Child and Adolescent Pornography Exposure.

Abstract

INSTRUCTIONSTo obtain continuing education credit:1.Read the article carefully.2.Read each question and determine the correct answer.3.Visit PedsCESM, ce.napnap.org, to complete the online Posttest and evaluation.4.You must receive 70% correct responses to receive the certificate.5.Tests will be accepted until April 30, 2021. OBJECTIVES1.Define traditional versus online pornography.2.Discuss the epidemiology of child and adolescent pornography use.3.Describe predictors of child and adolescent pornography use.4.Discuss possible consequences to child and adolescent pornography viewing.5.Explore practice implications related to child and adolescent pornography exposure.Contact hours: 1.0.Passing score: 70%This continuing education activity is administered by the National Association of Pediatric Nurse Practitioners (NAPNAP) as an Agency providing continuing education credit. Individuals who complete this program and earn a 70% or higher score on the Posttest will be awarded 1.0 contact hour. Earn FREE CE Contact Hours OnlineContact Hours for this online activity are FREE for NAPNAP Members. Non-Members will be charged a fee of $10 to receive contact hours for this online activity through PedsCESM. Payment can be made by credit card through PedsCESM.1.To take the Posttest for this article and earn contact hours, please go to PedsCESM at ce.napnap.org.2.In the Course Catalog, search for the name of the CE article.3.If you already have an account with PedsCESM, log in using your username and password. If you are a NAPNAP member, log in with your username and password. If you are a first-time user and NAPNAP nonmember, click on “New Customer? Click Here.”4.Once you have successfully passed the Posttest and completed the evaluation form, you will be able to print out your certificate immediately. To obtain continuing education credit:1.Read the article carefully.2.Read each question and determine the correct answer.3.Visit PedsCESM, ce.napnap.org, to complete the online Posttest and evaluation.4.You must receive 70% correct responses to receive the certificate.5.Tests will be accepted until April 30, 2021. 1.Define traditional versus online pornography.2.Discuss the epidemiology of child and adolescent pornography use.3.Describe predictors of child and adolescent pornography use.4.Discuss possible consequences to child and adolescent pornography viewing.5.Explore practice implications related to child and adolescent pornography exposure. Contact hours: 1.0. Passing score: 70% This continuing education activity is administered by the National Association of Pediatric Nurse Practitioners (NAPNAP) as an Agency providing continuing education credit. Individuals who complete this program and earn a 70% or higher score on the Posttest will be awarded 1.0 contact hour. Earn FREE CE Contact Hours Online Contact Hours for this online activity are FREE for NAPNAP Members. Non-Members will be charged a fee of $10 to receive contact hours for this online activity through PedsCESM. Payment can be made by credit card through PedsCESM.1.To take the Posttest for this article and earn contact hours, please go to PedsCESM at ce.napnap.org.2.In the Course Catalog, search for the name of the CE article.3.If you already have an account with PedsCESM, log in using your username and password. If you are a NAPNAP member, log in with your username and password. If you are a first-time user and NAPNAP nonmember, click on “New Customer? Click Here.”4.Once you have successfully passed the Posttest and completed the evaluation form, you will be able to print out your certificate immediately. Children and adolescents are growing up in a digital world. The rapid expansion of the development, accessibility, and use of cellular phones and the Internet is changing human existence. Adolescents are absorbed in the use of technology; however, this behavior is also becoming characteristic of younger children as well (Livingstone and Smith, 2014Livingstone S. Smith P.K. Annual research review: Harms experienced by child users of online and mobile technologies: The nature, prevalence and management of sexual and aggressive risks in the digital age.Journal of Child Psychology and Psychiatry, and Allied Disciplines. 