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Human Sexuality

A large international literature promotes restorative justice options as satisfying and empowering to crime victims. This paper examines restorative justice for sexual assault from the perspective of three groups of survivors:   (a) adults victimized by adult perpetrators; (b) adults or juveniles victimized by juveniles; and (c) adults sexually molested as children by adults. Sexual violence within a violent intimate relationship such as domestic violence is excluded from consideration. The use of restorative justice in cases of domestic violence is the subject of another VAWnet document by Ptacek and Fredericks (2008).   Although it may involve forced sexual relations, domestic violence, compared to adult sexual violence, is more likely to involve longer standing and more committed relationships, multiple co-occurring forms of psychological and physical violence, repetitiveness and often escalation of the abuse over time, and the involvement of children directly or as witnesses (Hopkins, Koss, & Bachar, 2004).

Our key terms are defined as follows.   The term survivor/victim is used throughout to retain the empowerment conveyed by the word ""survivor"" and the outrage implied by the word ""victim.""  The word offender is used to refer to the person responsible for perpetrating forced, unwanted sexual activity, without implying that an arrest has been made or charges issued. Rape is defined as unwanted oral, anal, or vaginal penetration against consent through force, threat of force, or when incapacitated.   The term s exual assault references a broader range of contact and non-contact sexual crimes up to and including rape.   The term restorative justice applies to programs that view crime as a violation of people and relationships, causing harm for which offenders and communities are accountable and have an obligation to repair (Umbreit, Vos, Coates, & Lightfoot, 2006)


A restorative justice conceptualization involves three constituencies: (a) survivor/victims and secondarily victimized family and friends who suffer distress along with their loved one; (b) community members who experience less safety and social connection when they perceive high levels of crime and low deterrence, yet who simultaneously may be contributing to an environment supportive of sexual violence; and (c) offenders as well as their families and friends, who experience guilt and shame that is associated with being accused of a sexual crime or belonging to the interpersonal relationship context from which the offense arose.   Restorative justice is implemented through a range of formats; those that have been used to address sexual assault will be defined later.   Restorative options include sharing circles, victim-offender dialogue, victim impact panels, community reparation boards, circles of support, sentencing circles, conferencing with juveniles and adults, and restorative discipline in educational settings (Umbreit et al., 2006).  

Restorative interventions may occur at multiple time points including pre-charging, post-conviction, in prison, pre- or immediately post release, and whenever the survivor/victim desires resolution outside the justice system, often many years after the crime has occurred. Programs may operate parallel to or outside conventional justice systems.   In practice this distinction determines how participants enter the program, whether they are prosecutor or self-referred, what judicial or extra-judicial consequences are available and the consequences when offenders fail to comply with accountability commitments they have made.   The term ìrestorativeî refers to the concept of the program, not to program outcomes.   Some restorative program designs may be ineffective or even have negative outcomes for sexual assault. We critically evaluate alternate program models shortly.


The literature on restorative justice is large and encompasses a range of crimes including severe violence such as homicide. We have attempted to review literature that references   sexual assault and to present a synthesis of findings that that focus on: (a) listening to what survivor/victims say they want from a justice process; (b) examining the capability of conventional criminal and civil justice systems to respond to the identified needs; (c) describing operational restorative programs that focus on or include sexual crimes; and (d) delineating still unmet survivor/victims' justice needs and the barriers faced in responding to them. We are unable within the space limitations to include a large portion of the published literature because the topics are very complex for reasons such as different legal systems, cultural settings, or in the case of indigenous people, issues that are specific to each group's history of cumulative trauma and colonialism.  

We strongly encourage interested readers to read more broadly about restorative justice and offer the following references as starting points:   philosophy, roots, and vision of restorative justice (Johnstone & Van Ness, 2006; Umbreit et al., 2006);   restorative responses to collective violence including rape in war and conflict ( Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002); outcome evaluations on crimes other than sexual assault (Latimer, Dowden, & Muise, 2005; Sherman, et al., 2005); intersections with gender, culture, indigenous status and socioeconomic considerations; debates over expectations regarding forgiveness (Armour & Umbreit, 2006); the effectiveness of conventional approaches such as community registration or sex offender therapy to managing sex offender risk (Mcalinden, 2006);   cost-benefit analyses (Couture, Parker, Couture, & Laboucane, 2001; and legal perspectives, practice standards, and ethical guidelines (United Nations, 2007; Ministry of Justice, 2004; Department of Justice Canada, 2000). We begin our review by summarizing what has been learned from listening to survivor/victims and their advocates.


Focus groups or listening projects with survivor/victims, service providers, and advocates have been conducted in several US states and in other countries to learn about justice needs in the aftermath of sexual assault and other violent crimes including other types of violence against women, and to catalogue these groups' ideas about what constitutes a victim-centered process (e.g., Nancarrow, 2006; Milka, Achilles, Halbert, Amstutz, & Zehr, 2003). A consensus of published studies is that survivor/victims need to tell their own stories about their experiences, obtain answers to questions, experience validation as a legitimate victim, observe offender remorse for harming them, receive support that counteracts isolation and self-blame, and above all have choice and input into the resolution of their violation. Victim-sensitive justice capable of responding to these needs would involve processes that respect survivor/victims as autonomous persons, individualize both their needs and the appropriate community responses including avenues for offender accountability, censure, and material reparation if desired, protect physical safety, reduce potential re-abuse, and maximize offender fulfillment of commitments.


Advocates and service providers have nuanced thoughts about the capacity of restorative justice to respond to survivor/victims' needs in cases of sexual assault and domestic violence. In Nancarrow's (2006) Queensland, Australia listening project, advocates believed that restorative justice could serve survivor/victims by expanding their options and lowering barriers for offenders to accept responsibility and convey remorse. Trepidations were most often expressed when restorative methods were proposed for domestic violence as opposed to sexual assault. Yet even in Australia where restorative justice is routinely utilized for juvenile sex crimes, advocates expressed concern about extending programs to adult offenders. Enthusiasm also varied depending on the point in the justice process where the restorative program occurred; pre-charging diversions were viewed less favorably than post-sentencing approaches.


Justice Needs Compared to Justice Response


The law and order agenda supported by the anti-sexual violence movement has achieved major law and policy reforms dating back to the 1970s, including expanding definitions for rape, removing corroboration requirements, establishing rape shield protections, opening avenues for civil justice, increasing punitive responses for sexual assault (longer sentences, sex offender registration, community notification, and civil commitment), educating criminal justice personnel, and introducing restorative elements including compensation schemes, rights to notification, and victim impact statements. Some coalitions have opposed some of these changes and recently the National Alliance to End Sexual Violence has expressed concerns about civil commitment and mandatory minimum sentences (personal communication, July 18, 2007).  

This coalition views these policies as reactionary agendas driven by politicians who respond expediently to high profile cases. For the purposes of this article, it is important to recognize that criminal sanctions are only realized when cases have been reported to police (compensation), charged (rights to notification) or proceeded through sentencing (e.g., impact statements, incarceration and sex offender registration).   Therefore, we must examine the extent to which survivor/victims receive accountability that addresses their needs and at what cost to them. Relevant studies focus on re-traumatization and case attrition. Re-traumatization refers to behavior of justice personnel and institutional culture that exacerbates rather than reduces survivor/victims' distress. Attrition examines the proportion of cases of sexual violence where validation of the survivor/victim and social condemnation/punishment of the offender ultimately occurs (Kelly, 2001; Koss, 2006).   Each is discussed in more detail below.


Re-traumatization


Examination of self-reports by physicians, nurses, police officers, and survivor/victims about the statements made or actions taken during rape care reveal that perceptions of their helpfulness differed (e.g., Campbell, 2005).   Whereas these groups of service providers rated their behavior as very supportive, survivor/victims frequently did not. The presence of an advocate beginning in the emergency room resulted in some improvement in survivor/victims' experiences compared to survivor/victims without advocates.   However, even with an advocate present more than half of survivor/victims still felt bad about themselves, guilty, depressed, anxious, violated, disappointed, distrustful, and reluctant to seek further help (Campbell, 2006). Despite efforts to sensitize a variety of personnel in the systems that respond to sexual violence, there is inherently some element of shame and degradation in the process; the justice system is adversarial by design. Survey responses showed that 46% of survivor/victims were dissatisfied with police interviews (Monroe et al., 2005). Likewise, interactions with prosecutors were negatively experienced.

Prosecutors are tasked with proving that the accused is guilty, which often causes survivor/victims to feel as if they must prove they were raped.   Most survivor/victims who participated in trials before juries in the US believed rapists had more rights, the system was unfair, their statutory victims' rights were not implemented, and they weren't given enough information or control over handling their case (Frazier & Haney, 1996).   The conclusions are supported by recent findings in Germany, even though rape trials in that country are not by jury and an extensive victim/survivor support system is in place (Orth & Maercker, 2004).   Likewise, results are similar in South Africa where special prosecution units for sexual assault and rape courts are utilized (Walker & Douw, 2006).   These authors' data fail to support the objectivity and ability of specialized prosecutors and courts to reduce re-traumatization.


Survivor/victims who pursue civil cases also frequently fail to achieve satisfaction of their primary goals.   Civil justice involves two types of cases, tort and non-tort.   A tort case involves an assertion of wrongful actions and available sanctions take the form of monetary recovery.   Non-tort cases seek remedy for problems such as immigration matters, wrongful termination, education disruption, or denied medical benefits. In civil actions an entirely new set of legal obstacles comes into play compared to criminal justice (Bublick, 1999; 2006).     Furthermore, attorneys are unmotivated to pursue most tort cases because most offenders are not wealthy enough from attorney's perspectives, as compensation is contingent on the amount of money awarded in a settlement or judgment.   And even if received, settlements virtually universally exclude any acknowledgement of wrong-doing by the offender (Bublick, 2006; Des Rosiers, Feldthusen, & Hankivsky, 1998; Herman, 2005).   Where non-tort legal representation could be of assistance, few attorneys will work with survivor/victims of sexual assault because they are often unable to afford the hourly fees that are charged (Seidman & Vickers, 2005). Civil attorneys also observe that many survivor/victims have problems that the civil justice system cannot resolve.  

 
Attrition


The US National Violence Against Women Survey identified 2,594 separate rape incidents among the 8,000 female respondents.   Only small numbers of these incidents were reported to police (N=441), prosecuted (N=33), convicted (N=13) and jailed (N=9; Tjaden & Thonnes, 1998).   Rape was far less likely to be reported to police (22%) compared to physical assault (78%; Felson & ParÈ, 2003). A statewide assessment of survivor/victims receiving care at 19 sexual assault centers in Maryland showed that 70% said they would not report to police.   Of those who did report, 56% waited years before doing so (Monroe, et al., 2005; for a review of rape reporting rates worldwide see Kelly, 2001). Studies in Australia, New Zealand, the UK and the US have found that depending on the data source, police officers judge that 1% to 70% of rape reports are false (Jordan, 2004). Cases that were particularly likely to be closed as ""false,"" ""unfounded,"" ""recanted,"" or ""uncooperative victim"" involved survivor/victims and offenders that were under the influence of substances, even slightly acquainted, delayed reporting, had previous consensual sex, and those with   a history of childhood sexual abuse or mental illness.  

Although police deemed worthy just a fraction of sexual assault cases, more than 30 studies across many nations document that prosecutors approached suspiciously even the pre-selected cases that police deemed to have the strongest evidence of sexual assault.   Worldwide the average proportion of cases where charges were issued was 28%; the figure was 16% in the two US jurisdictions included in the analysis (Indianapolis and another midwestern city that is unnamed due to a confidentiality agreement with prosecutors; DuMont & Parnis, 2007).   Prosecutorial decisions have been found to be unduly influenced by stereotypes and survivor/victims features that are not statutory elements of law including class, race, character, conduct, mental health, sexual history, lack of injury, failure to manifest extreme emotional distress, and absent evidence of strong resistance (Bublick, 2006).


Not only are rates of indictment low, guilty verdicts are also low.   Nine studies internationally reported conviction rates for rape.   The global average was 15% and it was 12% in the two US cities with available data (Boston and an unnamed midwestern city; Du Mont & Parnis, 2007).   Among juvenile offenses, rape was the least likely to be proved in trials (Daly & Crutis-Fawley, 2006).   The consensus is that justice reforms have not improved satisfaction of survivor/victims needs and that rape remains the ìleast reported, least indicted and least convicted non-property felonyî (Seidman & Vickers, 2005, p. 472).   Social psychological research has shown that not-guilty rape verdicts increase both men's and women's rape myth acceptance, which is among the best predictors of a juror's refusal to convict of rape.   Not-guilty rape verdicts create a self-perpetuating, negative downward spiral in public response to sexual assault because prosecutors fail to charge when they think juries will not convict.  

The conviction rate for rape has declined steadily in European countries over the past 30 years (Kelly & Regan, 1999).   For example, rates between 1977 and 1981 in Finland were 24% and from 1991 to 1997 declined to 13%.   Legal scholars point out that even where strong laws are in place prohibiting sexual offenses and providing rape prevention education, laws cannot successfully achieve their envisioned aims with a citizenry that condones sexual violence and is reluctant to convict in sexual assault cases (Seidman & Vickers, 2005).   Taken together, the results of listening projects and the data on attrition and re-traumatization support the worth of examining options that are premised on meeting the justice needs of survivor/victims that in many cases are not sufficiently fulfilled through conventional justice.  


