The following is a paper I originally wrote in the Fall Semester of 2016 for COUC 740: Advanced Research Methods, and revised and submitted April 21, 2018 for COUC 745: Advanced Multivariate Statistics & Quantitative Research class at Liberty University.
Abstract
The purpose of this proposed study is to determine how adolescent mental health has been affected by previous engagement in sexting behaviors, and how sexting prevention education and mental health treatment effect adolescent mental health. A gap in the literature regarding the consequences of sexting on adolescent mental health was identified. Due to inconsistencies in the literature, it is difficult to determine how widespread this phenomenon truly is; however, sexting has been determined to at least be a global phenomenon. A review of current literature will attempt to identify motivational factors for adolescent sexting, mental health issues associated with sexting, and interventions that can be utilized to either prevent or diminish effects of sexting. Further study is needed into this phenomenon to have a better understanding of how to best help these adolescents as they move from childhood to adulthood.
Keywords: sexting, adolescents, mental health, prevention, treatments
Adolescent Sexting and Mental Health: Experimental Research Proposal
The phenomenon of adolescent “sexting,” where an individual (aged 11-19) electronically sends or receives a sexually graphic image or text, has gained attention in the last several years (Krieger, 2016; Lenhart, 2009). Concerns raised in the literature regarding adolescent sexting include increased sexual risk behaviors, substance abuse, harassment, cyberbullying, attachment issues, internet addiction, depression, shame, suicide, legal matters and child pornography, and nonconsensual distribution of the sexually explicit images (Krieger, 2016; Lenhart, 2009). Despite the growing prevalence of sexting by adolescents, there is little data specific to the association between sexting and mental health (Gordon-Messer, Bauermeister, Grodzinski, & Zimmerman, 2013). It is hypothesized that adolescent mental health is negatively affected by adolescent sexting behaviors, and through the utilization of sexting prevention education and mental health treatment, reported increases in depressed mood and anxiety symptoms will decrease. A review of the literature will explore motives, effects on mental health, and prevention of adolescent sexting.
Motives for Adolescent Sexting
Numerous studies have identified motives for sexting (see Henderson & Morgan, 2011; Kopecký, 2011; Lenhart, 2009). Motives for engaging in sexting behavior include promotion or anticipation of initmate partner contact, to gain attention, used as a form of self-expression, and peer pressure among other reasons. Various motives for sexting such as normal adolescent behavior, attitudes, and if sexting is a coerced activity or voluntarily practiced will be discussed.
Researchers argue that adolescent sexting can be a part of healthy adolescent development; allowing teens to express themselves individually, and socially by communicating with others about sexual topics to create their sexual identity (Walrave et al., 2015). Valkenburg and Peter (2011) discussed, through the formation of identity, intimacy, and sexuality, adolescents develop self-presentation and self-disclosure. Traditionally, these skills are learned through face-to-face interactions; however, these interactions happen more over the internet where online communication enables adolescents a sense of security and anonymity in their interactions further promoting sexual development.
Researchers have found many different attitudes held by adolescents on the topic of sexting such as sexting viewed as a safe alternative for sexual activity, acceptable, inappropriate, concern or lack of concern over legality or other consequences, concern over unauthorized release of images, and others feeling labeled or judged (Lenhart, 2009; Strassberg et al., 2013). Albert and Steinberg (2011) found peer influences and instant gratification are associated with risk-taking behaviors, and that adolescents are more likely to engage in risk-taking behaviors with their peers. Albert and Steinberg (2011) encourage open, honest discussions of the benefits and consequences of risk-taking behaviors to help adolescents understand the difference between those two concepts.
Studies have indicated where coercion or peer pressure played a factor for those adolescents engaged in sexting behaviors (Lenhart, 2009; Smith, Thompson, & Davidson, 2014). Peer pressure is at times involved in acquiring sexual images, particularly of girls, for fear of being rejected (Walker, Sanci, & Temple-Smith, 2013). A possible offshoot of coercion and peer pressure could be the unauthorized or nonconsensual release of images, often shared out of carelessness or revenge, sent under the guise of a private communication (Willard, 2010).