2014; 55: 635-654Crossref PubMed Scopus (202) Google Scholar). Consider that in 1970, the average American child began to watch television regularly at age 4, yet today, children begin interacting with digital media at the age of 4 months (Reid Chassiakos et al., 2016Reid Chassiakos Y.L. Radesky J. Christakis D. Moreno M.A. Cross C. Council on Communications and MediaChildren and adolescents and digital media.Pediatrics. 2016; 138: 1-16Crossref Scopus (307) Google Scholar). Although technology can enhance communication, recreation, and education, its use can also present risks to children and adolescents. One such risk is exposure to pornography. It is difficult to dispute the fact that the Internet has revolutionized the pornography industry and has substantially expanded child and adolescent access to pornography. The Internet allows instant access to a wide variety of pornography that can be viewed anywhere, even from the privacy of a child's room, with little to no parental knowledge (Wright and Donnerstein, 2014Wright P.J. Donnerstein E. Sex online: Pornography, sexual solicitation, and sexting.Adolescent Medicine: State of the Art Reviews. 2014; 25: 574-589PubMed Google Scholar). This continuing educational article will explore child and adolescent Internet pornography exposure in terms of definition, epidemiology, predictors, consequences, and implications for practice. Pornography can be broadly defined as professionally produced or consumer-generated pictures or videos intended to sexually arouse the consumer (Peter and Valkenburg, 2016Peter J. Valkenburg P.M. Adolescents and pornography: A review of 20 years of research.Journal of Sex Research. 2016; 53: 509-531Crossref PubMed Scopus (179) Google Scholar). Traditional pornography relies on traditional media venues such as television, movies, and magazines. Internet pornography viewing is the online viewing or downloading of pictures and videos where genitals are exposed, and/or people are having sex with the intention of stimulating a sexual reaction in the viewer (Peter and Valkenburg, 2016Peter J. Valkenburg P.M. Adolescents and pornography: A review of 20 years of research.Journal of Sex Research. 2016; 53: 509-531Crossref PubMed Scopus (179) Google Scholar). A variety of sexual activities are depicted in both genres of pornography, including but not limited to masturbation, oral sex, and vaginal and anal intercourse, all with a focus on the genitals. The Internet has transformed pornography consumption. Online pornography differs from traditional pornography in several ways. The Internet has changed the fundamental relationship between the individual and pornography, allowing access to an endless supply of free and diverse material (Wood, 2011Wood H. The Internet and its role in the escalation of sexually compulsive behaviour.Psychoanalytic Psychotherapy. 2011; 25: 127-142Crossref Scopus (29) Google Scholar). Online pornography is accessible from virtually anywhere with an Internet connection and is available 24 hours a day, 7 days a week. The Internet allows for the global dissemination of pornography via the Triple-A Engine: accessibility, affordability, and anonymity (Cooper, 1998Cooper A. Sexuality and the Internet: Surfing into the new millennium.CyberPsychology and Behavior. 1998; 1: 187-193Crossref Scopus (440) Google Scholar). Traditional pornography requires acquiring a magazine or film from a store or a friend or viewing a television program, all of which carry a perception of increased risk of parental detection. Online pornography exposure is much more difficult for parents to monitor than traditional media exposure (Collins et al., 2017Collins R.L. Strasburger V.C. Brown J.D. Donnerstein E. Lenhart A. Ward L.M. Sexual media and childhood well-being and health.Pediatrics. 2017; 140: S162—S166Crossref Scopus (31) Google Scholar). The child or teen often perceives viewing online pornography as private and anonymous, which emboldens them to search for material that they would not search for via traditional media. The content of traditional pornography is somewhat regulated, whereas the content of online pornography is widely unregulated (Wright and Donnerstein, 2014Wright P.J. Donnerstein E. Sex online: Pornography, sexual solicitation, and sexting.Adolescent Medicine: State of the Art Reviews. 