Restorative Justice Programs


Examination of empirical reports in the restorative justice literature reveals that although sexual violence is not explicitly excluded, in reality no cases were included. The reasons are not known. New Zealand to some extent and much of Australia are the only jurisdictions where restorative justice for sexual assault is routine, but even so it is limited to juvenile cases.   South Africa has catalogued a wide range of restorative justice interventions that include traditional practices, social service, and criminal justice-based programs across the country (Skelton & Batley, 2006).   Most address a range of crimes and may include sexual assault partly out of necessity; South Africa records the highest rape rates in the world.   The Mennonite Central Committee of Canada also implements a wide array of restorative programs addressing sexual assaults.   In the material that follows we briefly describe some restorative justice programs that have included or focused on sexual assault.   The aim here is not an exhaustive review.


Victim-Offender Dialogue


Victim-Offender Dialogue (or mediation) has existed for 30 years. Whether a program uses the word ""dialogue"" or ""mediation"" in its title appears to be arbitrary because in both cases the processes appear identical.   Some scholars even use inconsistent terminology within their own body of work. Victim-Offender Dialogue is widely used in a variety of settings outside criminal justice such as ethnic conflicts.   When applied to crime, the method involves preparation for and facilitation of a direct meeting between survivor/victims and the offender, usually in a prison setting during incarceration or pre-release (Umbreit, et al., 2006). Although not specifically identified as responses to sex crimes, many of these programs do include sexual assaults.   After a general overview of the programs themselves, we will discuss why it is problematic to use the word ""mediation"" in programs designed to include gendered crimes.

 
One model that has been used for sexual assault is initiated when a survivor/victim notifies correctional authorities of a desire to meet and the offender agrees.   The agenda of the dialogue is determined by the survivor/victim and may include stating the impact of the crime, asking questions, and seeking acknowledgement of responsibility.   The Pennsylvania Office of the Victim Advocate has been very active offering the OVA Mediation Program for Victims of Violent Crime. Sexual assaults have constituted Ω of the survivor/victims they have assisted. This office also facilitates Victim Impact Panels (also known as Victim Impact Dialogue), which involve survivor/victims who volunteer to visit prisons and speak with incarcerated sex offenders about the impact of these types of crime on them (Allen, 2004). The Pennsylvania program has been documented in a film Beyond Conviction.   Skelton and Batley (2006) describe many programs of this type across South Africa.   In addition, t he victim-offender mediation program run by the Fraser Region Community Justice Initiatives Association in British Colombia is specifically designed to address traumatic criminal offenses, including rape, sexual assault, and child sexual abuse.  


The Centre for Sexual Assault in Copenhagen, Denmark, also offers a dialogue program. Here staff assists the survivor/victim to write or telephone the offender to establish communication.   Three cases have been described to date, two of which involved adult survivors of child sexual abuse. In the first the offender did not respond, leading to survivor/victim disappointment, in the second an e-mail exchange occurred, and the third resulted in a face-to-face meeting.   Both of the survivor/victims who received some form of response from the offender were satisfied with their experience primarily because they received acknowledgement.  


Umbreit and colleagues have been pioneers in providing quantitative and qualitative assessment of the outcomes of victim-offender dialogue.   In one study that included felons incarcerated for crimes of severe violence including sexual assault in Texas and Ohio, the most commonly stated reasons that survivor/victims participated were to seek answers to lingering questions, to express the impact, to experience a more human interaction with the offender, and to advance healing.   Preparation time depended on the scope of what the parties' desired to achieve through the meeting.   The dialogues lasted 3.5 to 8 hours in Texas and 2 to 4 hours in Ohio. Of the 46 cases across the two sites that were evaluated, 8 involved sexual assaults representing the mix of sex acts for which offenders are incarcerated.   The results were reported in aggregate across all crimes, which is clearly a limitation as is the small number of sexual assault cases. However, the overall survivor/victim satisfaction was so high (95% satisfied or very satisfied in Texas and 100% in Ohio), that large differences across crime types would be unlikely, but nevertheless merit examination in future research.   A caution to this rosy picture comes from the program offered by the Department of Correctional Services in Leeuwkop, South Africa.   Although overall program completion was 80% by offenders in general, commitment was more problematic among sex offenders (Skelton & Batley, 2006)


Many people in the sexual assault field object to programs that use the word ""mediation,"" and the term ""resolution of conflict.""   These terms connote practices involving parties with equal social resources, a neutral facilitator, a conflict that must be resolved, and a negotiation that results in each side getting something of what they want, such as the process for resolving labor disputes. Mediation methodology is not designed to respond to acts that involve parties with different levels of power.   Sexual violence is primarily a gendered crime that challenges the assumption of equal resources to speak and be heard.   In addition, crimes are not conflicts; there is an injured party and a wrongdoer.   Finally, although mediation is a negotiation, victim-offender dialogue often typically does not involve reparations but instead focuses on voicing impact and receiving validation.   Confusion exists not only in the professional literature but in community practice between the concepts of victim-offender mediation and divorce mediation. Divorce mediation uses different methods from victim-offender dialogue and is also frequently involuntary or mandated.   Coerced participation is never acceptable for survivor/victims of sexual assault. One lesson that may be learned is that the word ""mediation"" is confusing and contra-productive for those who work with survivor/victims of sexual violence.    


Sentencing Circles


Circles developed primarily in Canada and have been utilized most widely among First Nations people. They involve a large group of individuals that are invested in the resolution of a crime and who come together to determine a plan for the offender. The circle concept is seen in other indigenous societies on every continent and has ancient roots, but the Canadian model has been examined most carefully by scholars.   Attendees may include survivor/victims, offenders, their family/friends, offenders, criminal justice personnel (judges, prosecutors, defense attorneys, and police), social service providers, and community members (Shapeland, 2003).   Often a talking piece is passed to signify who is designated to speak, which in theory allows expression of a broader range of views than in traditional sentencing.  

However, circles are critiqued widely in the indigenous law literature (Rave, 2004).   One of the best known programs is the Hollow Water First Nation Community Holistic Circle Healing approach to sexual offenders, their victims, and families (see Umbreit et al., 2006). The identified strengths of this program were having a voice and a stake in justice, the context of mutual respect, and renewed community and cultural pride.   However, the model has been the subject of a series of critiques from within and outside the community.   Expressed concerns included lack of privacy, embarrassment working with family and close friends, unprofessional conduct, coercion on survivor/victims because they are outnumbered, deferral to professionals by Native people, and class, gender, culture, and race bias (Cuneen, 2004). One legal scholar has suggested that circles do not even qualify as restorative justice (Coker, 2004). To her, circles involve the same criminal justice players as a conventional sentencing and may lack a clear normative judgment about what constitutes illegitimate conduct towards women.


Conferencing


Conferencing is a widely used form of restorative justice that has been adopted specifically for sexual assault. It involves consensual agreement by survivor/victims, offenders, and their family and friends to prepare for a meeting together. It is premised on the offender taking responsibility for the acts committed, although this does not equate to a full understanding of why these acts are considered crimes.   The conference is preceded by weeks or months devoted to informed consent and preparation for the meeting.   The amount and content of the preparation process varies from program to program.   When the meeting is convened, it is typically guided by a facilitator who follows a strict or loose script to ensure that key points are discussed, speech is non-abusive, and everyone has a chance to speak.

  Facilitators may be social service professionals, volunteers or police officers, but in any case they have received specialized training.   Conferences have been conducted in a variety of settings, but many are sited in police stations for safety.   The typical agenda of a conference includes the offender describing his/her acts and taking responsibility for them, the survivor/victim voicing the impact of the crime, followed by family and friends of both the survivor/victim and offender.   The offender then acknowledges and responds to what he/she has heard about the harm that resulted from the acts.   The meeting concludes with discussions formalizing the programmatic and survivor/victim-driven components of a plan that the offender accepts to make amends, repair harm to the survivor/victim, family/friends, and community, and undertake personal changes to prevent reoccurrence of similar acts.  

The conference and the resulting redress plan constitute restorative punishment. In contrast to conventional criminal justice, the punishment is driven by the survivor/victim, individualized to the offender and re-balances survivor/victims and community involvement in determining justice.   In contrast to victim-offender dialogue, conferencing designs involve a wider circle of people affected by the crime and culminate in a plan for reparation and rehabilitation.


Conferencing may occur at various points within the justice process including being a component of the formal ""caution"" (warning) issued by police to the offender (not an option in the US justice system), as a pre-charge diversion, as a mandatory diversion subsequent to a guilty plea or verdict, or at any time point when a survivor/victim self-refers. Program process may also differ in their features. These include focus on juvenile or adult survivor/victims and offenders, inclusion of current and/or past sexual assaults, relationship to criminal justice, whether as an alternative form of accountability to criminal justice or a free-standing victim-services initiative, and the source of referrals (survivor/victim self-referral or prosecutor/court initiated).


Many conferencing programs operating in South Africa include rape within their scope.   Furthermore, our research located four conferencing programs specifically designed for sexual assault, including the South Australia Juvenile Justice Intervention, which was a formal comparison of restorative conference and conventional court outcomes (Daly, 2003; 2006).   Other programs include RESTORE in Pima County, Arizona (Koss, 2006; Koss, Bachar, Hopkins, & Carlson, 2004), RESTORE-NZ in Aukland (J¸lich, 2005), and Phaphamani Rape Crisis Counselling Centre in Uitenhage, South Africa (Skelton & Batley, 2006).


The program plan for RESTORE in Pima County, Arizona, includes many features that were specific responses to listening projects, published critiques of restorative justice for sexual assault, or were alterations introduced after implementation as a response to unanticipated problems.   Modifications from the standard conferencing model included (a) contacting survivor/victims first so that offender consent could not be used to coerce their participation; (b) providing survivor/victims with free legal consultation about their justice options to augment their conversations with program staff;   (c) careful screening for appropriateness of offenders in a community-based program consisting of prosecutor referral and comprehensive psychosexual evaluation (a multi-hour assessment administered by a forensic examiner of personal and sexual history, risk factors for offending, and arousal patterns as determined by clinical interview and standardized measures); (d) developing rigid rules to prevent verbal re-abuse or contact with the victim; (e) seating participants around a large table rather than in an open circle to maintain separation and perceptions of protection; (f) allowing the survivor/victims to choose to be present or to designate a family member/friend or community volunteer to represent them; (g) imposing minimum accountability (therapy, case manager supervision, monitoring by a volunteer community board, and community service) to augment survivor/victims' directed elements of the redress plan; (h) creating a volunteer community board of individuals pre-screened and trained to validate the survivor/victims, offer offenders assistance in problem solving, maintain contact with law abiding community members, and terminate when necessary for noncompliance; and (i) creating a formal program exit meeting where the offender prepares and delivers a letter of clarification and reflection to the community board and survivor/victims, if desired.  
RESTORE has been operational for two years, so some anecdotal information is available.

In a geographical area that received 749 rape reports in 2003 among a population of approximately one million, 65 referrals from prosecutors were received in 24 months. Participation rates have been 71% among those survivor/victims who could be contacted (many police reports lacked accurate contact information or parties had moved) and 84% of those offenders whose survivor/victims consented entered the program.   Of 22 consented cases, conferences were successfully conducted in 20. Not all survivor/victims attended the conference in person, but in every case they gave permission for the process to proceed.   Quantitative evaluation of survivor/victims' distress levels, offenders' recidivism and all parties' perceptions of satisfaction, fairness, and reparation are underway. Survivor/victims experiences are assessed by self-report survey including standard measures of PTSD.

Re-offending is assessed using the revised Sexual Experiences Survey to screen for self-reports of perpetration after program exit (Koss, Abbey, et al., in press) and through criminal records search for arrests for any crime. To date, four cases were returned to prosecutors because of noncompliance or voluntary termination by the offender.   None resulted in any prosecutors imposing any form of accountability despite the fact that a major reason for partnering with the justice system was to establish back-up consequences for drop-outs.   Offenders who successfully completed the program made positive changes in their understanding of themselves and the harm they caused based on qualitative analysis of their statement of responsibility at program entry compared to their letter of reflection at program exit (Bletzer, Koss, & Raskin, in press). Reports on quantitative analyses and further qualitative findings are in preparation.


RESTORE-NZ in Auckland, New Zealand, has expanded the program concept to serve cases referred from the criminal justice system as well as adult survivors of child sexual abuse who voluntarily seek out the program.   When this article was written the program had conferenced 2 cases, but descriptions of the case characteristics are not yet available.   The expansion of restorative justice conferencing to self-referral is an important innovation also found at the Phaphamani Rape Crisis Counseling Center in Uitenhage, South Africa.   This program works with both criminal and civil cases and receives referrals from criminal justice, social services, as well as self-referrals. The Centre has completed 63 conferences and 72 victim-offender dialogues. Although there is no formal evaluation, staff report that the interventions often caused survivor/victims' pain to resurface but that participants were satisfied at the end.   Program staff also commented that they encountered offenders who were willing but the family did not support participation.  However, as in the Arizona experience, the most serious problem reported was lack of referrals to the program by the formal justice system.


The largest conferencing initiatives are in Australia where juvenile sexual assault is mandated to conferencing in many states and territories. A large-scale evaluation of conferencing outcomes for sexual assault, and in fact the only experimental comparison of restorative to conventional justice is the South Australia Juvenile Justice Intervention (a bibliography of published papers. Young people charged with sexual assault who admitted their acts were randomly assigned to restorative justice conferencing or court.   Daly (2003) examined the results of 89 conferences.   Survivor/victim satisfaction was higher in the group that was assigned to conferencing compared to court and conferenced cases more frequently resulted in admission of responsibility and apology compared to trials.   In the courtroom the proved rate was 33% for sex crimes compared to 65% for burglary.   Survivor/victims ranged in age from 3 to 50 years.  

Offenders were 11 to 18 years.   Excluding the victims of a youth who exposed himself to older women, the median age of victims was 6 years.   The severity of the sexual assaults was approximately evenly divided across a spectrum from less serious to most serious.   Many cases involved brothers and sisters, step relations, cousins, family friends, and other friends.   All offenders participated for 12 months in the Mary Street Program, an adolescent sexual abuse prevention program and performed community service.