Effects of Adolescent Sexting on Mental Health
Despite previously stated concerns regarding adolescent sexting, there is little research specifically related to the direct association between adolescent sexting and mental health (Gordon-Messer et al., 2013). Significant associations between sexting and mental health that were identified include emotional difficulties (i.e., depression) and suicidal ideation (Houck et al., 2014; Van Ouytsel, Walrave, Ponnet, & Heirman, 2015). Additional effects identified include cyberbullying, forced sexual contact, physical violence, and substance abuse. Further research into the direct effects of sexting on adolescent mental health is greatly needed.
Diminishing the Negative Impact of Sexting
Despite the negative impact of sexting, programs are being developed to help adolescents through social and emotional learning (SEL). Although, not specific to sexting prevention, Mitchell, Jones, Finkelhor, and Wolak (2014), found SEL programs could be used as a form of sexting intervention. Mitchell et al., (2014) additionally called for a prevention approach that attempted to discourage adolescents from viewing risk-taking behaviors, such as sexting, as the norm, and emphasize the importance of education regarding the legality and consequences of possession and distribution of sexually suggestive images.
Adolescent sexting has gained much attention over the last several years due to various safety and physical concerns and the legality of sharing sexually suggestive images of minors (Gordon-Messer et al., 2013). This paper seeks to bridge the gap between adolescent sexting behaviors and the effects on adolescent mental health; however, the literature specific to this association is limited. Motivational influences, mental health issues, and intervention and prevention efforts regarding sexting were reviewed and discussed. The purpose of this proposed study is to determine how adolescent mental health has been affected by engagement in sexting behaviors, and how sexting prevention education and mental health treatment effect adolescent mental health.
Method
Participants
The study sample will consist of the following participants: adolescents (n = 200), aged 11 to 19, who have previously engaged in sexting behaviors. Participants will be recruited from various junior high and high schools, and community colleges from the Northeast Side of San Antonio. These students will be informed of the need of study participants in their classes at school. Participants will be given a $5 Starbucks gift card as compensation for their time. Parental consent will be obtained for those participants under the age of 18 years old and because they are minors they will sign assent forms. Adult participants will also sign informed consent forms for their participation in the study. All participants will only be identified by their age to ensure confidentiality.
Design
This study is a pretest-posttest control group design as there is a control group and two treatment groups. One treatment group will receive mental health counseling and the other treatment group will receive sexting prevention education. The control group will not receive any treatment. Each participant will be given a pre-test, and 12 weeks later, each participant will be given a post-test. The dependent measures are how each adolescent’s mental health is impacted as a result of the treatment.
Materials and Procedure
The intended purpose of this study is to determine how mental health (covariate variable) has been effected by previous engagement in sexting behaviors (independent variable), and how sexting prevention education and mental health treatment effect adolescent mental health (dependent variable). Selection criteria will include an initial telephone screening interview. Eligibility criteria will include: adolescents aged 11-19 years, accessibility to a smartphone capable of sending and receiving text and picture messages via cellular or Wi-Fi connection, and acknowledged engagement in some form of sexting behavior over the last six months. The screening interviewer will provide each adolescent with the definition of sexting to determine sexting behaviors. Exclusion criteria will include anyone aged ten years or younger and those 20 years or older, not in possession of a smartphone capable of sending or receiving text or picture messages, and those who have not engaged in sexting behaviors over the last six months.
Upon determination of eligibility, study participants will be randomly assigned to three separate groups: the control group and the two treatment groups. Treatment group A1 will participate in professional mental health counseling, while treatment group A2 will participate in the online sexting course. Before treatment or intervention, all study participants will be given the Inventory of Depression and Anxiety Symptoms (IDAS) as a pre-test measure to determine current mental health status (Watson et al., 2007). The control group will not receive any treatment for the duration of the study.
Following the pre-test measure participants in treatment group A1 will be given information on how to acquire a professional mental health counselor. Participants will be given a list of therapists who specialize in working with adolescents with depressed mood or anxiety and are familiar with sexting behaviors. Participants will be allowed to see the therapist of their choice over the 12 week time period of the study. Participants in treatment group A2 will be given information on how to access and complete the online sexting prevention course ‘Before You Text’ Sexting Prevention Course, created by Texas State University – Texas School Safety Center (Texas State University, n.d.). This course will be divided into six sections to be completed over a 12 week time period. Each participant will be given a specific schedule as to how the sexting prevention course modules are to be completed. Participants in the control group will not receive any treatment during the time of the study.
Definitions and Measurements. There are several core constructs identified for this study. Potential participants will need to have an understanding of sexting and sexting behaviors. During the study, participants will be instructed on how the pre- and post-test instrument provided information regarding symptoms of depression and anxiety, procedures for engagement in mental health counseling and will be given a description of what mental health counseling is, and how to use the sexting prevention curriculum.