2014; 25: 574-589PubMed Google Scholar). Studies suggest that Internet pornography often portrays extreme forms of sexuality and sexually violent content more so than traditional pornography (Collins et al., 2017Collins R.L. Strasburger V.C. Brown J.D. Donnerstein E. Lenhart A. Ward L.M. Sexual media and childhood well-being and health.Pediatrics. 2017; 140: S162—S166Crossref Scopus (31) Google Scholar; Strasburger, Jordan and Donnerstein, 2012Strasburger V.C. Jordan A.B. Donnerstein E. Children, adolescents, and the media: Health effects.Pediatric Clinics of North America. 2012; 59 (vii): 533-587Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar). Studies also indicate that Internet pornography presents sexual scripts supportive of aggressive and gender-stereotypic behavior (Bridges et al., 2010Bridges A.J. Wosnitzer R. Scharrer E. Sun C. Liberman R. Aggression and sexual behavior in best-selling pornography videos: A content analysis update.Violence Against Women. 2010; 16: 1065-1085Crossref PubMed Scopus (253) Google Scholar). Men are perpetrators and women are victims typically. A variety of aggressive behaviors accompanying sex are often portrayed, including choking, spanking, kicking, use of weapons, whipping, smothering, and biting (Wright and Donnerstein, 2014Wright P.J. Donnerstein E. Sex online: Pornography, sexual solicitation, and sexting.Adolescent Medicine: State of the Art Reviews. 2014; 25: 574-589PubMed Google Scholar). Derogatory namecalling is often present. Depictions of rape can be found via an Internet search to fuel fantasies or enhance rape-supportive scripts (Gossett and Byrne, 2002Gossett J.L. Byrne S. ‘Click here’-a content analysis on Internet rape sites.Gender and Society. 2002; 16: 689-709Crossref Scopus (76) Google Scholar). Online pornography provides motivational, disinhibiting, and opportunity aspects that make it different from traditional pornography in terms of potential effects on children and adolescents (Malamuth, Linz and Yao, 2005Malamuth N. Linz D. Yao M. Amichai-HamburgerThe Internet and aggression: Motivation, disinhibitory and opportunity aspects.The social net: Human behavior in cyberspace. Oxford University Press, New York, NY2005: 163-191Google Scholar). It can be engaging and interactive, yielding a potential for increased viewing time and learning. Online chat rooms and blogs provide support and reinforcement for these pornographic images and messages. Child and adolescent pornography exposure can be either intentional or unintentional. Examples of unintentional exposure include the opening of unsolicited messages or receiving spam emails (Chen, Leung, Chen and Yang, 2013Chen A. Leung M. Chen C. Yang S.C. Exposure to Internet pornography among Taiwanese adolescents.Social Behavior and Personality. 2013; 41: 157-164Crossref Scopus (36) Google Scholar), mistyping Web site addresses, searching for terms that have a nonsexual as well as sexual meaning (Flood, 2007Flood M. Exposure to pornography among youth in Australia.Journal of Sociology. 2007; 43: 45-60Crossref Scopus (86) Google Scholar), or accidentally viewing pop-up images and advertisements (Ševčíková, Šerek, Barbovschi and Daneback, 2014Ševčíková A. Šerek J. Barbovschi M. Daneback K. The roles of individual characteristics and liberalism in intentional and unintentional exposure to online sexual material among European youth: A multilevel approach.Sexuality Research and Social Policy. 2014; 11: 104-115Crossref Scopus (21) Google Scholar). Intentional pornography exposure is deliberate and purposeful, often involving an active online search for the material. It is unclear to what extent unintentional online pornography viewing contributes to intentional pornography viewing. It is impossible to determine the exact number of children and adolescents unintentionally and intentionally exposed to pornography. The prevalence rate varies per study. The prevalence rates for unintentional adolescent pornography exposure range from 19% (Mitchell and Wells, 2007Mitchell K.J. Wells M. Problematic Internet experiences: Primary or secondary presenting problems in persons seeking mental health care?.Social Science and Medicine. 