Source: Current Psychiatry Reviews, Volume 14, Number 1, March 2018, pp. 47-58(12)
Publisher: Bentham Science Publishers
Background: Pornography Use (PU) has been defined as the viewing of explicit materials in the form of pictures and videos, in which people are performing intercourse with clearly exposed and visible genitals. The prevalence of PU has increased dramatically among adolescents, partly attributed to the wide availability of such online material.
Objective: The aim of this systematic literature review is to map the research interest in the field and to examine whether statistically significant results have emerged from the areas of research focus.
Methods: To address these aims: a) the PRISMA guidelines are adopted and; b) an integrative conceptualization (derived from the merging of two widely accepted models of understanding of Internet use behaviours) was introduced to guide the synthesis of the findings.
Results: In total, 57 studies were integrated into the present literature review. Findings were conceptualized/ classified into individual, contextual and activity factors related to PU in adolescence. In that context, individual associated factors, such as development, victimization, mental health and religiosity, appear to have primarily captivated research interest demonstrating significant relationships with adolescent PU.
Conclusion: Results indicate that more research focus on contextual and activity related factors is required to improve the level of understanding of adolescent PU and to inform a more holistic conceptual framework of understanding of the phenomenon during adolescence that could potentially guide future research.
Document Type: Review Article
Publication date: March 1, 2018
3.2. Major/Primary Research Trends
The most researched variables (appearing as variables of interest in at least 6 studies) were reviewed in terms of the significant relationships revealed in relation to PU in adolescence and the main literature conclusions are highlighted below. The summary of the findings is organized under the three superordinate groups of studies referring to an individual, contextual and activity related factors and approaches variables from the most to the least researched ones.
3.3. Individual Related Factors
3.3.1. Biological Sex
Biological sex has been examined as a research variable in 46 out of the 57 studies included in the present systematic literature review. In brief, findings converge on males reporting higher and more intentional pornography consumption than females with gender differences increasing over the course of adolescence, relating to significantly higher levels of experienced sexual behaviors and; higher chances of a sexual intercourse with a friend for males [7, 10, 11, 25-32]. Gender-related differences on pornography consumption were replicated in regards to the exposure to online and offline material and the use of porn related material in a sexting context (sexting is the exchange of sexually explicit or provocative content, text messages, photos, and videos via smartphone, Internet, or social networks) [33, 34]. However, despite acknowledging that males presented to seek sex associated content more than females, other studies indicated differences according to the medium, with males scoring significantly higher than females on seeking pornographic material on the web, movies and television . Interestingly, being a boy was found to act protectively against passive sexual violence, when consuming pornographic material, with some effects of viewing pornographic films on passive unwanted sex revealed to be higher among girls . More recent literature tends to interpret gender differences in the consumption of pornographic material in the context of the differential susceptibility to the media effects approach , assuming that such differences may not only exist but additionally affect males and females differently; and especially in relation to their sexual performance orientation .
3.3.2 Attitudes Towards Sex
Overall, 21 studies examined adolescents’ sexual attitudes and behaviors towards sex in relation to PU. Not surprisingly, intentions to consume pornographic material have been primarily linked to a perceived normalizing attitude considering PU  and a significant impact to adolescents’ sexual attitudes and sexual behaviors [7, 37, 38]. Specifically, longitudinal and cross-sectional studies using Chinese,
United States, Taiwanese and Dutch samples showed that early exposure to pornography predicted more permissive sexual attitudes, sexual harassment perpetration, a range of sexual behaviors in females and sexual preoccupation and later sexual experimentation in males [7, 30, 39-41]. In that line, Haggstrom-Nordin, Hanson, Hanson and Tyden  working with a population of Swedish adolescents, found that male high porn consumers tended to become sexually aroused, to fantasize, or to perform acts manifested in pornographic films. This appears to be in consensus with literature indicating that frequent users of pornography reported more sexual arousal in general, as well as more distorted assumptions about sexual life, conceptions of gender and sexuality and negative gender attitudes (e.g. sexist features related to pornography such as control and humiliation in particular)[27, 42-44].
Twelve studies (out of the 57 included in the present literature review) have examined developmental changes in PU behaviors, as well as in relation to them during adolescence. Conclusively, findings have supported that pubertal timing, early maturation and older age are associated to higher PU [7, 13, 45, 46]. Counterintuitively, viewing pornography has been found to affect the development of values, and more specifically those towards religion during adolescence . Not surprisingly, viewing pornography has been shown to have a secularizing effect, reducing adolescents’ religiosity over time, independent of gender . In that context, positive youth development has been associated to the initial level of PU and its rate of change over time in Chinese adolescent samples .
