By Lisa Rapaport

(Reuters Health) – While teen sexting is linked to increased odds of certain types of risky behavior, a new analysis of research to date on the impact of sexually explicit content on adolescent health also suggests there’s a lot we still don’t know.

What is known is that sexting is a fact of life for many teens today. At least one in four teens are receiving sexually explicit texts and emails, and at least one in seven are sending these kinds of “sexts,” researchers note in JAMA Pediatrics. What’s less clear, however, is how much of this activity is a normal and healthy part of growing up and how much may be harmful.

For the current study, researchers examined data from 23 sexting studies with more than 41,000 participants. Sexting in this analysis included sending, receiving, requesting and forwarding sexually explicit written content, pictures and videos using text messages, email, apps or social media.

Compared to teens who didn’t do any type of sexting, those who did were more than three times as likely to be sexually active, more than five times as apt to have multiple sex partners and more than twice as likely to have unprotected sex. Teens who sext were also more than three times as likely to drink alcohol or use drugs.

“Some youth may sext with the harmless intention of sexual exploration, but distress may occur when these intentions result in harmful or unwanted consequences, such as having their sexually explicit picture shared without their consent or not having their sext reciprocated,” said Sheri Madigan of Alberta Children’s Hospital Research Institute and the University of Calgary in Canada.

“In other instances, teens may be pressured into sexting, such as being asked or coerced into sending a sext, which can cause emotional distress,” Madigan, the study’s senior author, said by email. “Then there are those who use sexting as a means of soliciting attention because they’re feeling isolated, depressed or lacking confidence.”

Whether sexting is harmful or not really depends on the situation, Madigan added.

Although sexting was associated with engaging in risky behaviors, the study was not designed to be able to determine cause and effect.

One limitation of the analysis is that it lumped all types of sexting together. This made it impossible to distinguish between intimate exchanges in the context of a committed relationship and unwanted interactions, or to see if simple text messages might have a different impact than photos or videos.

Depending on the nature of the sext, however, teens could face prosecution in the U.S. under federal child pornography laws and those of some states.

Still, noted David Finkelhor of the Crimes against Children Research Center at the University of New Hampshire in Durham, U.S. teens today are waiting longer to have sex for the first time, having fewer partners and doing a better job at using contraception than they did a generation ago.

“These are all things that matter a great deal more than sexting,” Finkelhor, who wasn’t involved in the study, said by email.

Sexting can also run the gamut “from sending to receiving, from text messages to underwear pictures to explicit sexual acts, from private exchanges between dating couples to malicious efforts to humiliate someone to adults trying to recruit child pornography,” Finkelhor said. “We have no idea if all these things are equivalently worrisome.”

Still, the study results suggest that sexting needs to be part of the sex talk parents have with their kids.

“Specific conversations about digital citizenship, that is, how to be safe, legal and ethical online, should be initiated around the age of 10, which happens to be the age when most children get their first cell phone,” Madigan advised.

“Conversations about digital health and citizenship are never ‘one and done’ type conversations,” Madigan added. “Because ‘tweens and teens will be exposed to different online risks as they develop, conversations about online and offline sexual behavior should be repeated and tailored to the individual needs of each ‘tween or teen in a family.”

SOURCE: JAMA Pediatrics, online June 17, 2019.