Unmet Needs


This article has identified some innovative responses to survivor/victims' justice needs that are currently unmet by conventional justice.   Compared to current practice, new groups that could receive services from restorative justice programs include: (a)   adult survivor/victims who choose not to initiate a report to law enforcement; (b) those who reported but whose cases were closed against their wishes; (c) survivor/victims whose offenders were never apprehended; (d) adult survivors of child sexual assault who were unable to come forward at the time of the offense; (e) juvenile survivor/victims whose offenders are frequently young family members and friends where evidence of predilection to offending is absent upon psychosexual examination; and (e) family and friends of survivor/victims, who may suffer equal or more distress than the survivor/victims.  


Some legal scholars have suggested that the justice response to intimate crimes such as sexual assault should be removed from the criminal justice system and handed over to service providers (Seidman & Vickers, 2005).   Although it is true that sexual assault survivor/victims are vastly more satisfied with the help they receive from these agencies compared to conventional justice, an array of arguments exist against this position.   There are elements of the criminal justice system that neither survivor/victims nor advocates are ready to give up, including the power to force or coerce participation of the offender. Even if restorative justice were mandated, and we do not advocate that it should be, success depends substantially on the acceptability of restorative methods by individual survivor/victims and offenders, well-designed and implemented program processes, and offenders' willingness to accept responsibility and face expectations that they will participate in activities aimed at repair of themselves and others (e.g., Kaly, 2003).  


Given the size and richness of the restorative justice literature, the minimal number and small scale of programs for sexual assault is notable.   The reality is that policy, system, and resource barriers hinder their development more than for other crimes. For example, programs that treat both survivor/victims and offenders are ineligible to apply for grant funds made available through the Violence Against Women Act and there are system and resource barriers that hinder their development more than other crimes. Other funds to address victim or offender services are earmarked for continuation of existing programs, resulting in a failure to reward or nurture innovation.   Finally, many available federal dollars cover only evaluation costs, not the much more significant costs to develop and operate new programs.   System change can happen and we hope that this brief overview of survivor/victims' needs and restorative innovations will begin to encourage a re-envisioning of how the field could advocate for growth in responsiveness to the injustice of sexual assault.


Concept of Sexual Addiction

The idea that sex can be an addiction is new to many people.
The term "addiction" has become a popular metaphor to describe any form of self-destructive behavior that one is unable to stop despite known and predictable adverse consequences. For some people, sexual behavior fits that description. It involves frequent self-destructive or high risk activity that is not emotionally fulfilling, that one is ashamed of, and that one is unable to stop despite it causing repeated problems in the areas of marriage, social relationships, health, employment, finances, or the law.
Recognition that self-destructive sexual behavior can be an addiction has spawned the rapid growth of four nationwide self-help organizations for persons trying to recover from this problem. All are 12-step recovery programs patterned after Alcoholics Anonymous.


One might ask how sex can be an addiction when it is doing what comes naturally and does not involve abuse of a psychoactive substance like drugs or alcohol. The scientific argument for addiction is based, in part, on recent advances in neurochemistry that suggest we carry within us our own source of addictive chemicals.


When pleasure centers in the human brain are stimulated, chemicals called endorphins are released into the blood stream. Endorphins are believed to be associated with the mood changes that follow sexual release. Any chemical that causes mood changes can be addictive, with repeated exposure altering brain chemistry to the point that more of the chemical is "required" in order to feel "normal."


For example, experiments with hamsters have shown that the level of endorphins in their blood increases dramatically after several ejaculations. Experimental rats habituated to endorphins will go through much pain in order to obtain more. In rats, the addiction to endorphins is even stronger than the addiction to morphine or heroin.

Indicators of Sexual Addiction

The sex addict uses sex as a quick fix, or as a form of medication for anxiety, pain, loneliness, stress, or sleep. Sex addicts often refer to sex as their "pain reliever" or "tension reliever." In a popular novel, the heroine describes sex as "the thinking women's Valium."


Other indicators that sexual behavior may be out of control include: an obsession with sex that dominates one's life, including sexual fantasies that interfere with work performance; so much time devoted to planning sexual activity that it interferes with other activities; strong feelings of shame about one's sexual behavior; a feeling of powerlessness or inability to stop despite predictable adverse consequences; inability to make a commitment to a loving relationship; extreme dependence upon a relationship as a basis for feelings of self-worth; or little emotional satisfaction gained from the sex act.


Compulsive or addictive sexual behavior may take various forms, including what many regard as "normal" heterosexual behavior. The type of sexual activity and even the frequency or number of partners are not of great significance in diagnosing this problem. Some individuals have a naturally stronger sex drive than others, and the range of human sexual activity is so broad that it is difficult to define "normal" sexual behavior. What is significant is a pattern of self-destructive or high risk sexual behavior that is unfulfilling and that a person is unable to stop.


The first major study of sexual addiction was published by Patrick Carnes in 1991.4 It was based on questionnaires filled out by 752 males and 180 females diagnosed as sex addicts, most of them admitted for treatment in the in-patient Sexual Dependency Unit of a hospital in Minnesota. The others had at least three years of participation in one of the 12-step programs for recovery from sexual addition. Of the sex addicts in this survey, 63% were heterosexual, 18% homosexual, 11% bisexual, and 8% were unsure of their sexual preference .


The sexual addicts who responded to Carnes' questionnaire were typically unable to form close friendships. Their feelings of shame and unworthiness made them unable to accept real intimacy. They were certain they would be rejected if others only knew what they were "really" like, so they found myriad obsessive ways to turn away a potential friend or loving partner. Despite a large number of superficial sexual contacts, they suffered from loneliness, and many developed a sense of leading two lives--one sexual, the other centered around their occupation or other "normal" activity.


In Carnes' survey, 97% responded that their sexual activity led to loss of self-esteem. Other reported emotional costs were strong feelings of guilt or shame, 96%; strong feelings of isolation and loneliness, 94%; feelings of extreme hopelessness or despair, 91%; acting against personal values and beliefs, 90%; feeling like two people, 88%; emotional exhaustion, 83%; strong fears about own future, 82%; and emotional instability, 78%.


Carnes found that 42% of sex addicts in his sample also had a problem with either alcohol or drug dependency and 38% had eating disorders.The roots of out-of-control sexual behavior may be quite varied. It may be caused by an underlying personality disorder, an "addiction" to sex, or a physical disorder. The traditional disorders of exaggerated sexuality, nymphomania in the female and satyriasis in the male, are believed to be caused by a disorder of the pituitary gland or irritation of the brain cortex by a tumor, arteriosclerosis or epilepsy. These physical disorders are rare.

Consequences of Sexual Addiction

Out-of-control sexuality may have serious adverse consequences. In the Carnes survey of individuals in treatment, 38% of the men and 45% of the women contracted venereal diseases; 64% reported that they continued their sexual behavior despite the risk of disease or infection. Of the women, 70% routinely risked unwanted pregnancy by not using birth control, and 42% reported having unwanted pregnancies.


Many patients had pursued their sexual activities to the point of exhaustion (59%) or even physical injury requiring medical treatment (38%). Many (58%) pursued activities for which they felt they could be arrested and 19% actually were arrested. Sleep disorders were reported by 65%; they usually resulted from stress or shame connected with the sexual activity.


Of the survey respondents, 56% experienced severe financial difficulty because of their sexual activity. Loss of job productivity was reported by 80%, and 11% were actually demoted as a result. Many of these problems are, of course, encountered by persons whose sexuality is not out of control, but the percentages are much lower.

Security Concerns

Compulsive or addictive sexual behavior is a security concern because it may lead to poor judgment or lack of discretion, indicate a serious emotional or mental problem, open one to exploitation, manipulation, or extortion, or attract the attention of hostile intelligence or security services. Sexual intimacy often leads to personal intimacy. The bedroom is an ideal location for a hostile intelligence or security service to learn of an individual's resentment of a boss, longing to be rich, compulsive need to feel important, or problems with a spouse.


Addicts of all types typically organize a part of their life and their circle of friends around their addiction. Intelligence and security services generally maintain sources in these circles, and it is easy for them to place an agent in contact with a potential target who attracts attention through these activities. Habitual behaviors that provide such access opportunities for foreign intelligence and security services increase the risk that an individual will become a target and that any vulnerabilities that do exist will be discovered and exploited.Recovery Programs

Sex Addicts Anonymous, Sex & Love Addicts Anonymous, Sexaholics Anonymous, and Sexual Compulsives Anonymous are all nationwide organizations for individuals recovering from problems with compulsive sexual behavior. They are 12-step recovery programs patterned after Alcoholics Anonymous.


A membership survey of Sex and Love Addicts Anonymous found that 58% of its members were male, 92% Caucasian, 44% in professional jobs, 24% with a postgraduate degree and 31% with a college degree. The sexual orientation of its members was 63% heterosexual, 11% bisexual, and 26% gay or lesbian.
It is normal for recovery groups like this to have a disproportionate number of highly educated members. That is only because well-educated persons are more likely to seek out self-help programs. There is no evidence that well-educated persons are more likely than others to suffer from sexual addiction.

The Sexual Orientation Non-Discrimination Act ("SONDA") What is the Sexual Orientation Non-Discrimination Act?

The Sexual Orientation Non-Discrimination Act, typically known by its acronym "SONDA," prohibits discrimination on the basis of actual or perceived sexual orientation in employment, housing, public accommodations, education, credit, and the exercise of civil rights. New York has long prohibited discrimination on the basis of certain characteristics, such as race, sex, and religion. SONDA added the term "sexual orientation" to the list of specifically protected characteristics in various State laws, including the Human Rights Law, the Civil Rights Law, and the Education Law.

When did SONDA take effect?

SONDA, which was passed by the State Legislature and signed into law by the Governor in late 2002, became effective on January 16, 2003, and protects individuals who are discriminated against on the basis of sexual orientation from that date forward.

What is the meaning of the term "sexual orientation" as used in the law?

SONDA defines sexual orientation as "heterosexuality, homosexuality, bisexuality, or asexuality, whether actual or perceived." Thus, the law affords protection where individuals are targeted either based on their actual sexual orientation, or based on what the discriminator believes their orientation to be.

What legal protections does SONDA provide?

SONDA prohibits discrimination on the basis of actual or perceived sexual orientation in various areas, including:

  • In employment;
  • In the admission to and use of places of public accommodation, resort, or amusement;
  • In the admission to and use of educational institutions;
  • In publicly assisted housing;
  • In private housing accommodations and commercial space; and
  • In relation to credit.

SONDA also prohibits discrimination and/or harassment on the basis of actual or perceived sexual orientation in the exercise of an individual's civil rights. Civil rights are those rights guaranteed by State law, including the right to vote, to serve on a jury, and to be free from discrimination in the areas listed above.

Are there any exceptions to SONDA?

Some exemptions that preexisted SONDA – and apply to discrimination on any of the grounds listed in the law, not only sexual orientation – affect SONDA's application. A "religious or denominational institution," or an "organization operated for charitable or educational purposes" that is "operated, supervised or controlled by or in connection with a religious organization," may:

  • Limit employment, sales or rental of housing accommodations, and admission to persons of the same religion;
  • Give preferences to persons of the same religion or denomination; and
  • Take "such action as is calculated by such organization to promote the religious principles for which it is established or maintained."

In addition, the prohibition on discrimination in private housing does not apply to the rental of single-family and owner-occupied two-family homes.

Does SONDA protect transgender persons?

SONDA protects everyone in the State from discrimination on the basis of sexual orientation. Therefore, SONDA applies when a transgender person is discriminated against based upon his or her actual or perceived sexual orientation. In addition, courts in the State have held that transgender people are protected under other provisions of the Human Rights Law, including prohibitions against discrimination on the basis of sex and/or disability.

What can I do if I believe I have been discriminated against?

If you feel you have been the victim of discrimination, you may file EITHER:

  • A charge of discrimination with the New York State Division of Human Rights ("State Division"), or a local human rights agency, within one (1) year of the most recent act of discrimination; OR
     
  • A complaint directly in State court within three (3) years of the most recent act of discrimination.

Regardless of which of the above options you choose, you may also file a complaint with the New York State Attorney General's Civil Rights Bureau. However, filing a complaint with the Attorney General does not relieve you of the obligation to meet the filing deadlines described in #1 and #2 above.

What will happen if I file a charge with the State Division?

The State Division will investigate the charge. If it determines that the charge has merit, the State Division will hold a hearing before an administrative law judge who can provide relief. There is no fee for filing a charge with the State Division, and you do not need to have an attorney, though you may choose to retain one.

How do I choose where to file?

Each of the options has different consequences and deadlines. Thus, your decision about where to file may depend on, among other things, the outcome sought and the amount of time that has elapsed since the discrimination occurred. You should consider each option prior to acting. It is best to consult with an attorney to determine the best option. Your local bar association can provide attorney referrals.

What relief is available under SONDA?

Various remedies are available if an individual can show discrimination. 
The victim may be awarded, among other things, compensatory damages for pain and suffering and the monetary value of any lost wages or benefits. Neither punitive damages (which are used to punish particularly egregious conduct) nor attorneys' fees are generally available. However, in housing discrimination cases only, up to $10,000 in punitive damages (paid to the victim) and up to $100,000 in fines (paid to the State) may be ordered.
The discriminator may be ordered to take certain affirmative steps, including: hiring, reinstating, or promoting an employee; providing full, equal, and unsegregated accommodations and facilities to all persons; granting an application for credit; or evaluating applications for membership or admission on a nondiscriminatory basis.
The type of relief that is actually ordered will depend on the facts of each case. An individual will not necessarily receive all types of damages in every case, and the discriminator will not necessarily be ordered to take all of the affirmative steps listed above.