2007; 65: 1136-1141Crossref PubMed Scopus (51) Google Scholar) to 32% (Hardy, Steelman, Coyne and Ridge, 2013Hardy S.A. Steelman M.A. Coyne S.M. Ridge R.D. Adolescent religiousness as a protective factor against pornography use.Journal of Applied Developmental Psychology. 2013; 34: 131-139Crossref Scopus (56) Google Scholar). A nationally representative study of U.S. youth between the ages of 10 and 17 years indicated that 34% of the study population intentionally viewed pornography (Wolak, Mitchell and Finkelhor, 2007Wolak J. Mitchell K. Finkelhor D. Unwanted and wanted exposure to online pornography in a national sample of youth Internet users.Pediatrics. 2007; 119: 247-257Crossref PubMed Scopus (290) Google Scholar). However, younger children in that study, aged 10 to 11 years were unlikely to seek pornography, with only 2% to 5% of boys and 1% of girls reporting intentional pornography viewing (Wolak, Mitchell and Finkelhor, 2007Wolak J. Mitchell K. Finkelhor D. Unwanted and wanted exposure to online pornography in a national sample of youth Internet users.Pediatrics. 2007; 119: 247-257Crossref PubMed Scopus (290) Google Scholar). Ybarra et al., 2011Ybarra M.L. Mitchell K.J. Hamburger M. Diener-West M. Leaf P.J. X-rated material and perpetration of sexually aggressive behavior among children and adolescents: Is there a link?.Aggressive Behavior. 2011; 37: 1-18Crossref PubMed Scopus (111) Google Scholar found 15% of youth aged 12 to 17 years reported intentional pornography exposure in the past year. A U.S. study of nearly 1,000 adolescents reported that 66% of males and 39% of females had viewed online pornography (Short et al., 2012Short M.B. Black L. Smith A.H. Wetterneck C.T. Wells D.E. A review of internet pornography use research: Methodology and content from the past 10 years.Cyberpsychology, Behaviour and Social Networking. 2012; 15: 13-23Crossref PubMed Scopus (156) Google Scholar). Pornography exposure in children less than 10 years of age is relatively unexplored (Rothman et al., 2017Rothman E.F. Paruk J. Espensen A. Temple J.R. Adams K. A qualitative study of what US parents say and do when their young children see pornography.Academic Pediatrics. 2017; 17: 844-849Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar). However, both unintentional and intentional pornography viewing by children and adolescents increases with age and varies by gender (Mitchell and Wells, 2007Mitchell K.J. Wells M. Problematic Internet experiences: Primary or secondary presenting problems in persons seeking mental health care?.Social Science and Medicine. 2007; 65: 1136-1141Crossref PubMed Scopus (51) Google Scholar; Tsaliki, 2011Tsaliki L. Playing with porn: Greek children's explorations in pornography.Sex Education. 2011; 11: 293-302Crossref Scopus (21) Google Scholar). Another study of online pornography use in the United States revealed that 42% of 10 to 17 year olds had seen pornography online, with 27% describing the use as intentional (Wright and Donnerstein, 2014Wright P.J. Donnerstein E. Sex online: Pornography, sexual solicitation, and sexting.Adolescent Medicine: State of the Art Reviews. 2014; 25: 574-589PubMed Google Scholar). Multiple studies report boys to be more likely to intentionally view pornography than girls (Bleakley, Hennessy and Fishbein, 2011Bleakley A. Hennessy M. Fishbein M. A model of adolescents’ seeking of sexual content in their media choices.Journal of Sex Research. 2011; 48: 309-315Crossref PubMed Scopus (64) Google Scholar; Luder et al., 2011Luder M.T. Pittet I. Berchtold A. Akré C. Michaud P.A. Surís J.C. Associations between online pornography and sexual behavior among adolescents: Myth or reality?.Archives of Sexual Behavior. 2011; 40: 1027-1035Crossref PubMed Scopus (118) Google Scholar). Another study in the United States reported that 54% of boys and 17% of girls between the ages of 15 to 17 years reported intentional online pornography viewing. However, a study of adolescent pornography use in the European Union found variability of gender-based pornography use differed by the social progressiveness of the country (Ševčíková, Šerek, Barbovschi and Daneback, 2014Ševčíková A. Šerek J. Barbovschi M. Daneback K. The roles of individual characteristics and liberalism in intentional and unintentional exposure to online sexual material among European youth: A multilevel approach.Sexuality Research and Social Policy. 