027–35.
| Associations between online pornography and sexual behavior among adolescents: myth or reality?CrossRef | 21290259PubMed |
 Kunnuji M. Online sexual activities and sexual risk-taking among adolescents and young adults in Lagos Metropolis, Nigeria. Afr J Reprod Health 2012; 16 207–17.
 Dake JA, Price JH, Maziarz L, Ward B. Prevalence and correlates of sexting behavior in adolescents. Am J Sex Educ 2012; 7 1–15.
| Prevalence and correlates of sexting behavior in adolescents.CrossRef |
 Houck CD, Barker D, Rizzo C, Hancock E, Norton A, Brown LK. Sexting and sexual behavior in at-risk adolescents. Pediatrics 2014; 133 e276–82.
| Sexting and sexual behavior in at-risk adolescents.CrossRef | 24394678PubMed |
 Ferguson CJ. Sexting behaviors among young Hispanic women: incidence and association with other high-risk sexual behaviors. Psychiatr Q 2011; 82 239–43.
| Sexting behaviors among young Hispanic women: incidence and association with other high-risk sexual behaviors.CrossRef | 21153441PubMed |
 Gordon-Messer D, Bauermeister JA, Grodzinski A, Zimmerman M. Sexting among young adults. J Adolesc Health 2013; 52 301–6.
| Sexting among young adults.CrossRef | 23299018PubMed |
 Bauermeister JA, Yeagley E, Meanley S, Pingel ES. Sexting among young men who have sex with men: results from a national survey. J Adolesc Health 2014; 54 606–11.
| Sexting among young men who have sex with men: results from a national survey.CrossRef | 24361235PubMed |
 The World Bank. Country and lending groups. Available from: http://data.worldbank.org/about/country-classifications/country-and-lending-groups#Low_income [verified 25 May 2014].
 Hendrick C, Hendrick SS, Reich DA. The brief sexual attitudes scale. J Sex Res 2006; 43 76–86.
| The brief sexual attitudes scale.CrossRef | 16817070PubMed |
 Ward LM. Does television exposure affect emerging adults’ attitudes and assumptions about sexual relationships? Correlational and experimental confirmation. J Youth Adolesc 2002; 31 1–15.
| Does television exposure affect emerging adults’ attitudes and assumptions about sexual relationships? Correlational and experimental confirmation.CrossRef |
 Centers for Disease Control and Prevention. National YRBS Data Users Manual. Centers for Disease Control and Prevention; 2005 [cited 2014 26 August].
 Guy RJ, Patton GC, Kaldor JM. Internet pornography and adolescent health. Med J Aust 2012; 196 546–7.
| Internet pornography and adolescent health.CrossRef | 22621132PubMed |
 Collins RL, Elliott MN, Berry SH, Kanouse DE, Kunkel D, Hunter SB, et al Watching sex on television predicts adolescent initiation of sexual behavior. Pediatrics 2004; 114 e280–9.
| Watching sex on television predicts adolescent initiation of sexual behavior.CrossRef | 15342887PubMed |
 Brown JD, L’Engle KL. X-rated sexual attitudes and behaviors associated with US early adolescents’ exposure to sexually explicit media. Communic Res 2009; 36 129–51.
| X-rated sexual attitudes and behaviors associated with US early adolescents’ exposure to sexually explicit media.CrossRef |
 Cavazos-Rehg PA, Krauss MJ, Spitznagel EL, Schootman M, Bucholz KK, Peipert JF, et al Age of sexual debut among US adolescents. Contraception 2009; 80 158–62.
| Age of sexual debut among US adolescents.CrossRef | 19631791PubMed |
 Haglund KA, Fehring RJ. The association of religiosity, sexual education, and parental factors with risky sexual behaviors among adolescents and young adults. J Relig Health 2010; 49 460–72.
| The association of religiosity, sexual education, and parental factors with risky sexual behaviors among adolescents and young adults.CrossRef | 19565334PubMed |