Sending, receiving, or forwarding sexually explicit images or texts via electronic devices-a practice known as "sexting"-has become increasingly popular among teenagers. While some experts contend that consensual sexting can be a normal, even healthy, form of expression, concerns are intensifying about the potential health risks to adolescents from nonconsensual sexting or sharing a sexual photo without the subject's permission. The ability to share sexually revealing photos electronically with any number of people gives rise to growing worry among health care professionals about the consequences for teens.

To gauge the prevalence of nonconsensual sexting and analyze its impact on adolescent physical and mental health, researchers reviewed data from four large urban school districts participating in the 2017 Youth Risk Behavior Survey and published their results in JAMA Pediatrics. The survey asked 8,660 high schoolers if a sexual photo of them had been shared electronically without their consent in the past 30 days. Almost 6% of boys and 5% of girls answered yes. Lesbian, gay, and bisexual teens experienced higher rates of unwanted exposure.

For both boys and girls, having a sexual photo shared without consent was significantly associated with acts of interpersonal violence (forced sexual intercourse, physical date violence, cyber or in-person bullying), depression, and suicidal thoughts. Christa Varga, a certified school nurse with the Camden, New Jersey, public schools, has witnessed the trauma and drama resulting from nonconsensual sexting. "Nurses can educate adolescents that nonconsensual texting, either words or photos, gives a false sense of confidence behind the protection of a screen," Varga told AJN, adding that "unsolicited sexual innuendo is not OK."

The study's limitations include its focus on just four school districts and on events that transpired over the course of only 30 days. The prevalence of nonconsensual sexting is likely to be higher over students' lifetimes, the authors acknowledge. Indeed, another JAMA Pediatrics study found that 12.5% of middle and high schoolers admitted to forwarding a sext without permission.

The authors of both studies concur that action is needed to mitigate nonconsensual sexting, prevent sexual violence, and establish a multifaceted strategy involving parents, clinicians, and schools.-Lucy Wang Halpern