Teen Sexting and Health Risk Behaviors: A Meta-Analysis

Introduction: While various studies have examined the association between sexting and health risk behaviors, results remain inconclusive. To address this, we conducted a meta-analytic synthesis of studies examining the associations between sexting and health risk behaviors, using gender, age, publication status, and study methodological quality as moderators. Methods: Electronic searches were conducted in April 2018 in MEDLINE, PsycINFO, EMBASE, and Web of Science, yielding 1431 non-duplicate records. Studies were included if: (1) participants were < 18 years of age and (2) an association between sexting and health risk behaviors was reported. All relevant data were extracted by two independent reviewers. Random-effects meta-analyses were used to derive Odds Ratios (OR). Twenty-three studies (41,723 participants) met inclusion criteria. Results: Sexting, sexual activity, lack of contraception use, anxiety/depression, delinquent behavior, as well as alcohol, drug use, and smoking. Participants totaled 41,723 from 23 included studies. The mean age was approximately 14.85 years (age range 11.9-16.8 years), and approximately 42.1% were female. Significant increased risk was observed between sexting and sexual activity (N = 35,467; OR: 3.66; 95% CI: 2.71-4.92), multiple sexual partners (N = 6,466;OR: 5.37; 95% CI: 2.72-12.67), lack of contraception use (N = 7,388; OR = 2.16; CI: 1.08-4.32), delinquent behavior (N = 3,024; OR: 2.50; 95% CI: 1.29-4.86), anxiety/depression (N = 29,559; OR: 1.79; 95% CI: 1.41-2.28), alcohol use (N = 31,255; OR: 3.78; 95% CI: 3.11-4.59), drug use (N = 8,487; OR: 3.48; 95% CI: 2.24-5.40), and smoking behavior (N = 10,356; OR: 2.66; 95% CI: 1.88-3.76). Moderator analyses revealed that the association between sexting and several health risk behaviors was strongest in younger compared to older aged youth. Conclusions: Sexting is associated with various health risk behaviors. Longitudinal research is needed to assess directionality of effects, and to analyze the mechanisms by which sexting and health risk behaviors 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.