Sexting is defined as the sending or receiving of sexually suggestive material via text or picture message (Krieger, 2016; Lenhart, 2009). Potential participants will be asked if they have engaged in sexting behaviors within the last six months. There are no parameters placed on the amount of sexting transactions that have occurred over the last six months.
The Inventory of Depression and Anxiety Symptoms (IDAS) is the pre- and post-test instrument used to determine each participant’s mental health status (Watson et al., 2007). The IDAS is a 99-item instrument that measures symptoms of depression and anxiety through 10 different scales: suicidality, weariness, sleep problems, appetite changes, irritability, health, panic, anxiety, and trauma, along with more extensive scales for general depression and dysphoria (Watson et al., 2007). IDAS has been shown to demonstrate strong short-term retest reliability, convergent validity, and discriminant validity as compared to other self-reported and interview-based measures (Watson et al., 2007).
Depending on the age and experience of the participant, familiarity of such terms as depression, anxiety, and mental health counseling, may be foreign concepts. Study participants will be provided with information regarding symptoms of depression and anxiety based on diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013). Depressed mood is described as having feelings of hopelessness, helplessness, sadness, worthlessness, guilt, loss of interest in pleasurable activities, significant and unexplained weight loss or gain, sleep problems, observable restlessness or sluggishness, fatigue, loss of energy, difficulties with making decisions, recurrent thoughts of death, and recurrent suicidal ideation with a plan, means, or intent to do harm to oneself (APA, 2013). Anxiety is described as excessive and uncontrollable worry concerning a number of events or activities, feelings of restlessness, fatigue, difficulties making decisions, irritability, muscle tension, and difficulty sleeping (APA, 2013).
Mental health counseling is defined as the practice of applying principles of psychotherapy and human development to assess, facilitate, plan, and implement healthy strategies for the purpose of treating mental and behavioral disorders resulting in increased distress for the client, all while maintaining continuous collaboration with the client (Licensed Professional Counselor Act, 1999). Unlike a friendship relationship, mental health counseling is a relationship between a professional counselor and a client. There are rules and laws in place to protect the client from any inappropriate behaviors on the part of the counselor, such as sharing information with others (Confidentiality and Required Reporting, 2013). There are many forms of counseling to include: individual, couples, family, psychoeducational, and career counseling, all aimed at the purpose of empowering those who are served (American Counseling Association, 2010).
The sexting prevention course that will be utilized for this study is ‘Before You Text’ Sexting Prevention Course, created by Texas State University – Texas School Safety Center (Texas State University, n.d.). This course is available to the general public on the Texas State University website to be used as an educational tool to address the legal, social, emotional, academic, and occupational consequences of sexting behaviors (Texas State University, n.d.).
Analysis
Analysis of Covariance (ANCOVA) will be used as the statistical measure to predict the scores on the Y outcome variable. The study will utilize a pretest/posttest design where the posttest score (mental health status after treatment) represents the Y outcome variable, the pretest score (mental health status before treatment) represents the covariate Xc, and previous sexting behaviors represents the independent variable X. Three different forms of treatment will be administered and evaluated during the study. Group A1 will receive mental health counseling, Group A2 will participate in an online sexting prevention course, and Group A3 will receive no treatment. To obtain strong information about the effects of the three treatment conditions included in the study an analysis of adjusted means on the Y outcome variable is necessary. This adjustment means that there is no linear association with the Xc covariate (pretest scores) from statistically adjusted Y outcome scores. Potentially, the statistical adjustment to the Y outcome variable will address any confound variables of the covariate with the treatment provided and as a result some of the error variance or “noise” is overpowered and statistical power of tests of group differences is increased.
Discussion
Results of this study will be restated and assessed related to the original hypothesis. If the results are as anticipated, that sexting prevention education and mental health counseling are shown to have a positive effect on the mental health of adolescents who engage in sexting behaviors, generalities can be extended to this population of adolescents. Connections to previous research reviewed will be identified and discussed. Applied implications of the results for adolescents who engage in sexting behaviors will also be discussed.
Limitations
It is not possible to control for every potential limitation in a study; however, minimizing threats to internal and external validity will help reduce alternate explanations and allow the study to be replicable (Heppner, Wampold, Owen, Thompson, & Wang, 2016). The following sections will discuss the various threats to internal and external validity and threats to statistical conclusion validity, as well as how these threats can be controlled for during the study.