Are there any other legal protections against discrimination on the basis of sexual orientation in New York State?

Many localities within New York State have laws that prohibit discrimination based on sexual orientation. These laws typically prohibit the same conduct as SONDA, though they may contain additional filing or jurisdictional requirements and may allow for damages not available under State law. Under New York City's Human Rights Law, for example, an individual may be entitled to punitive damages and attorneys' fees in addition to the relief available under SONDA.


In addition, the New York Hate Crimes Act of 2000 enhances criminal penalties for perpetrators who commit specific crimes against individuals because of various protected characteristics, including sexual orientation. This type of crime is called a "hate crime." Those who commit a crime because of their victim's actual or perceived sexual orientation may be punished more severely than if that bias motive was not present.

Child Sexual Abuse

It can be very difficult to talk about sexual abuse and even more difficult to acknowledge that sexual abuse of children of all ages including infants happens every day. Sexual abuse of children has become the subject of great community concern and the focus of many legislative and professional initiatives. This is evidenced by the expanding body of literature on sexual abuse, public declarations by adult survivors and increased media coverage of sexual abuse issues.


According to the National Child Abuse and Neglect Data System (NCANDS), an estimated 9.3 percent of confirmed or substantiated child abuse and neglect cases in 2005 involved sexual abuse (U.S. Department of Health and Human Services, 2007). This figure translates into over 83,800 victims in 2005 alone (USDHHS, 2007). Other studies suggest that even more children suffer abuse and neglect than is ever reported to child protective services agencies. Statistics indicate that girls are more frequently the victims of sexual abuse, but the number of boys is also significant.

What Is Child Sexual Abuse?

At the extreme end of the spectrum, sexual abuse includes sexual intercourse or its deviations. Yet all offences that involve sexually touching a child, as well as non-touching offenses and sexual exploitation, are just as harmful and devastating to a child’s well-being.
Touching sexual offenses include:

  • Fondling;
  • Making a child touch an adult’s sexual organs; and
  • Penetrating a child’s vagina or anus no matter how slight with a penis or any object that doesn’t have a valid medical purpose.

Non-touching sexual offenses include:

  • Engaging in indecent exposure or exhibitionism;
  • Exposing children to pornographic material;
  • Deliberately exposing a child to the act of sexual intercourse; and
  • Masturbating in front of a child.

Sexual exploitation can include:

  • Engaging a child or soliciting a child for the purposes of prostitution; and
  • Using a child to film, photograph or model pornography.

These definitions are broad. In most states, the legal definition of child molestation is an act of a person—adult or child—who forces, coerces or threatens a child to have any form of sexual contact or to engage in any type of sexual activity at the perpetrator’s direction.

What Are the Effects of Child Sexual Abuse?

The effects of sexual abuse extend far beyond childhood. Sexual abuse robs children of their childhood and creates a loss of trust, feelings of guilt and self-abusive behavior. It can lead to antisocial behavior, depression, identity confusion, loss of selfesteem and other serious emotional problems. It can also lead to difficulty with intimate relationships later in life. The sexual victimization of children is ethically and morally wrong.

Proving Sexual Abuse

When sexual abuse occurs the child victim may be the only witness and the child’s statements may be the only evidence. In such cases, the central issue sometimes becomes whether the child’s statements can be trusted. Some child welfare experts feel that children never lie about sexual abuse and that their statements must always be believed. According to Douglas Besharov in The Future of Children (1994), “Potential reporters are not expected to determine the truth of a child’s statements. As a general rule, therefore, all doubts should be resolved in favor of making a report.” He continues, “A child who describes being sexually abused should be reported unless there is clear reason to disbelieve the statement.”


Child sexual abuse cases can be very difficult to prove largely because cases where definitive, objective evidence exists are the exception rather than the rule. The first indicators of sexual abuse may not be physical, but rather behavioral changes or abnormalities. Unfortunately, because it can be so difficult to accept that sexual abuse may be occurring,the adult may misinterpret the signals and feel that the child is merely being disobedient or insolent.
The reaction to the disclosure of abuse then becomes disbelief and rejection of the child’s statements.
Sexual abuse is usually discovered in one of two ways:

  • Direct disclosure (e.g., the victim, victim’s family member or parent seeking help makes a statement)
  • Indirect methods (e.g., someone witnesses the abuse to the child, the child contracts a sexually transmitted disease or the child becomes pregnant)

Sometimes the child may be so traumatized by sexual abuse that years pass before he or she is able to understand or talk about what happened. In these cases, adult survivors of sexual abuse may come forward for the first time in their 40s or 50s and divulge the horror of their experiences.

What Should You Look for If You Suspect Sexual Abuse?

Children who are sexually abused may exhibit behavioral changes, based on their age.
Children up to age 3 may exhibit:

  • Fear or excessive crying
  • Vomiting
  • Feeding problems
  • Bowel problems
  • Sleep disturbances
  • Failure to thrive

Children ages 2 to 9 may exhibit:

  • Fear of particular people, places or activities
  • Regression to earlier behaviors such as bed wetting or stranger anxiety
  • Victimization of others
  • Excessive masturbation
  • Feelings of shame or guilt
  • Nightmares or sleep disturbances
  • Withdrawal from family or friends
  • Fear of attack recurring
  • Eating disturbances

Symptoms of sexual abuse in older children and adolescents include:

  • Depression
  • Nightmares or sleep disturbances
  • Poor school performance
  • Promiscuity
  • Substance abuse
  • Aggression
  • Running away from home
  • Fear of attack recurring
  • Eating disturbances
  • Early pregnancy or marriage
  • Suicidal gestures
  • Anger about being forced into situation beyond one’s control
  • Pseudo-mature behaviors

What Can You Do?

Protect your children. Teach your children what appropriate sexual behavior is and when to say “no” if someone tries to touch sexual parts of their bodies or touch them in any way that makes them feel uncomfortable. Also, observe your children when they interact with others to see if they are hesitant or particularly uncomfortable around certain adults. It is critical to provide adequate supervision for your children and only leave them in the care of individuals whom you deem safe.


Support child abuse victims. Children need to know that they can speak openly to a trusted adult and that they will be believed. Children who are victims of sexual abuse should always be reassured that they are not responsible for what has happened to them. Offer encouragement for victims by supporting organizations that help victims of incest or by simply reassuring victims of sexual abuse that they should not feel shame or guilt. It is important to understand that troubled families can be helped and that everyone can play a part in the process.


Teach others about child abuse. Help make others aware of sexual abuse by arranging for knowledgeable guest speakers to present to your organizations or groups. Encourage your local school board to establish programs to educate both teachers and students about the problem.


Report, report, report. If you suspect sexual abuse and believe a child to be in imminent danger, report it to the local child protective services agency (often called “social services” or “human services”) in your county or state. Professionals who work with children are required by law to report reasonable suspicion of abuse or neglect. Furthermore, in 20 states, citizens who suspect abuse or neglect are required to report it. “Reasonable suspicion” based on objective evidence, which could be firsthand observation or statements made by a parent or child, is all that is needed to report. Remember that you may be the only person in a position to help a child who is being sexually abused.


Case Management Considerations


One of the reasons sexual abuse treatment is such a challenge is that it occurs in a larger context of intervention. Therefore, coordination is of utmost importance and ideally is provided by a multidisciplinary team. Treatment issues are then handled by the team as part of overall intervention.


The team usually consists of the various professionals directly involved in the case and their consultants and, as noted earlier, begins its activity at the time of case investigation. The composition and functioning of teams vary by locality, and the level of participation of team members often varies depending on the stage of the intervention. In an intrafamilial case, the members active at the treatment stage will ordinarily include the Child Protective Services (CPS) and/or foster care workers, the therapists treating various family members, professionals providing other services (e.g., homemaker, parenting guidance), a representative from the prosecutor's office, and relevant consultants. The frequency of meetings will depend on the needs of the case and how the team is structured. Child Sexual Abuse continuing education.


The following issues are the most important of those the team should consider at this stage of intervention: separation of the child and/or the offender from the family, the role of the juvenile court, the role of the criminal court, the treatment plan for the family, visitation, and family reunification.


Case management decisions are often provisional; that is, they are based on what information about the family members and their functioning is available when decisions are made. Treatment is often a diagnostic process. The positive or negative responses of family members to treatment determine future case decisions. Outcomes of court proceedings can impinge upon and alter case management decisions and treatment.
The team meets periodically to assess progress and make future plans. Because of the complexity of case management decisions and the fact that a decision in one realm can have an impact on other aspects of the case, especially on treatment progress and outcome, multidisciplinary decision making is crucial. In the absence of a multidisciplinary team, such decisions should be made in consultation with other relevant professionals.


Before the implementation of the treatment plan, the following case management decisions should be addressed:
Should the child remain a part of the family?
Do the courts have a role in the case?
Is there a question of visitation?


Guidelines for making these decisions will be discussed.


Should the Child Live With the Family?
The preferred outcome in cases of sexual abuse, as in other types of child maltreatment, is that after intervention the family will be intact.
Generally at the time of disclosure of the sexual abuse, the offender is not separated from the family. The victim may be removed if the mother is unable or unwilling to protect and support the victim or if the victim wishes to be removed. Many professionals advocate the removal of the offender even in circumstances in which the victim is removed.
After these initial decisions, a longer term plan must be made about whether the child should be a part of the family and, if so, whether or not that family should include both parents. This plan will be based on an assessment of each parent.
Aspects of the functioning of both parents outlined previously in the discussion of risk assessment should be examined in deciding about the child's future living situation. These include the following factors for the offender:
the extent of the offender's sexually abusive behavior;
the degree to which the offender takes responsibility for the sexual abuse;
the number and severity of the offender's other problems, for example;
- substance abuse,
- violent behavior,
- mental illness, and
- mental retardation.
Regarding the nonoffending parent, the following factors should be assessed:
reaction to knowledge about the sexual abuse,
quality of relationship with the victim,
level of dependency on the offender, and
the number and severity of other problems.


Other possible problems are similar for the nonoffending parent and the offender.
Although these factors are universally useful to consider, in specific cases other factors may be important or even overriding.


Offenders who have engaged in a small number of sexual acts, have taken responsibility for their behavior, and have few other problems are judged to have positive findings in these key areas and are usually treatable. Negative findings in these three areas mean that the prognosis for positive treatment outcome is quite guarded. When mothers are protective of victims when they discover the sexual abuse, have good relationships with victims, are not unduly dependent on the offender, and do not have other significant problems, their treatment prognosis is positive. Again negative findings mean that the treatment prognosis is poor.


These proposed variations in parental functioning suggest four possible combinations: both parents may have positive findings, indicating a good treatment prognosis (case type 1); the nonoffending parent may have positive findings, and the offender negative ones (case type 2); the offender may have positive findings and the nonoffending parent negative ones (case type 3); and finally, both parents may have negative findings (case type 4).


Different combinations argue for different intervention plans and long-term goals.
This matrix suggests how professionals hope to be able to make decisions. However, the parents are usually more complex than the matrix suggests. Probably in the majority of cases, the parents present a mixed picture, rather than appearing to have either a very good or bad prognosis. Moreover, as already suggested, there may be gaps in information about the family when treatment planning is undertaken and parental functioning is not static. Progress or lack of progress in treatment may result in reconsideration of the initial placement and treatment plan.

Because of these complexities, most sexually abusive families should and do receive a trial of treatment. This generally entails individual treatment for all parties and the appropriate use of groups. Initial case decisions are periodically evaluated based on treatment outcome and reassessed accordingly. In addition to being useful in placement and treatment planning decisions, the matrix may offer guidance in terms of court intervention. Most professionals would agree that the Juvenile Court should be involved in all four types of cases, perhaps with the exception of a small number of those falling into case type 1. These might be cases in which the offender confesses to his wife or family, the family seeks treatment, and the abuse is then reported to CPS by their therapist.


There is also increasing consensus that criminal charges should be filed, even though the offender appears treatable. Some professionals feel that even treatable offenders should do some jail time, while others see the criminal process as a means of ensuring that the treatable offender will take responsibility for his behavior and/or enter into treatment. However, criminal prosecution is especially important in cases categorized as case types 2 and 4 to offer some protection to both the family and society from the offender.
In addition, factors related to the child should also be considered. These include the child's wishes. To be more precise, if the child does not wish for a reunified family, that desire should be given a great deal of weight. A child's wish for the offender not to leave the home, however, should generally not be granted. In addition, some sexually abused children are so damaged, because of the abuse and other conditions, that they require specialized care outside the home.


The same assumption is made here as in earlier chapters, that there is a single offender, usually a father figure, and a nonoffending parent, usually a mother figure. If that is not the case, and there is more than one offender, especially within the family, prognosis is much poorer. Even more problematic are cases in which both parents are offenders; in such instances, family reunification is extremely unlikely to be in the child's best interest.

The Role of the Courts


Two or three courts are potentially involved in a sexual abuse case—the Juvenile Court, responsible for child protection; the Criminal Court, responsible for offender prosecution; and the Divorce Court, if either parent decides to pursue divorce.
Court involvement can be either a help or a hindrance to therapeutic goals. The challenge is to integrate court involvement into the overall intervention. Early decisions about the role of the court can facilitate its role in the therapeutic process.
The court can be helpful in compelling family members, especially offenders, into treatment; in protecting victims and families from offenders; and in effecting alternative living situations for offenders (or victims, if necessary).


Court involvement can be problematic because legal safeguards for the defendant may prevent certain evidence from being admitted; because the adversarial process may interfere with the therapeutic process, including disruption of offender treatment by incarceration; and because it allows procedural delays that may prevent timely intervention.


