Adolescent Responses to Coercive Requests for Sexual Images.

Importance: Requests for sexual images are a common but understudied component of adolescent digital interactions. Although image sharing or sexting can be a consensual behavior between peers, when requests for sexual images are coercive it is a form of sexual harassment. Objective: To examine experiences with coercive requests for sexual images received before the age of 18 years and the incident and respondent characteristics associated with sharing an image in response to coercion. Design, Setting, and Participants: This survey study was conducted in the US between June 28, 2023, and April 1, 2024. Survey participants were a sample of 6204 young adults (aged 18-28 years). Screening procedures were designed to oversample individuals with histories of image-based sexual abuse to examine questions related to incident dynamics. Analyses used statistical weighting to improve generalizability to the US population. Main Outcomes and Measures: Bivariate and multivariate logistic regression modeling examined whether demographic and incident-level factors were associated with a decision by respondents to share a sexual image in response to coercion, defined as threats or strong pressure, and the impact of sharing on disclosure and mental health outcomes. Results: A total of 2853 respondents reported 4205 incidents of image-based sexual abuse, including 2003 coercive requests for sexual images that occurred before they were 18 years of age; in 1886 (mean respondent age, 22.8 [95% CI, 22.6-23.1] years; 91.0% female [95% CI, 89.4-92.4]) of these incidents, respondents provided information on whether they did or did not share an image in response, making up the analytic sample for the study. In 1067 coercive request incidents (55.6%; 95% CI, 51.5%-59.6%), adolescents shared an image in response. Sharing was significantly less likely when the perpetrator was someone the adolescent met online vs a dating partner (odds ratio [OR], 0.33; 95% CI, 0.20-0.54; P < .001) and was more likely for incidents lasting longer than month (OR, 3.55; 95% CI, 2.44-5.16; P < .001). Respondents who shared images reported significantly worse mental health outcomes than those who did not (OR, 1.10; 95% CI, 1.04 -1.17; P = .001) and were less likely to disclose the incident (OR, 0.69; 95% CI, 0.48-0.98; P = .04). Conclusions and Relevance: In this survey study of young adults in the US, findings identified significant harms associated with providing sexual images in response to coercive requests during adolescence. Results highlight the importance of providing adolescents with skills to respond to image requests and information about the harmful outcomes of coercive sexual image requests.