2014; 11: 104-115Crossref Scopus (21) Google Scholar). The gender differences in pornography use were less distinct in more socially liberal countries when compared with more socially conservative ones. It is important to understand the trajectory of adolescent pornography use. Doornwaard et al., 2016Doornwaard S.M. van den Eijnden R.J. Baams L. Vanwesenbeeck I. ter Bogt T.F. Lower psychological well-being and excessive sexual interest predict symptoms of compulsive use of sexually explicit internet material among adolescent boys.Journal of Youth and Adolescence. 2016; 45: 73-84Crossref Scopus (26) Google Scholar describe three trajectories of pornography use for boys: nonuse or infrequent use, strongly increased use, occasional use, and decreasing use. Pornography use for girls followed three trajectories: stable nonuse or infrequent use, strongly increasing use, and stable occasional use. Although prevalence rates vary among studies, national and international studies reveal that online pornography use is common among boys and not uncommon among girls (Collins et al., 2017Collins R.L. Strasburger V.C. Brown J.D. Donnerstein E. Lenhart A. Ward L.M. Sexual media and childhood well-being and health.Pediatrics. 2017; 140: S162—S166Crossref Scopus (31) Google Scholar). Certain factors are important predictors of child and adolescent pornography use (Box 1). Demographic factors associated with increased pornography exposure include male gender and lower socioeconomic status (Hardy, Steelman, Coyne and Ridge, 2013Hardy S.A. Steelman M.A. Coyne S.M. Ridge R.D. Adolescent religiousness as a protective factor against pornography use.Journal of Applied Developmental Psychology. 2013; 34: 131-139Crossref Scopus (56) Google Scholar). Bisexual or gay adolescent males tend to use Internet pornography more often than straight males (Luder et al., 2011Luder M.T. Pittet I. Berchtold A. Akré C. Michaud P.A. Surís J.C. Associations between online pornography and sexual behavior among adolescents: Myth or reality?.Archives of Sexual Behavior. 2011; 40: 1027-1035Crossref PubMed Scopus (118) Google Scholar). Family factors can also increase risk for pornography exposure. Living in a single-parent home, lower level of caregiver surveillance, and weak emotional bonds with caregivers can lead to increased pornography exposure (Ybarra and Mitchell, 2005Ybarra M.L. Mitchell K.J. Exposure to internet pornography among children and adolescents: A national survey.Cyberpsychology and Behavior. 2005; 8: 473-486Crossref PubMed Scopus (223) Google Scholar). BOX 1Predictors of child and adolescent online pornography useMale genderBrown and L'Engle, 2009Brown J.D. L'Engle K.L. X-rated: Sexual attitudes and behaviors associated with U.S. early adolescents’ exposure to sexually explicit media.Communication Research. 2009; 36: 129-151Crossref Scopus (347) Google Scholar; Hardy, Steelman, Coyne and Ridge, 2013Hardy S.A. Steelman M.A. Coyne S.M. Ridge R.D. Adolescent religiousness as a protective factor against pornography use.Journal of Applied Developmental Psychology. 2013; 34: 131-139Crossref Scopus (56) Google Scholar; Strouse, Goodwin and Roscoe, 1994Strouse J.S. Goodwin M.P. Roscoe B. Correlates of attitudes toward sexual harassment among early adolescents.Sex Roles. 1994; 31: 559-577Crossref Scopus (49) Google Scholar;Wolak, Mitchell and Finkelhor, 2007Wolak J. Mitchell K. Finkelhor D. Unwanted and wanted exposure to online pornography in a national sample of youth Internet users.Pediatrics. 2007; 119: 247-257Crossref PubMed Scopus (290) Google Scholar; Ybarra and Mitchell, 2005Ybarra M.L. Mitchell K.J. Exposure to internet pornography among children and adolescents: A national survey.Cyberpsychology and Behavior. 2005; 8: 473-486Crossref PubMed Scopus (223) Google ScholarBisexual or gay maleLuder et al., 2011Luder M.T. Pittet I. Berchtold A. Akré C. Michaud P.A. Surís J.C. Associations between online pornography and sexual behavior among adolescents: Myth or reality?.Archives of Sexual Behavior. 