Finally, testifying in court may have a positive or negative effect on the child. The effect, in part, depends on its outcome. That is, if the case is won, the impact of court testimony is more likely to be positive.


Victims may gain a sense of mastery over the sexual abuse from testifying. If they are believed, they may derive a degree of vindication when they see that the offender has to pay for what he did. Completing the court process may also engender a sense of closure for the victim.


On the other hand, victims may experience court testimony as additional trauma. Some are required to confront their abusers, endure lengthy cross-examination, and reveal shameful experiences to an audience. If possible, the courtroom should be cleared during the child's appearance. Testifying in court, which rarely entails a single appearance, may enhance the child's perception of him/herself as a victim, rather than a normal child. Moreover, because the court process tends to be protracted, it may delay resolution of the victim's treatment issues. For more detailed information on the role of the court in child abuse and neglect cases, the reader is referred to another manual in this series entitled Working With the Courts in Child Protection.


Causal Models of Sexual Abuse


Before developing a treatment plan, it is important to have an understanding of why the sexual abuse occurs, both generally and in the particular case under consideration.
It is useful to briefly examine the history of causal theories of sexual abuse before a discussion of the current level of professional understanding. Historically there have been two rather separate efforts to understand the phenomenon of sexual abuse, its causes, and its resolution. These can be conceptualized as the family-focused perspective and the offender-focused perspective.


The Family-Focused Perspective


Those taking a family perspective focused their attention on incest and developed hypotheses that family dynamics are at the root of sexual abuse. Specifically, clinicians taking this perspective described the collusive mother, who has estranged herself from the father, as the "cornerstone" of the incestuous triad and the victim as a parental child who has replaced her mother as sexual partner to the father.


The implications of this model in terms of treatment are that the mother and the daughter must change, but the offender is not necessarily required to take responsibility for his behavior and develop strategies to control it. Most professionals working in the sexual abuse field recognize the limitations of a perspective that focuses purely on family dynamics.


This perspective does not help very much in explaining extrafamilial sexual victimization and, taken to its extreme, represents the offender as the hapless victim of family dynamics. Moreover, recent research, which finds that a substantial proportion of incest offenders begin their sexual victimization as adolescents and experience arousal to children before they become fathers, calls into question assumptions about the pivotal role of family dynamics in incest.


The Offender-Focused Perspective


Those who work primarily with perpetrators have historically been located in institutions for adjudicated offenders. Most of these clinicians/researchers appreciate that their clientele do not represent the full spectrum of sex offenders. Their focus has been on understanding the etiology of sexual abuse by examining the physiological and psychological functioning of offenders. They typically do not have access to families to understand any role they might have played in the victimization, nor its impact on the families. Moreover, as these clinicians develop and implement treatment strategies, they may have to do so in a vacuum and in an artificial environment. There are frequently both problems translating what is learned in treatment in the institution to the offender's normal environment and failure to continue needed treatment when the offender returns to the community.


An Integrated Model


Efforts to integrate the family and offender perspectives to the causes of sexual abuse began in the mid-1980's. Finkelhor examined the spectrum of clinical literature and research into the causes of sexual abuse and developed a model of causation that incorporates both the family-, and offender-focused perspectives. He posits four preconditions that must obtain for sexual abuse to occur: factors related to the offender's motivation to sexually abuse; factors predisposing the offender to overcoming internal inhibitors; factors predisposing to overcoming external inhibitors (e.g., absence of environmental obstacles); and factors predisposing to overcoming child's resistance (e.g., a vulnerable child or the use of coercion). Finkelhor applied this model on both the individual (case) level and the socio-cultural level.


The model presented here is somewhat different and more practice-focused. It proposes that there are some causal factors that are prerequisites for sexual abuse and there are others that play a contributing role. Prerequisite factors – sexual arousal to children and a propensity to act on arousal – are to be found within the offender, whereas contributing factors may come from the culture, from the family system (including the marital relationship), from his current life situation, from his personality, or from his past life experience.


An Integrated Model of the Casual Factors of Sexual Abuse


The presence of the two prerequisite factors (sexual arousal to children and propensity to act on arousal) is both necessary and sufficient to result in sexual abuse. This is not the case for the contributing factors. For example, a man does not sexually abuse his daughter because his marriage is unhappy. More than half of American marriages end in divorce, suggesting that a substantial number of marriages are unhappy. But only a very small number of men in unhappy marriages sexually abuse their children.


Contributing factors may enhance the prerequisite factors or they may, independent of an effect on the prerequisites, increase risk. An example of the former dynamics is found in the role of alcohol abuse. It usually leads to diminished capacity to control behavior, which may increase the propensity to act on sexual arousal to children. (Chemicals are also used by some offenders to cope with guilt related to their abuse behavior.) An example of the latter dynamic is that found in situations of unsupervised access to children. It may enhance risk because it provides opportunity for an offender who is aroused to children and prone to act on that arousal. This model will be referred to again in the discussion of treatment issues.


Treatment Modalities


In this section, the role of various treatment modalities is described. An approach to treatment that addresses prerequisite and contributing causes of sexual abuse and meets the treatment needs of victim, family, and offender must be multimodal. Ideally, individual, dyadic, family, and group treatment modalities should be available, especially if reintegration of the offender and/or the victim into the family is planned. However, therapists and programs without this full spectrum of services can be successful in treatment.


Although group, individual, dyadic, and family modalities should be available, it does not appear to be necessary to have a rigid progression from individual to dyadic to family therapy. However, it is crucial that progress be made in individual and sometimes dyadic therapy before family therapy is indicated and before individuals can benefit from it. The types of treatment and their uses will be discussed as follows:


Group therapy is generally regarded as the treatment of choice for sexual abuse. However, usually groups are offered concurrent with other treatment modalities, and some clients may need individual treatment before they are ready for group therapy. Furthermore, there will be a few clients who are either too disturbed or too disruptive to be in group treatment.


- Groups are appropriate for victims, siblings of victims, mothers of victims, offenders, and adult survivors of sexual abuse. In addition, "generic" groups that include offenders, parents of victims, and survivors of sexual abuse have been found to be very powerful and effective for all parties involved.


- Groups may be time-limited, long-term, or open-ended. They may deal with specific issues (e.g., relapse prevention, sex education, or protection from future sexual abuse), or they may deal with a range of issues. Some programs have "orientation" groups for new clients, usually with separate groups for children and adults.


- Victim's and offender's groups have been brought together for occasional sessions. Models that have concurrent groups for victims or children and their non-offending parents, where from time to time the two groups join for activities, are very productive.
Individual treatment is appropriate for victim, offender, and mother of victim (as well as for siblings of victims and survivors). As a rule, an initial function and a major one for individual treatment is alliance building. All parties have to learn to trust the therapist and come to believe that change is possible and desirable. The members of this triad may have different levels of commitment to therapy, with the victim usually the most invested and the offender the least.


Dyadic treatment is used to enhance and/or repair damage to the mother-daughter relationship, the husband-wife relationship, and the father-daughter relationship, as well as to deal with issues initially addressed in individual treatment.


Family therapy is the culmination of the treatment process and is usually not undertaken until there has been a determination that reunification is in the victim's best interest.
Multiple therapists can be very helpful. Such a complex series of interventions can rarely be provided by one individual. If possible, two therapists should be involved, even if it is only one person doing the group work and another the individual, dyadic, and family work. However, because each family member will typically participate in a group as well as other treatment modalities, there are usually several clinicians involved with a single family. Moreover, there are reasons other than logistics for involving several clinicians.


- Sexually abusive families are very difficult to work with, and therapists need one another's support. Such families are crisis-ridden and multiproblem, making it very difficult for one person to have total responsibility for the family.


- Assigning a different therapist to the victim and to the offender "recreates," although artificially, a family boundary that was crossed when the sexual abuse occurred. It also enhances a sense of privacy and safety for the victim—two elements violated by the offender.


- In addition, cotherapy, using both a male and female therapist, has considerable therapeutic advantage. It exposes family members to appropriate role models of both sexes. Cotherapy also enhances the ability of clinicians to effect change because of the leverage it allows, particularly in group therapy.


- Finally, decisions that must be made in the course of treatment are very difficult ones, and mistakes are potentially devastating. Two or more heads may be better than one. And as noted earlier, ideally clinicians should be guided in their decisions by the input of a multidisciplinary team.


Treatment Issues
There are two main objectives in sexual abuse treatment:
dealing with the effects of sexual abuse, and
decreasing risk for future sexual abuse.


Victim treatment tends to focus more on the former; mother's treatment issues are fairly evenly split; and the offender's issues are predominantly in the realm of preventing future victimizing behavior, although the initial stage of treatment may focus on the effects of the abuse disclosure on him/her.


Treatment Issues for the Victim


The saliency of treatment issues discussed in this section will vary for each victim, some possibly being irrelevant. Also, there may be additional treatment issues for victims that are not discussed here. The following issues appear to be the most important:
trust, including patterns in relationships;
emotional reactions to sexual abuse;
behavioral reactions to sexual abuse;
cognitive reactions to sexual abuse; and
protection from future victimization.
These issues are interrelated. As the following discussion illustrates, the categorization is somewhat artificial.


Emotional Reactions to Sexual Abuse


Three common emotional consequences of sexual victimization are a sense of somehow being responsible and therefore feeling guilty, an altered sense of self and self-esteem because of involvement in sexual abuse, and fears and anxiety.
Feeling responsible. An offender may make the victim feel responsible for the sexual abuse, for the offender's well-being, and/or for the consequences of disclosure. Victims may also feel guilty for not having stopped the sexual abuse as well as for any positive aspects of the abuse, such as physical pleasure, the special attention given by the offender, or an opportunity to have control over other family members because of "the secret."


The role of the clinician is to help the child understand intellectually and accept emotionally that the child was not responsible. The adult sexually abused the child; the child did not sexually abuse the adult. It was the adult's job – not the child's – to stop or prevent the abuse.


Altered sense of self. Guilt feelings as well as the invasive and intrusive nature of the sexual activity impact negatively on the child's sense of self and self-esteem. As Sgroi puts it, victims suffer from "damaged goods" syndrome.   The effect is both physical, in that children have an altered sense of their bodies, and psychological, in that children may see themselves as markedly different from their peers.


The task of the therapist is to make victims feel whole and good about themselves again. Work, mentioned above, that addresses the issue of self-blame is helpful. However, so are interventions that help children view themselves as more than merely victims of sexual abuse. Normalizing and ego-enhancing activities, such as doing well in school, participating in sports, getting involved in scouts, or helping a younger victim, can be very important in victim recovery.


Anxiety and fear to be discussed here are related to the traumatic impact of the abuse per se on the child rather than environmental responses to it. The victim develops phobic reactions to the event, the offender, and to other aspects of the abuse. Experiences that evoke recollections of the abuse come to elicit anxiety. In some children this anxiety and phobias become pervasive and crippling because of the level of avoidance they engage in to reduce their stress.


Before treating the child's fears and anxiety, the therapist must be sure the child is not being sexually abused or at risk for sexual abuse. Then the therapist engages the victim in a series of interventions that allow her/him to gradually deal with the abuse and related phobias and anxiety in ways that usually avoid excessive stress and allow mastery.  These may include discussions, play therapy, or interventions in the child's environment. For example, the victim may be encouraged to ventilate by talking about the abuse and accompanying feelings, thereby reducing the level of distress related to it. Similarly, a child who is phobic about being left with a babysitter may be left with a relative first for short and then longer time periods, then with a babysitter for brief and then longer periods and thereby be desensitized to babysitting situations. Child Sexual Abuse CEU Course, Continuing Education Online. Meets state board requirements.


Additional emotional reactions may be found. Depending on the circumstances of the victimization and the child's personality, she/he may react with regression, anger, depression, revulsion, or posttraumatic stress disorder to sexual abuse. These emotional reactions are likely to manifest themselves in problematic behaviors. These behaviors will be discussed in the next section.


Behavioral Reactions to Sexual Abuse


As suggested in the second chapter, behavioral effects of sexual abuse can include sexualized behavior and other behavior problems.


Sexualized behavior. A serious reaction is sexualized behavior. Children who have been sexually victimized may masturbate excessively and openly or sexually interact with other people. Every act of sexualized behavior has the potential for increasing the probability of future acts. Not only is the activity likely to be physically pleasurable, but it may also enhance the child's view of her/himself as a sexually acting out person. Such acts may also stigmatize the child, which has a negative impact on the child's sense of self.


Clinicians should work to diminish and/or eliminate sexualized behavior through teaching behavioral controls. Sexual acting out may be controlled, for example, by teaching the child to masturbate privately. Behavior management techniques, which can involve rewarding "sex-free" days and using "time-out" for sexual acting out, can be taught to the child's caretaker. In addition, the child's energies that might have gone into sexual behavior can be channeled into more age-appropriate activities by having a caretaker monitor the child, interrupt any sexual acting out, and provide opportunities for positive alternative behaviors. These interventions are conducted with the child's caretaker and/or in dyadic work with child and caretaker.


One of the reasons treatment of sexualized behavior is so essential is because of a recently recognized phenomenon called the victim to offender cycle. Both male and female victims are at risk for this problem. Many offenders begin as victims, whose response to sexual abuse is to identify with the aggressor and to sexually act out in order to cope with their own sense of vulnerability and trauma. Professionals must recognize the potential danger of allowing sexualized behavior to go untreated, which is that the child then is at risk for becoming first an adolescent offender and eventually an adult offender. The child not only damages him/herself, but also may cause grave harm to many other children over the course of time.


