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Sexting in 7th: At-Risk Middle Schoolers’ Sexual Messaging and Sexual Behaviors


Christopher D. Houck, David Barker, Christie Rizzo, Evan Hancock, Alicia Norton, and Larry K. Brown, “Sexting and Sexual Behavior in At-Risk Adolescents.” Pediatrics (February 2014).


Researchers analyzed self-reported data from over 400 Rhode Island teens who attended 5 urban public middle schools. All were in seventh grade and between the ages of 12 and 14. Students were enrolled in the study (Project TRAC – Talking About Risk and Adolescent Choices) after being identified by school personnel “for symptoms of behavioral or emotional difficulties”[1] and were therefore considered to be at-risk for sexual health concerns including HIV/STI or unintended pregnancy. 

The students responded to questions on private laptop computers, with prior consent from parents or guardians. Four of the questions asked whether students had texted or e-mailed sexual messages or sexual pictures of themselves during the preceding six months. These activities were all defined as “sexting” for the purpose of this study.

Key Findings:

  • Among middle school students in this study, 5% reported texting or e-mailing a sexual picture of themselves to someone else in the preceding six months.
  • An additional 17% reported texting or e-mailing sexual messages (with no photo).
  • Middle schoolers who had texted or e-mailed sexual messages or photos were 4-7 times more likely to have engaged in sexual activity with another person (including having a ‘friend with benefits,’ oral sex, vaginal intercourse, etc.) compared to their non-sexting peers.
  • Sexting was also associated with same-sex sexual behaviors (“making out, touching genitals”).[2]


Despite the ubiquity of smart phones in the U.S. and observable teen texting behavior, few studies have been published on teen sexting. Even in 2014, little is known about the effect of sexting on sexual behaviors of people at any age.  The Rhode Island middle school study focused on teens considered ‘at-risk’ because of behavioral or emotional problems, and found that teens in this sample who engaged in sexting were more likely to have already engaged in sexual activities than their non-sexting peers. 

Some adolescent sexual health stakeholders are likely to interpret this study as a confirmation that teen sexting is widespread: over 1 in 5 of the 7th graders in this sample had sent a sexual message or photo of themselves to someone in the preceding six months. In contrast, others may view the study as evidence that for most middle schoolers – particularly those who are not coping with emotional or behavioral problems, sexting is not a major threat to overall healthy sexual development. 

The study enriches our understanding of possible connections between sexting and teen sexual risk behaviors, but it raises more questions than it answers. For example, what constitutes a ‘sexual picture’ of oneself? Some of the 7th graders may have interpreted this to mean ‘nude’ while others may have understood it to mean posing flirtatiously. Likewise, who was the “someone” to whom 7th-graders had sent a sexual message or photo in the preceding six months? If the receivers were often adults, the implications for sexuality education policy and programming may be more serious than if receivers were typically middle-school peers.

The authors conclude from their findings that pediatricians and other clinicians should initiate conversations about sexting with parents and their early-adolescent patients. This is common-sense advice that sexuality educators can reinforce, when training medical students and seasoned providers, by highlighting the study, its unanswered questions, and its value in filling-in some of the gaps that remain in the scant literature on sexting and sexual risk behaviors.

[1]  Houck CD, Barker D, Rizzo C, et al. (2014). Sexting and sexual behavior in at-risk adolescents. Pediatrics. February: 133(2). DOI: 10.1542/peds.2013-1157: accessed January 31, 2014 at

[2] Ibid.