2011; 40: 1027-1035Crossref PubMed Scopus (118) Google ScholarLack of caregiver monitoring of child/adolescent online behaviorsYbarra and Mitchell, 2005Ybarra M.L. Mitchell K.J. Exposure to internet pornography among children and adolescents: A national survey.Cyberpsychology and Behavior. 2005; 8: 473-486Crossref PubMed Scopus (223) Google Scholar; Wingood et al., 2001Wingood G.M. DiClemente R.J. Harrington K. Davies S. Hook E.W. Oh M.K. Exposure to X-rated movies and adolescents’ sexual and contraceptive-related attitudes and behaviors.Pediatrics. 2001; 8: 473-486Google ScholarPoor emotional bond with a caregiverYbarra and Mitchell, 2005Ybarra M.L. Mitchell K.J. Exposure to internet pornography among children and adolescents: A national survey.Cyberpsychology and Behavior. 2005; 8: 473-486Crossref PubMed Scopus (223) Google ScholarVictim of physical or sexual abuseYbarra and Mitchell, 2005Ybarra M.L. Mitchell K.J. Exposure to internet pornography among children and adolescents: A national survey.Cyberpsychology and Behavior. 2005; 8: 473-486Crossref PubMed Scopus (223) Google Scholar; Wolak, Mitchell and Finkelhor, 2007Wolak J. Mitchell K. Finkelhor D. Unwanted and wanted exposure to online pornography in a national sample of youth Internet users.Pediatrics. 2007; 119: 247-257Crossref PubMed Scopus (290) Google ScholarRecent other traumatic negative life experiencesYbarra and Mitchell, 2005Ybarra M.L. Mitchell K.J. Exposure to internet pornography among children and adolescents: A national survey.Cyberpsychology and Behavior. 2005; 8: 473-486Crossref PubMed Scopus (223) Google Scholar; Wolak, Mitchell and Finkelhor, 2007Wolak J. Mitchell K. Finkelhor D. Unwanted and wanted exposure to online pornography in a national sample of youth Internet users.Pediatrics. 2007; 119: 247-257Crossref PubMed Scopus (290) Google ScholarVictim of bullyingShek and Ma, 2014Shek D.T.L. Ma C.M.S. Using structural equation modeling to examine consumption of pornographic materials in Chinese adolescents in Hong Kong.International Journal on Disability and Human Development. 2014; 13: 239-245Google ScholarDepressionYbarra and Mitchell, 2005Ybarra M.L. Mitchell K.J. Exposure to internet pornography among children and adolescents: A national survey.Cyberpsychology and Behavior. 2005; 8: 473-486Crossref PubMed Scopus (223) Google ScholarDelinquent/rule-breaking behaviorHardy, Steelman, Coyne and Ridge, 2013Hardy S.A. Steelman M.A. Coyne S.M. Ridge R.D. Adolescent religiousness as a protective factor against pornography use.Journal of Applied Developmental Psychology. 2013; 34: 131-139Crossref Scopus (56) Google Scholar; Ybarra and Mitchell, 2005Ybarra M.L. Mitchell K.J. Exposure to internet pornography among children and adolescents: A national survey.Cyberpsychology and Behavior. 2005; 8: 473-486Crossref PubMed Scopus (223) Google Scholar; Wolak, Mitchell and Finkelhor, 2007Wolak J. Mitchell K. Finkelhor D. Unwanted and wanted exposure to online pornography in a national sample of youth Internet users.Pediatrics. 2007; 119: 247-257Crossref PubMed Scopus (290) Google ScholarSensation-seeking personalityBrown and L'Engle, 2009Brown J.D. L'Engle K.L. X-rated: Sexual attitudes and behaviors associated with U.S. early adolescents’ exposure to sexually explicit media.Communication Research. 2009; 36: 129-151Crossref Scopus (347) Google ScholarSocial devianceHasking, Scheier and Abdallah, 2011Hasking P.A. Scheier L.M. Abdallah A.B. The three latent classes of adolescent delinquency and the risk factors for membership in each class.Aggressive Behavior. 2011; 37: 19-35Crossref Scopus (38) Google Scholar Male gender Brown and L'Engle, 2009Brown J.D. L'Engle K.L. X-rated: Sexual attitudes and behaviors associated with U.S. early adolescents’ exposure to sexually explicit media.Communication Research. 2009; 36: 129-151Crossref Scopus (347) Google Scholar; Hardy, Steelman, Coyne and Ridge, 2013Hardy S.A. Steelman M.A. Coyne S.M. Ridge R.D. Adolescent religiousness as a protective factor against pornography use.Journal of Applied Developmental Psychology. 2013; 34: 131-139Crossref Scopus (56) Google Scholar; Strouse, Goodwin and Roscoe, 1994Strouse J.S. Goodwin M.P. Roscoe B. Correlates of attitudes toward sexual harassment among early adolescents.Sex Roles. 