Other behavior problems. Other behavioral reactions to sexual abuse include such problems as aggression toward people and animals, running away, self-harm (cutting or burning), criminal activity, substance abuse, suicidal behavior, hyperactivity, sleep problems, eating problems, and toileting problems.


Some of these problems, for example, difficulties with sleep, eating, toileting, and being alone, may be acute after disclosure but diminish over time and eventually disappear. Short-term intervention, labeling the behavioral problems as common reactions, and helping the victim resolve the underlying emotional or cognitive issues is generally helpful. Parents are encouraged to be understanding.


Treatment strategies for all behavioral problems include helping the victim understand the relationship between the behaviors and the sexual abuse and emotional or cognitive reactions to it; helping the child develop insight into the self-destructive nature of some of these behaviors; assisting the victim in more appropriate expression of the emotions, for example, anger; and behavioral interventions to diminish and eliminate problematic behavior. With older children, group therapy is usually very useful in addressing these problems.

Adolescent Sexual Behavior


Sexual intercourse is the most commonly studied form of adolescent sexual behavior, and there is a substantial literature on the determinants of initiation of coitus. Forty-eight percent of high school students have ever had sexual intercourse; 35 percent are currently sexually active. Much is known about the predictors of sexual debut. For example, studies show the influence of perceived parental and peer norms on adolescent sexual activity and risk-taking. Race and ethnicity are key predictors of age of intercourse initiation, as is gender, with minority youth and males more likely to have sex at a younger age. According to the most recent Youth Risk Behavior Surveillance survey, a study of U.S. high school students conducted by the Centers for Disease Control and Prevention (CDC), more black male (72.1 percent) and Hispanic male (52.8 percent) students have ever had sex than black female (58.3 percent) and Hispanic female (45.4 percent) students. These rates compare to 42 percent among white males and females, who do not differ from each other in terms of the percent who have ever had sex. Possible explanations of gender differences include the differential consequences of unintended pregnancies and the opportunity costs of sexual activity, as well as differences in parental supervision. Racial and ethnic differences may stem from socioeconomic factors that limit opportunities for poor youth, cultural factors that consider parenting a path to adulthood among African-American youth, and differences in the normative environment surrounding sexual activity and parenting. Social bonds, including strong relationships with parents, schools, or religious organizations, serve as protective factors, reducing rates of early sex.


 Early intercourse appears to be part of a cluster of adolescent problem behaviors. It correlates with substance use, truancy, and aggression and is also well predicted by indicators of behavioral deviance. Intercourse at any age places an individual at risk for pregnancy and at greater risk for STIs. But early intercourse initiation poses special risks, with an increase in the odds of both pregnancy and STIs when it occurs at a younger age. As noted at the outset of this paper, rates of pregnancy and STIs are high among U.S. teens, and delaying the age of sexual debut may be one method of addressing these high rates.


In comparison to the study of intercourse, researchers have paid little attention to other forms of sexual behavior. However, carefully conducted surveys of a Los Angeles County high school and a nationally representative group of adolescent males (aged 15-19 years) indicate that substantial proportions of adolescents who have not engaged in vaginal intercourse have engaged in other sexual activity involving genital contact, such as mutual masturbation and oral sex. Because noncoital activities are an important part of adolescent sexuality, and because some of them pose a risk of STIs and may be precursors to the initiation of coitus, researchers are becoming more interested in understanding and predicting these behaviors.


Researchers have also looked at the predictors of sexual risk-taking — sex without condoms, sex without birth control, or sex with multiple partners in a short period of time (e.g., one year). Many of the factors that predict intercourse initiation also predict these risk behaviors. These behaviors are the primary risk factors for STIs and pregnancy. As noted earlier, nearly 800,000 young women aged 15-19 years become pregnant in the United States each year. This represents a pregnancy rate of 71.5 per 1,000 women and is one of the highest rates among industrialized nations. Half of the roughly 19 million new STIs diagnosed each year are among 15- to 24-year-olds. That amounts to one STI for every four sexually active youth. A recent study conducted biological testing for five STIs among a nationally representative group of females aged 14-19 years. Twenty-four percent tested positive for at least one of these infections, and among those who were sexually experienced, the prevalence rate was 37.7 percent. Fifteen percent of 9th-12th graders report having four or more partners in their lifetime. Among sexually active adolescents in this age group, only 63 percent report that they or their partner used a condom the last time they had sexual intercourse. Given these high rates of risk-taking, the number of pregnancies and STIs experienced by U.S. adolescents is unsurprising.


The challenge to promoting sexual health in the United States has been to identify addressable risk factors for adolescent intercourse, sex outside of a monogamous ongoing relationship, and unprotected sex that will have maximum impact on a large number of youth. Given its broad reach and the potential to control exposure, media may be one such modifiable risk factor. For the same reasons, media may also represent a particularly useful tool when employed as part of a sexual health intervention. Both possibilities depend, of course, on whether media use is related to sexual attitudes and behavior. In the next section, we review theories and evidence bearing on this question.


Theories and Evidence Linking Media Use and Adolescent Sexual Attitudes and Behaviors


Videos are both downloaded and posted on the Internet, offering opportunities for participation and media creation, as well as exposure. Twenty-two percent of Americans have shot their own videos, and 14 percent of those users have posted them online. Young adults aged 18-29 years and men are the most active users of online video (70 percent and 53 percent of users, respectively). They more often receive video links, send video links to others, watch videos with others, rate them, comment about them, upload them, and post links online. Fifty-seven percent of online teens aged 12-17 watch video online, and 14 percent have posted videos online. The most popular site for web videos is YouTube, with almost 5.4 billion views at most recent count. Although the use of other sites, most notably Hulu (which allows users to view television programming from all but one of the major networks, as well as other sources), is growing, 40 percent of all online video-viewing is attributable to YouTube and only 2 percent to Hulu.


Other online activities are less common. Use of email has declined among teens over the past few years. The overwhelming majority, 73 percent, still use it, but only 14-16 percent use it daily, and it accounts for only 6 percent of time spent with computers by youth. In contrast, instant messaging accounts for 13 percent of time spent with computers, and social networking accounts for 25 percent. Pew estimates that 26 percent of teens send and receive instant messages on a daily basis, and the percentage who send messages through social networking sites is the same. According to another Pew report, 14 percent of online teens currently blog, down from the 28 percent of teen Internet users, as estimated in a 2007 report.


One of the newer online social media platforms is Twitter, a social networking and blogging service that allows posts of only 140 or fewer characters. Currently, few of its users are youths: Seven percent are 18- to 24 years old and fewer than 4 percent are 17 or under. It boasts only 20 million recent visits across age categories, less than a fifth of the number of Facebook visitors. Pew reports that 8 percent of Internet users aged 12-17 use Twitter, though numbers are higher among the older teens in this group, particularly girls. Thirteen percent of girls aged 14-17 years report using it.


Nearly 90 percent of all Americans are mobile (cell) phone users. The Kaiser report estimates that two-thirds of youth aged 8-18 years own their own cell phone. This closely tracks with an estimate of 71 percent ownership among 12- to 17-year-olds, based on a 2008 Pew survey. Both organizations find that the use of cell phones rises rapidly at about age 14, and the vast majority of older teens (84-85 percent of those 17 and older) have a cell phone. Teens from families of lower socioeconomic status are somewhat less likely to own a cell phone (62 percent of those with household incomes below $30,000 own a cell phone, while 79 percent of those from households with incomes of $75,000 or more do so). Cell phone ownership does not vary by teens' race/ethnicity or gender. However, teen girls use their cell phones for talking and texting more often than do boys.


In general, more teens use their cell phones for talking than texting. But the overall frequency with which cell phones are used for texting is higher, indicating that those who do text do so with great frequency: Youth spend an average of 33 minutes talking on their cell phones each day but an average of 1.5 hours sending and receiving texts. This fits with statistics regarding the general population of U.S. cell phone users, who are more often sending text messages than making calls. U.S. mobile users send an average of 357 texts per month and make an average of 204 calls. Teens make up the vast majority of those using text messages, with youth aged 13-17 years sending or receiving about 1,742 text messages per month. Increasingly, cell phones are also being used to access email and the Internet. The number of persons who did so daily last year was about 22 million. Cell phones are also used to play games (17 minutes/day among youth), watch television content (15 minutes/day), and listen to music (17 minutes/day).30 Indeed, cell phones are becoming indistinguishable from the MP3 players owned and used by 74 percent of teens. A number of lessons emerge from these data. Among them is the finding that television content still dominates the media landscape. While new media combined are taking up more and more of teens' time and television programming is increasingly being viewed on platforms other than a traditional set, television is still, by far, the most central aspect of adolescents' media lives. No other activity comes close in terms of time spent with a particular form of content or a particular platform. In terms of time spent online, YouTube, game playing, and social networking sites are the key activities and are equal-attention grabbers for youth, though as we will note below, they have not been equally attended to by researchers. Cell phones are increasingly the platform of choice: When time spent texting and talking is included in estimates, teens spend more time with them than with computers and use them for a full range of activities. Cell phones are used for listening to music, watching television content, and playing games (when combined) more than for talking. Text messaging is not yet the preferred mode of phone communication for the majority of youth, but among those who use it, it is vastly preferred over talking.


Though largely expected, some other patterns are also apparent and should be emphasized. First, a substantial portion of the time spent with newer media involves creating content and interacting with others — posting comments and information on social networking sites and looking at or posting video on YouTube. Second, platform and content are increasingly independent. A large amount of "television" is watched on something other than a set. As the technology and software to use the Internet on television sets becomes available, shifts may occur in this direction as well, such that televisions become the preferred mode of listening to music, browsing online, or communicating with friends. Thus, it will be critical to think about both platform and content in exploring media effects and developing interventions related to sexual health, and to make no assumptions about how or where a particular form of content will be consumed. Finally, we note that the use of new media spans racial/ethnic and gender boundaries, though there are small gender differences in the use of video and online games, somewhat lower rates of cell phone ownership among the youngest teens, and somewhat less game playing among older teens. As with traditional media, the rates of many forms of new media use are somewhat higher in the minority groups that are at higher risk for teen pregnancy and STIs. Thus, there is much potential to reach these groups with interventions, as well as some potential for negative effects of exposure.


Associations Between New Media Use and Adolescent Sexual Attitudes and Behaviors


Little is yet known about the effects of these trends on sexual socialization and development, but there is reason to believe that there may be differences in the effects of new versus traditional media. Content creation that involves portraying oneself in a sexual manner may have different effects on subsequent sexual activity than exposure to sexual content as an audience member. For example, we can speculate based on psychological theory that creating sexual content may more directly influence self-perception (e.g., perceptions of the self as a sexual object or agent) or may influence how others perceive and interact with the content creator (resulting in treatment as a sexual object or agent). Because sexual postings and messages may result from perceived peer or other social pressures, or are intended to be funny (but not always perceived as such), the materials that teens post and the messages that they receive may be inconsistent with prior sexual experience and sexual intentions. That is, a sexually inexperienced teen may post a sexual message to appear mature or to make a joke. Once he or she observes his or her own actions, and particularly if other people's reactions reinforce the teen's sexualized behavior, the teen may shift to see him or herself as sexually mature or as a sexual object. Ultimately, this could accelerate sexual activity or lead to more casual or risky activity than might otherwise take place.


Some Internet-based media (e.g., social networking sites, chat rooms) also provide youth the opportunity to construct and "try on" identities that may not fit the users' offline selves while interacting with others. One can be any gender, race, age, or level of physical attractiveness online. This unique property is particularly relevant to a stage of life characterized by a search for one's identity and an attempt to integrate sexuality into that identity. It leads us to speculate that, if youth use this opportunity to try on sexualized identities, social media use might result in youth making or receiving more offers of sex than would be the case if the same time were spent passively viewing sexual materials on television sets or in film.


We can also speculate that differences in the effects of new versus traditional media might result from variations in the content and manner of use. The specific content that a person is exposed to may vary by platform (e.g., television programs viewed on a set versus over the Internet), or the platform may change the manner in which content affects youth (e.g., by influencing whether content is viewed with divided attention or accompanied by peers' comments). As noted above, the key platforms for new media are cell phones and the Internet. The Internet affords adolescents easy access to sexual information in a context of anonymity, and the content is largely free. Cell phones provide a particularly portable method of engaging with content. They can be taken everywhere and used throughout the day. Thus, they give youth access to media at every waking hour and, like the Internet, can give youth the perception of anonymity. They also make youth particularly accessible for interventions to address sexual health needs. With cell phones, youth can seek information and assistance in real time as issues and questions regarding sexual health come up, and conversely, youth can be reached easily with reminders about sexual safety. Thus, we might hypothesize that new media results in more exposure to sexual content, more privately, at more times of the day, and in more contexts than does use of traditional media.

While there is reason to believe that the effects of new media may differ from those of traditional media, there is little empirical evidence on this issue. Indeed, few studies of new media effects have been conducted. However, there are studies describing how these media are used by adolescents and the types of new media in which sexual content is known to reside that speak to this issue. Below, we review these studies and the limited available evidence regarding new media influence on adolescent sexuality. Our literature search identified five types of new media about which relevant research has been conducted: (1) online pornography, (2) online social

networking sites, (3) online chat rooms, (4) "sexting" (the posting or sending of sexual text or sexual images of oneself), and (5) video games. We look at each of these media, in turn, below. We begin with the three media that are Internet-specific (online pornography, social networking, and chat rooms) and then turn to those that cross platforms (for example, sexting occurs online as well as via cell phone, and we discuss both on- and offline video games because the literature combines the two). In the section on Internet-specific media, we also review the fairly substantial literature concerning online sexual solicitation. While not a specific medium, it is a form of sexual content, both created and received, that occurs in new media and is therefore clearly relevant to the issues addressed in this paper.