Threats to internal validity. History cannot be controlled for by isolating the participants of this study, as the participants are in school and are required to attend; therefore, the potential for unforeseen events may occur. History will be controlled for by reducing the time period of the study to 12 weeks. Maturation will also be controlled for by the short time period between pre- and post-test administration, in addition to the participants being randomly assigned to three groups, thus making the groups comparable. Testing will be controlled for by only administering the pre- and post-test measure at the beginning and end of the 12-week treatment period. The testing instrument will be used to measure mental health status, not aptitude of a specific task or performance, providing another way for testing threats to be controlled.
For this study, participants will be randomly assigned to the control and treatment group before pre-test administration, thus controlling for regression. Selection bias will be controlled for in this study by random assignment of participants to each treatment group. Contamination cannot be controlled for entirely; however, participants will be advised not to discuss study details until after the conclusion of the study. Attrition is a potential possibility in the treatment groups as these participants will receive both sexting prevention education and mental health counseling over a 12 week time period. Attrition can be controlled for by conducting a pre-test on all participants prior to administration of treatment to establish the mental health status of participants. Instrumentation threats can be controlled for by consistent review of study measurements, and as a result decreasing threats to alteration of instruments or procedures.
Threats to external validity. Unit threats to external validity will be controlled for by random selection of participants from various schools and random assignment of participants into each treatment group. Treatment variations will not be controlled for in the current study as participants will be referred to various counselors in the community who have specialization working with adolescents with depressed mood and anxiety, and are familiar with sexting behaviors. Setting threats will be controlled for by recruiting a random sample of participants for this study, which should be generalizable to students in other school districts and community colleges in the larger setting.
Threats to statistical conclusion validity. The threat of low statistical power will be controlled for by the number of participants in the study (n=200). Violated assumption threats will be controlled for by participants being referred to multiple therapists, thus reducing client dependence on one therapist, thus avoiding Type I or Type II error. “Fishing” and error-rate problems will be controlled for by the utilization of two statistical tests to calculate the pre-and post-test scores, in addition to stating a clear hypothesis. Unreliability of measures will be controlled for by utilizing a measurement instrument that has been previously used with a similar population. Restriction of range will be controlled for by the employment of an instrument appropriate for what is being measured in the study.
Treatment implementation will be provided by multiple therapists who specialize in working with the population represented in the study sample. No parameters were developed regarding how the counseling will be implemented other than being specific to depression or anxiety treatment for adolescents. Therefore, at this time, the unreliability of treatment implementation will not be formally controlled. Extraneous variance in the experimental setting will not be controlled for in this study as participants will complete the sexting prevention course in the location of their choosing and will be free to choose the therapist they will see for counseling. Heterogeneity of units will be controlled for by random sampling in participant selection and random assignment to the control and treatment groups. Lastly, inaccurate effect size estimation will be controlled for by the size of the sample (n=200).
Future Research
As time presses on and new technologies for communication are developed there will be an even greater need to empower teens to the potential dangers of sexting. Future research must focus on a direct connection of how adolescent sexting behaviors effect mental health (i.e., depression, anxiety, shame, suicidal ideation and attempted suicide, associated self-harming behaviors). Physical effects have been established in that sexting can lead to unwanted sexual advances or assault, cyberbullying, physical violence, substance abuse, and legal entanglements due to child pornography laws. Prevention programs focused on self-esteem, self-worth, and empowerment will help teens make better choices for themselves.
Adolescent sexting has gained much attention over the last several years. As a result, there is much concern related to this practice; however, there is little information regarding adolescent sexting and its effect on mental health. Motivational influences, mental health issues, and intervention and prevention efforts regarding sexting were discussed. The proposed structure, design, procedures, participants, definitions of core concepts, analysis, and discussion of possible limitations and threats to validity were identified and discussed. The purpose of this proposed study is to determine how adolescent mental health has been affected by engagement in sexting behaviors, and how sexting prevention education and mental health treatment effect adolescent mental health. It is important that parents, educators, health care professionals, mental health practitioners, and anyone who works with adolescents help them understand the consequences of sexting behaviors (Houck et al., 2014; Willard, 2010). Further research is needed to have a better understanding of how adolescent mental health is affected by sexting behaviors.
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