1994; 31: 559-577Crossref Scopus (49) Google Scholar; Wolak, Mitchell and Finkelhor, 2007Wolak J. Mitchell K. Finkelhor D. Unwanted and wanted exposure to online pornography in a national sample of youth Internet users.Pediatrics. 2007; 119: 247-257Crossref PubMed Scopus (290) Google Scholar; Ybarra and Mitchell, 2005Ybarra M.L. Mitchell K.J. Exposure to internet pornography among children and adolescents: A national survey.Cyberpsychology and Behavior. 2005; 8: 473-486Crossref PubMed Scopus (223) Google Scholar Bisexual or gay male Luder et al., 2011Luder M.T. Pittet I. Berchtold A. Akré C. Michaud P.A. Surís J.C. Associations between online pornography and sexual behavior among adolescents: Myth or reality?.Archives of Sexual Behavior. 2011; 40: 1027-1035Crossref PubMed Scopus (118) Google Scholar Lack of caregiver monitoring of child/adolescent online behaviors Ybarra and Mitchell, 2005Ybarra M.L. Mitchell K.J. Exposure to internet pornography among children and adolescents: A national survey.Cyberpsychology and Behavior. 2005; 8: 473-486Crossref PubMed Scopus (223) Google Scholar; Wingood et al., 2001Wingood G.M. DiClemente R.J. Harrington K. Davies S. Hook E.W. Oh M.K. Exposure to X-rated movies and adolescents’ sexual and contraceptive-related attitudes and behaviors.Pediatrics. 2001; 8: 473-486Google Scholar Poor emotional bond with a caregiver Ybarra and Mitchell, 2005Ybarra M.L. Mitchell K.J. Exposure to internet pornography among children and adolescents: A national survey.Cyberpsychology and Behavior. 2005; 8: 473-486Crossref PubMed Scopus (223) Google Scholar Victim of physical or sexual abuse Ybarra and Mitchell, 2005Ybarra M.L. Mitchell K.J. Exposure to internet pornography among children and adolescents: A national survey.Cyberpsychology and Behavior. 2005; 8: 473-486Crossref PubMed Scopus (223) Google Scholar; Wolak, Mitchell and Finkelhor, 2007Wolak J. Mitchell K. Finkelhor D. Unwanted and wanted exposure to online pornography in a national sample of youth Internet users.Pediatrics. 2007; 119: 247-257Crossref PubMed Scopus (290) Google Scholar Recent other traumatic negative life experiences Ybarra and Mitchell, 2005Ybarra M.L. Mitchell K.J. Exposure to internet pornography among children and adolescents: A national survey.Cyberpsychology and Behavior. 2005; 8: 473-486Crossref PubMed Scopus (223) Google Scholar; Wolak, Mitchell and Finkelhor, 2007Wolak J. Mitchell K. Finkelhor D. Unwanted and wanted exposure to online pornography in a national sample of youth Internet users.Pediatrics. 2007; 119: 247-257Crossref PubMed Scopus (290) Google Scholar Victim of bullying Shek and Ma, 2014Shek D.T.L. Ma C.M.S. Using structural equation modeling to examine consumption of pornographic materials in Chinese adolescents in Hong Kong.International Journal on Disability and Human Development. 2014; 13: 239-245Google Scholar Depression Ybarra and Mitchell, 2005Ybarra M.L. Mitchell K.J. Exposure to internet pornography among children and adolescents: A national survey.Cyberpsychology and Behavior. 2005; 8: 473-486Crossref PubMed Scopus (223) Google Scholar Delinquent/rule-breaking behavior Hardy, Steelman, Coyne and Ridge, 2013Hardy S.A. Steelman M.A. Coyne S.M. Ridge R.D. Adolescent religiousness as a protective factor against pornography use.Journal of Applied Developmental Psychology. 2013; 34: 131-139Crossref Scopus (56) Google Scholar; Ybarra and Mitchell, 2005Ybarra M.L. Mitchell K.J. Exposure to internet pornography among children and adolescents: A national survey.Cyberpsychology and Behavior. 2005; 8: 473-486Crossref PubMed Scopus (223) Google Scholar; Wolak, Mitchell and Finkelhor, 2007Wolak J. Mitchell K. Finkelhor D. Unwanted and wanted exposure to online pornography in a national sample of youth Internet users.Pediatrics. 2007; 119: 247-257Crossref PubMed Scopus (290) Google Scholar Sensation-seeking personality Brown and L'Engle, 2009Brown J.D. L'Engle K.L. X-rated: Sexual attitudes and behaviors associated with U.S. early adolescents’ exposure to sexually explicit media.Communication Research. 2009; 36: 129-151Crossref Scopus (347) Google Scholar Social deviance Hasking, Scheier and Abdallah, 2011Hasking P.A. Scheier L.M. Abdallah A.B. The three latent classes of adolescent delinquency and the risk factors for membership in each class.Aggressive Behavior. 2011; 37: 19-35Crossref Scopus (38) Google Scholar