Before we begin the review, we note for readers that the Internet research we describe focuses exclusively on youth who describe themselves as 13 years of age or older. The Children's Online Privacy Protection Act requires parental consent to collect personal information from children under 13 using the Internet. Social networking sites, chat rooms, and others must not allow users under the age of 13 unless the sites do not ask for or allow youth to supply personal information. This affects what researchers can do in terms of studying online behavior and what youth say about their ages when online (i.e., whether they represent themselves accurately). Following this discussion, we address research evidence regarding cell phones and sex and the empirical studies of video games.


Internet-Specific Media


Pornographic Web Sites.
A broad literature has examined the influence of pornography exposure on young adults, using both correlational and experimental designs. These studies have, for the most part, looked at traditional media, such as films and magazines, and focused on young men. Nonetheless, they suggest the range of effects that one might expect to observe among adolescents exposed to pornography on the Internet. Such effects include more permissive sexual attitudes, overestimation of various sexual activities engaged in by others, and less satisfaction with one's own sex life (see Zillmann, 2000, Huston et al., 1998 for reviews). Among adolescents, Brown and L'Engle found that those exposed to pornographic materials through a variety of media (including Internet pornography and traditional media) were subsequently more likely to report permissive sexual attitudes (e.g., acceptance of casual or premarital sex) and to have oral or vaginal sex than youth with less exposure. The study used a particularly strong longitudinal survey design, reducing the likelihood that permissive attitudes led to interest in pornography, rather than the reverse.


In the sexual socialization of youth, Internet pornography may be at least as influential as pornography appearing in traditional media. The Internet makes pornography readily accessible to young people, generally without cost. It also affords the user greater privacy than magazines or film and more explicit content than most television programming. The Internet is probably also more likely than traditional media to expose youth to pornography inadvertently, and inadvertent exposure might reach youth less inured to the messages contained in pornographic media. Internet content, because much of it is user-generated, may also be perceived as more realistic (or actually real); moreover, it can be viewed in "real time" via webcam and can be interactive. Each of these factors may increase viewer involvement and thus enhance any effects of exposure relative to the same content in traditional media, though this is untested. In our review of the literature, we found a number of studies that describe the prevalence of exposure and the background characteristics of those exposed. A few studies have also tested for cross-sectional associations between exposure to online pornography and youths' sexual attitudes, behavior, and health. And, finally, a set of studies have examined longitudinal correlates of online pornography exposure, all based on surveys of Dutch youth.


Estimates of the percentage of youth exposed to Internet pornography vary. Ybarra and Mitchell based their estimate on the Youth Internet Safety Survey (YISS), a survey of a representative group of 1,501 U.S. 10- to 17-year-olds who were regular Internet users, conducted in the years 1999-2000. Twenty-five percent of the sample reported unwanted exposure to sexual images (naked people or people having sex) on the Internet in the prior year. Eight percent of youth sought pornography online in the same period — that is, they reported visiting an X-rated website on purpose. About half of these youth also sought pornography offline, through magazines, movies, or telephone sex lines. Offline-only seekers of such material constituted 7 percent of those surveyed.
Wolak and colleagues examined similar issues in the 2005 YISS, a subsequent survey of another sample of 1,500 U.S. Internet users aged 10-17 years. They found that 42 percent of youth reported past-year exposure to online pornography, overall. Among these, 13 percent sought this exposure — a 50-percent increase from the prior YISS. Increases in unwanted exposure from 1999-2000 were nearly as large, climbing from 25 percent to 34 percent. Most of these youth (66 percent of those exposed, or 28 percent of youth overall) reported that all of their online pornography exposure was unwanted.


Estimates from the YISS are probably the best available for U.S. youth, given their representative sample. However, it is important to note that only regular Internet users are represented, not all youth. Those who spend little time online are probably less likely to encounter pornography, simply because they view less online content overall. The YISS sample also does little to illuminate the online experiences of disadvantaged youth, who are likely to be infrequent Internet users. Some information regarding such youth is provided by Braun-Courville and Rojas, who found that, among U.S. adolescents (12-22 years) attending a primary care clinic that serves primarily minority and disadvantaged youth, 46 percent said that they had been accidentally exposed to sexually explicit websites. Although a comparison of this figure to the YISS estimate of 34 percent suggests that disadvantaged youth may be more vulnerable to inadvertent online-pornography exposure, other study factors make the difference across studies difficult to interpret. In particular, Braun-Courville and Rojas looked at a somewhat older sample and asked about any exposure, while the YISS assessed exposure in the prior year.


One other U.S. study also collected estimates of "any" online pornography exposure. Sabina and colleagues surveyed college students, collecting retrospective reports of their lifetime exposure to Internet pornography. Since all participants had reached college age, this provides a longer window for assessing exposure than any other study, allowing conclusions about the number of adolescents ever exposed. But this method also increases the possibility of biased or inaccurate recall. Results indicated that 93 percent of males and 62 percent of females had been exposed to pornography on the Internet prior to age 18. Mean age at first exposure was 14 years for males and 15 years for females. Males were more likely to seek out pornography, while most females ever exposed (42 percent of females overall) reported that all of their exposure was involuntary.


Overall, then, it appears that between 38 and 55 percent of youth are exposed to pornography on the Internet each year, and most youth will be exposed by the time they are 18. Some of the variability in this estimate appears to be due to shifts in exposure over time, with higher estimates coming from more recent studies. This interpretation is supported by a trend observed in the single survey that has been repeated over time using the same methodology. Although the studies discussed here are not consistent, they suggest, on balance, that most such exposure is inadvertent, with only a small minority of youth reporting that they seek pornography online (this may reflect a reporting bias, however). It also appears that exposure in the United States is similar to rates in other countries that have been studied. Differences in the representativeness of the samples, ages studied, question wording, reference periods, and definitions of pornography almost certainly also contribute to the variable estimates in the literature so far. A more definitive estimate of exposure to pornography online will be possible as researchers come to an agreement regarding the best methods of defining and asking about such exposure, based on the emerging data.


What online behaviors and conditions predict exposure? One factor may be the search strategies employed by youth. In one of the earliest reports on exposure to Internet pornography, the Kaiser Family Foundation found that 70 percent of 15- to 17-year-olds were accidentally exposed to pornography when searching for health information online. Consistent with this, analysis of the first YISS indicated that unwanted exposure occurred as a result of search results, misspelled web addresses, links on websites, pop-up adds, or spam email. However, that study included in the "unwanted exposure" category youth who had experienced wanted as well as unwanted encounters with Internet pornography. Analysis of the second YISS showed that, among youth for whom all exposures were unwanted, exposure was related to only one Internet activity: using file-sharing software to download images. Filtering and blocking software appear to reduce the likelihood of both wanted and unwanted exposure to Internet pornography.


Certain demographic and behavioral characteristics also predict exposure to online pornography. Several studies indicate that males are more likely to be exposed than females. Age is also a factor, with older youth more often exposed. Other identified predictors suggest that youth who are "at risk" offline are more likely to be exposed to pornography online, whether deliberately or inadvertently. Youth exposed to online pornography score higher in sensation-seeking, a personality characteristic linked with multiple risk behaviors. Consistent with this, online pornography seekers more often report substance use (37 percent used cigarettes, alcohol, or other substances four or more times per week) or delinquent behavior (48 percent) in the prior year, compared with youth who do not seek out pornography online. Those who experience only unwanted exposure to Internet pornography are more likely than those not exposed at all to be harassed or victimized both online and offline and to show symptoms of depression. It is also important to note that some of these characteristics distinguish offline seekers of pornography from nonseekers of such materials.79 Thus, the seeking of pornography on the Internet may be another in the cluster of risk behaviors that distinguish some adolescents.


Exposure to Internet pornography is of interest to those who study or attempt to improve public health and positive youth development because theory predicts that it may influence beliefs and behaviors. Few studies have attempted to assess this, but those that have done so indicate that this could be the case. For example, a survey of adolescents (13-18 years) recruited from an online convenience panel found that those who reported exposure to sexually explicit material online were more likely to endorse statements that describe women as sex objects and sex as recreational. In their study of adolescents attending a primary care clinic, Braun-Courville and Rojas found that reported exposure to Internet pornography was related to permissive sexual attitudes, having multiple lifetime and recent sex partners, use of alcohol and other drugs at most recent sex, and ever having engaged in anal sex. It was not related to condom use or STIs. Similarly, in a survey of Taiwanese adolescents, Lo and Wei found that youth with more Internet pornography exposure reported more sexually permissive attitudes and sexually permissive behavior, even after accounting for gender, age, religion, and exposure to pornography in traditional media.


While this research provides some preliminary insights, the results are limited by a few key factors. First, all of these studies employed a cross-sectional design in which data were collected at a single time point. It is unclear whether positive attitudes toward casual sex and more casual sexual behavior lead to an interest in Internet pornography or are caused by it. It is also possible that both are caused by a third factor. For example, permissive parenting might lead to both pornography exposure and permissive sexual attitudes or behavior; this was not controlled for in the studies. While each study did include some covariates in its analyses, the set used was sparse in most cases and not exhaustive in any case.

Longitudinal studies go one step beyond this. By measuring pornography exposure at one point in time and "outcomes" at a later point, they reduce the possibility that attitudes and behaviors precede adolescents' use of pornography and thus the likelihood that the causal relationship between these factors is reversed. As yet, no studies have examined longitudinal correlates of online pornography exposure among U.S. youth, but a few reports have been published based on a longitudinal study of Dutch youth. Peter and Valkenburg followed 1,052 Dutch adolescents and young adults (13-20 years) over a period of one year, collecting three waves of data. Self-reported intentional exposure to Internet pornography at wave 1 and wave 2 each predicted lower levels of sexual satisfaction at the subsequent survey wave, after controlling for prior levels of satisfaction. Some, but not all, analyses indicated that this relationship is stronger among youth with less prior sexual experience and among those who believe their peers to be sexually inexperienced. In an earlier analysis of the same data set, the amount of intentional exposure to Internet pornography was also found to predict subsequent "sexual preoccupancy" (defined as a strong cognitive engagement in sexual issues, i.e., "I have thought frequently of sex").


Social Networking Sites.
Social networking sites are places where youth can encounter sexual text, photos, and videos and can also create and/or post such materials themselves. No study has attempted to determine the effect of such materials on young people's sexual attitudes and behavior. A few studies have examined the potential for this by documenting the sexual content of these sites. Although what is known even in this area is still quite preliminary, a few insights can be gained from their results. As with the Internet more generally, some caveats to what can be studied on such sites are in order before this evidence is reviewed. It should be noted that all of the research is based on publicly available profile content. Social networking sites allow users to mark some information as private, and what is hidden is probably more personal in nature. Of course, adolescents surfing through profiles will not encounter this private information, but if it is posted on the profile of an online "friend," they will, and this is the more typical way of using social networking services. We also note that one of the major social networking sites, MySpace, automatically sets profiles of youth who report their ages as 14 or 15 to "private." Thus, content analysis of their profiles is not possible.


Hinduja and Patchin analyzed the content of a random sample of 1,475 public MySpace profiles posted in June through August 2006 by individuals describing their age as 16 or 17 years. They found that 5.4 percent had posted a picture of themselves in a swimsuit or underwear, and 15.5 percent included a picture of a family member or friend in a swimsuit or underwear. There are some difficulties in interpreting these results; for example, it is unclear whether these photos were sexual in nature. But the authors note that there may be some risk to picture-posting adolescents from sexual predators. We note here that, if the pictures are sexual, exposure to these photos on others' profiles may also influence normative perceptions regarding sexuality.


Moreno and colleagues also conducted content analyses of MySpace profiles in order to determine to what extent sexual and other information is displayed there. In their initial study, they examined 500 profiles of youth aged 18 years that were publicly accessible and had been recently accessed by their owners. They coded for sexual content in each profile, defining sexual content as "completion and display of a 'sex survey'" (i.e., one of the many surveys that one can complete on a social networking site, sharing results on one's own profile) or "describing personal sexual preferences, self-disclosures of sexual experiences, pictures of profile owner in undergarments, and downloaded sexually suggestive icons such as Playboy bunnies." Based on these criteria, 24 percent of youth profiles contained sexual content. There was a trend indicating that female adolescents may be more likely to display sexual content than males. Reporting a sexual orientation other than "straight" was associated with more references to sexual behavior, while displays of religious, sports, or hobby involvement were associated with fewer references to sex.


In a subsequent report, these researchers explored the homophily hypothesis for sexual content: that youth who posted sexual content on their own profiles were more likely to have online friends with posted sexual content than were youth who did not include sexual content in their profiles. Moreno and colleagues collected a representative set of public MySpace profiles belonging to individuals who posted their age as 18 years. From these, they selected 10 profiles that included at least one sexual reference (using the definition from the aforementioned study) and 10 that did not. The profiles for all eight of each individual's "Top 8 Friends" (a feature on MySpace at the time of data collection) were then sampled, resulting in a total of 160 friend profiles for analysis. Based on the broad definition of sexual content in the study, friends of persons with a sexual reference on their own profile were as likely to display a reference to sex on their own profile as friends of persons who did not display a sexual reference (i.e., there was no association between a person's sexual references and the likelihood of a sexual reference among their friends). However, when a more narrow definition was applied that focused on explicit references (e.g., a "personally revealing" photograph or a statement using explicit language), those with a sexual reference on their own profile were more likely to have friends with an explicit sexual reference in their profiles.


Williams and Merten looked at 100 profiles posted by youth reporting their ages as 16 to 18 years and accessed within the 60 days prior to data collection. The sample was purposive and based on equal distributions by region of the country, school affiliation (public or private), gender, and age. Sexual text was coded as referring to sexual activity or as sexual language. Photos were coded for whether or not they were "inappropriate," including scanty clothing and/or risky behavior or sexually suggestive body positioning, as well as activities such as alcohol use. Seventeen percent of photos were coded as inappropriate. Nearly half of all profiles (44 percent) contained explicit or graphic language, and 16 percent contained references to sexual activity.


There is also evidence that some youth who use social networking sites will be subject to unwanted sexual solicitations. Of the 15 percent of youth who reported receiving an unwanted online solicitation in a 2006 survey, 27 percent reported that such an incident occurred on a social networking site, while 32 percent and 43 percent reported that an incident occurred in a chat room or via instant messaging, respectively. Thus, while social networking sites open youth up to solicitation, other online activities pose a greater risk. The study did not examine the percentage of youth who receive wanted solicitations or who sexually solicit others. We will say more on these issues later, in the section on sexual solicitation.


Chat Rooms.


Although they are less popular with teens, teen chat rooms appear to be highly sexualized environments. In an early analysis, it was found that a sexual comment was made every four minutes in a sample of 321 minutes of conversation from AOL teen chat rooms, observed during after-school and weekend hours. This is roughly three times the frequency with which sexual content was likely to appear on television in 1997-1998 (among shows that contained any sexual content).


More recently, Subrahmanyam, Smahel, and Greenfield conducted a content analysis of 20 chat sessions, constituting approximately 600 minutes of conversations among 583 individuals (as indicated by distinct screen names). They looked at two popular teen chat services, one in which chats were monitored and one in which they were not, coding 10 chats from each type. Monitors warn chatters not to reveal personal information that might make them vulnerable (e.g., names, zip codes) and enforce rules such as not encouraging drug use and not engaging in hate speech. Nineteen percent of all nicknames were sexual in nature (note that "sexual" was very broadly defined and included anything that "made its owner more sexually attractive," such as "angel" or "prettygirl"). Across the two types of chats, sexual themes constituted 5 percent of all utterances, which translated into one sexual comment per minute of discussion. These comments were uttered by 28 percent of all participants (as indicated by distinct screen names). Males and females (based on the gender suggested by screen names) were equally likely to contribute sexual comments, though males were more likely to contribute explicitly sexual comments. Explicitly sexual utterances were also twice as common on unmonitored as monitored sites, but there was no difference between sites in the frequency of implicit sexual comments (e.g., "all hot guys that wanna chat . . ."). It is important to note that, while teens who want to engage in more sexually oriented chat may gravitate to unmonitored sites, the study also found a difference in what was said online within monitored sites when the monitor stepped away from the conversation periodically. Thus, the presence of a monitor does seem to affect conversational content among teens. Finally, the study found that chatters who claimed to be older were more likely to make explicitly sexual remarks than those who reported a younger age.


Whether chat room experiences affect sexual attitudes or behavior has not been tested. The only evidence speaking to this possibility are analyses of a cross-sectional, statewide survey of ninth-grade public school students in Minnesota. The study found that youth who used chat rooms to connect with others were more likely to engage in a variety of risk behaviors, including initiating sexual intercourse. Those who reported chatting online were between 50 percent (among boys) and more than 100 percent (among girls) more likely to have ever had sex than those who did not chat online. However, the assessment of chatting and intercourse initiation in a single survey, and the absence of statistical controls for factors that might affect both of these behaviors, renders these results inconclusive. Teens who chat online may be more likely to initiate intercourse as a result, but it may be instead that risk-prone youth tend to engage in both behaviors. One final issue of note with regard to chat rooms is that their use by teens has been discussed and examined as possibly placing teens at risk for sexual solicitations. We discuss this in more detail in the next section.


Sexual Solicitation.


Another way in which youth may encounter sexual information online is through experiencing sexual solicitations or witnessing them. Unwanted online sexual solicitation is defined by most research as "the act of encouraging someone to talk about sex, to do something sexual, or to share personal sexual information even when that person does not want to." Solicitations have received a great deal of public attention, largely because of fears that they may result in the rape or abduction of adolescents by adults. As a result, the literature focuses primarily on determining the likelihood of these risks. It is important to note that more benign solicitations (e.g., solicitations between acquainted same-age youth) may also be of research interest. Such solicitations could theoretically influence the ways that youth think about sex, fostering perceptions of casual sex as normative, and perhaps as menacing or harassing (when solicitations are perceived as such). They might also influence sexual activity, if solicitations are accepted. Below, we review what is known about online solicitations, including both the prevalence and predictors of receiving such communications.


The primary source of information concerning online sexual solicitation is the YISS, described earlier, in the section on Internet pornography. The initial survey, conducted in 1999-2000, found that 19 percent of regular Internet users aged 10-17 years reported receiving an unwanted online solicitation in the prior year. Three percent of youth reported receiving an aggressive solicitation, defined as an attempt by the solicitor to make offline contact. The primary behavioral factors in solicitation risk were communicating with strangers online (i.e., persons who were not known offline), participating in chat rooms, and using the Internet more frequently. Demographic risks included being female, being older, and having problems in other areas of life. Parental supervision of youth Internet use, measured in a variety of ways, was unrelated to risk for solicitation.


In the 2005 version of the YISS (conducted with a new cross-sectional sample), Mitchell and colleagues found a decrease in reports of solicitation receipt of approximately 50 percent, compared with the prior survey. This decrease was found regardless of age and gender but did not occur for low-income and minority youth. There was no decrease in the number of aggressive solicitations in any subgroup.


In another analysis of the YISS, Mitchell and colleagues examined whether young bloggers are at greater risk of online sexual solicitation. They found no evidence that this is the case. As in their prior analyses, those who interacted with people they met online were at greater risk for solicitation, but bloggers were no more likely to do this than those who did not blog. Bloggers were more likely to post personal information, but this was unrelated to risk for solicitation. The study did find, however, that young bloggers were more likely to report online harassment, suggesting that some nonsexual forms of risk may be increased by the activity.

In the Growing Up with Media study, a national survey of 10- to 15-year-olds who had used the Internet at least once in the six months prior to survey (conducted in August through September 2006), 15 percent reported receiving an unwanted online sexual solicitation in the prior year. As noted in the section on social networking, the most common venue for such incidents was instant messaging (43 percent), followed by chat rooms (32 percent) and social networking sites (27 percent). The same survey provides the only published data regarding perpetration of unwanted sexual solicitation. In an analysis of the Growing Up with Media data, Ybarra and colleagues find that 3 percent of Internet users aged 10-15 years report engaging in this behavior in the past year.

That report and others suggest that sexual solicitation overlaps with other forms of interpersonal victimization. Ybarra and colleagues found that 13 percent of all youth reported being victims of both Internet harassment and online solicitation, and 3 percent of youth said they were perpetrators of both. All youth who were perpetrators of online sexual solicitation reported being either a victim or a perpetrator of harassment. Internet harassment involves making rude or mean comments online, spreading rumors about someone online, or making aggressive or threatening comments online.


Others have linked online receipt of sexual solicitations with a history of child abuse victimization. Mitchell and colleagues looked at factors associated with aggressive sexual solicitation (solicitations accompanied by an attempt at offline contact) in the YISS at both survey time points. They found that youth who had experienced offline physical or sexual abuse were more likely to be aggressively solicited online. In addition, girls were at more risk than boys, as were youth who participated in chat rooms or used a cell phone to access the Internet.


In a 2009 study with a convenience sample of girls aged 14-17 years, more than half of whom were selected for participation based on a history of child abuse, 40 percent reported experiencing an online sexual solicitation, and 26 percent reported meeting someone in person whom they originally met online. Consistent with prior work, youth with a history of child abuse were more likely to report having been sexually solicited online. This same study provides some novel insight into a factor that may place adolescents at risk for solicitation. The report found that youth who have experienced online solicitation tend to construct avatars (animated images that represent the youth in online encounters) that are more sexualized in appearance. This may indicate either an outcome of experiencing sexual solicitation (i.e., the creation of a sexualized self-image) or a tendency for those who create such avatars to conduct themselves online in ways that result in solicitations.


Another key factor in online solicitation appears to be the pattern of youths' online relationships. Those who converse with persons they meet online are more at risk than others. Examining this pattern in more depth, Wolak and colleagues confirmed that while those who interact only with those they know offline experience aggressive sexual solicitations at a very low rate (1 percent), but those who interact freely with others online are at differential risk for solicitation, depending on the specifics of their online interactions. Exchanging personal information and photos with others, talking about sex, and harassing others are associated with much higher rates of online sexual solicitation. Similar findings have been reported by Ybarra and colleagues.


Finally, we note that sexual solicitation of minors is more likely to be perpetrated by other minors than by adults. This is consistent with national surveys looking at "sexting," the sending of sexual text messages and suggestive photos via cell phone, email, or social networking sites, which we describe below. Like Internet sexual solicitation, when sexting involves a sexual solicitation, it is usually between teens.
 
Other New Media


"Sexting": Sending Sexual Messages and Photos of Oneself.


No studies of sexting have been published in peer-reviewed venues. However, there have been four surveys or polls on the issue whose results have been published. According to one national survey conducted by the National Campaign to Prevent Teen and Unplanned Pregnancy (the National Campaign) 20 percent of teens aged 13-19 years have sent or posted nude or seminude pictures or video of themselves. The number of youth posting or sending messages that are sexually suggestive but do not necessarily include pictures is approximately double these rates (39 percent). Thirty-one percent of teens reported having received a nude or seminude picture via cell phone or email from someone (i.e., a photo or video of the sender), 29 percent had such a photo/video shared with them (i.e., it was sent to someone else initially), and 48 percent had received a suggestive message (text without pictures or video). A subsequent survey conducted by Cox Communications reported rates approximately half of these: Nine percent of teens (13-18 years) have sent, and 3 percent have forwarded, a nude or nearly nude photo via text or email. Seventeen percent have received such a message. Results of an MTV-AP poll are more consistent with Cox's numbers. Ten percent of youth aged 14-24 years reported sending images of themselves, and 22 percent have received naked images of someone else. Finally, in the its 2009 report, Pew finds that only 4 percent of teens 12-17 years who own cell phones have sent nude or nearly nude images of themselves via cell phone, and only 15 percent have received them.


It is difficult to point to a single factor that might account for this wide variety of estimates. The National Campaign survey was conducted online, and as such may have elicited more candid responses from participants than did Pew's phone survey. It may also be a less representative sample, however, drawing a more Internet-savvy group than the average teen. Pew used a telephone survey and sampled randomly from those with cell phones and household landlines and may therefore have produced better estimates. The context of the questions also varied substantially (i.e., the other items in the survey), and this may have influenced participants. Pew focused only on messages sent via cell phone, while Cox and the National Campaign asked respondents to include "email, IM, etc." and asked about posting to Internet sites. Finally, the substantial press coverage of sexting during the period covered by these studies may have changed the way adolescents think about and report their sexting experiences. Surveys conducted after major news stories may either exaggerate levels of sexting (if youth wish to appear part of a trend) or underestimate them (if youth wish to disassociate themselves from a practice portrayed as risky or illegal). A clear understanding of the prevalence of these messages and the characteristics of those involved (as senders or as recipients) will require collection of data from a nationally representative survey using items that distinguish these various methods of digital communication and collection data in a nonreactive and private manner.


What are the correlates of sexting? None of the studies find gender differences in the sending or posting of sexual messages, but they do find an increasing likelihood of sending and receiving these messages as teens reach young adulthood.63, 71 Pew found that teens who pay the costs of their own phones are substantially more likely (more than five times as likely) to send sexually suggestive texts compared to those who pay none or only a part of the cost. The same report found that those for whom cell phones were more central to their lives (e.g., were always on, were used to combat boredom) were more likely to send or receive sexually suggestive texts. It is unclear to what extent these various factors are independent contributors to sexting. It is likely that they are highly correlated, and multivariate analyses were not reported.


Most of these exchanges, like most online interaction, are with persons already part of teens' offline social networks. The survey conducted by the National Campaign found that most teens sending these messages online or via cell phone sent them to a boyfriend or girlfriend (71 percent of girls and 67 percent of boys who have sent such messages). Many also sent them to someone they wanted to date or "hook up" with (21 percent of girls and 39 percent of boys who have sent such messages). Thus, "sexting" may be an extension of behavior that was equally commonplace but involved paper and pencil or telephone audio in the past, although text messaging may be increasing the prevalence of sexually suggestive communication between sex partners, friends, and acquaintances. The ubiquity of cell phone ownership among youth, ease of communication, and the apparent tendency to be more disclosing via relatively impersonal digital media could certainly lead to the latter. Available data make it difficult to assess this, since no historical information on sexual messages between teens was published prior to the wide availability of the Internet and text messages.


There is some indication that at least a portion of this behavior goes beyond the mere transfer of sexual messages from print to digital media. Some teens report that they are more forward and aggressive in their use of sexual words and images online than offline. Further, in both the National Campaign and Pew reports, a small but not trivial minority of teens report that they have sent these messages to someone they only know online (15 percent of all those who sext). Thus, sexting may be resulting in greater exposure of youth to sexual messages, and greater incidence or prevalence of creating sexual messages among youth. If so, this may affect adolescents' developing attitudes toward sex or their sexual behavior.

It is important to note that sexting may also affect youth in ways other than through altering their sexual attitudes, beliefs, or behaviors. The ease with which sexual messages can be shared with very broad audiences suggests a greater potential to result in social stigma. One posting to a social networking profile, or one photo sent via cell phone, can quickly reach hundreds of people. Moreover, the difficulty of permanently deleting all copies of a digital message means that risks to college admission, employment, and personal relationships could persist for many years. Most web information is available even after a site has been altered or deleted, and users can easily save and redistribute text messages and photos from their cell phones.

 

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