Interpersonal victimization and harassment were studied in 11 studies with significant relationships revealed in relation to adolescent PU. Exposure to violent/degrading pornography appears to have been common among adolescents, associated with at-risk behaviors, and, for females in particular, it correlates with a history of victimization . Specifically, Ybarra and Mitchell’s study  concluded that pornography users (either online or offline) tended to report more experiences of physical or sexual victimization, while other studies highlighted a specific link between unintentional exposure to pornography and offline victimization . Interestingly, in a later research of theirs, Ybarra and Mitchell  supported that developing individuals between 10-15 years (independent of gender) were more inclined to report sexually aggressive behaviours when they had previously been exposed to PU. This result was, however, contradictory to previous studies which indicated gender differences in regards to the engagement in PU and the involvement in violent behaviour, with adolescent males being significantly more likely to exhibit both behaviours (9). Nevertheless, other studies concluded that pornography exposure did not have an association with risky sexual behaviors and that the willingness of exposure to pornography did not seem to have an impact on risky sexual behaviors among adolescents in general . Despite these, other findings indicated that overall, intentional exposure to PU was associated with higher conduct problems among adolescents, higher online sexual solicitation victimization and online sexual solicitation perpetration with boys’ perpetration of sexual coercion and abuse being significantly associated with regular viewing of pornography [14, 27]
3.3.5. Mental Health Characteristics
Eleven studies revealed mental health features/ characteristics and/or symptoms to be associated to adolescent PU, as well as variations considering mental health status according to the medium of pornography consumption (e.g. online and offline) [11, 49]. Conclusively, and despite some studies not confirming an association between poorer psychosocial health and PU , the vast majority of findings converges on that higher PU during adolescence tends to relate to higher emotional (e.g. depression) and behavioral problems [10, 14, 34]. In that context, the study of Ybarra and Mitchel  showed that online pornography seekers are more likely to report symptoms of depression compared to offline and non-seekers. Nevertheless, Tsitsika et al.  suggested that although frequent Internet PU was significantly associated with emotional and psychosocial problems, infrequent use wasn’t. Therefore, she implied a potentially normative form of PU (defined by lower frequency). In that line, Luder et al.  suggested gender-related variations in the association between PU and depressive manifestations with males presenting with higher risk. This finding was in consensus with longitudinal studies revealing that poorer psychological wellbeing factors were involved in the development of compulsive use of sexually explicit Internet material among adolescentboys .
3.3.6. Sensation Seeking
Sensation seeking tendencies also seem to have been repeatedly examined in relation to PU in adolescence [4, 13, 34, 46, 52, 53]. However, results have been inconsistent with some studies confirming [46, 54] and others not confirming any specific patterns of associations between sensation seeking and adolescent PU . Nevertheless, the majority of studies inclines towards confirming an association between sensation seeking inclinations and PU in adolescence. Specifically, Braun and colleagues  supported that both male and female adolescents with a high need for stimulation are more likely to seek pornography. In that line, Luder et al.  found that both males and females, who expose themselves to pornographic material, are more likely to be sensation seekers. Similarly, Ševčikova, et al.  investigated factors associated with exposure to sexual material and found sensation seeking to be a predictor of frequent exposure to pornography both online and offline. Finally, there is evidence that the relationship between sexual media use and sexual behavior may be mediated by sensation seeking .
Higher levels of religiosity have been associated with lower levels of PU in adolescence [9, 47, 55, 56]. Studies have shown that weaker ties to mainstream social institutions, including religious institutions tend to be more prevalent among pornography users . In that context, more frequent pornography viewing has been supported to decrease religious service attendance, the importance of religious faith, prayer frequency, and perceived closeness to God, while it was shown to increase religious doubts . Interestingly, these effects hold regardless of gender and appear to be stronger for teenagers compared to emerging adults . However, while other studies have also confirmed that religious attendance also weakens with higher PU, they revealed a gender differentiation in the association between lower religiosity and PU, with pornography consumption being weaker at higher levels of religious attendance, particularly among boys . Not surprisingly, attachment to religious leaders has been found to be associated with lower levels of consumption of pornography among adolescents . Nevertheless, it should be noted that diverse culturally adolescents differ on pornography consumption, which could involve religious differences at a cultural level. This aligns with findings suggesting that adolescents from different religious groups (e.g. Catholics, Protestants, etc.) vary on pornography consumption, likely due to differences in tolerance to porn.
3.3.8. Social Bonds
The association between PU in adolescence and the social bonds that the adolescents engage seems to have frequently captivated research attention . Overall, there seems to be a consensus that adolescent frequent users of the Internet for pornography tend to differ in many social characteristics from adolescents who use the Internet for information, social communication and entertainment . Specifically, a relational independence style seems to be associated with increased pornography consumption . In consensus with these, Mattebo et al.,  supported that a higher proportion of frequent adolescent pornography users reports more relationship problems with peers versus average and non-frequent users. Finally, a tendency of liberalism in regards to social bonds has been associated to higher PU during adolescence .
3.4. Activity Related Factors
3.4.1. Online Usage Characteristics
Online usage characteristics were researched in 15 out of the 57 studies included in the present review. These suggest that common characteristics of adolescents exposed to online pornography and sexual solicitation victimization include higher levels of online game use, internet risk behaviors, depression and cyberbullying manifestations, and voluntary self-sexual exposure online . This is potentially consistent with research conducted by Doornward et al. , which also indicated that both male and female adolescents’ tend to use social networking sites on a daily basis. In contrast other studies suggested that poor psychosocial health and problematic relationships with parents were not associated with online usage characteristics. However, voluntary sexual exposure online was significantly associated with online sexual vulnerability amongst male and female adolescents . Moreover, the study conducted by Mattebo et al.,  found that males, who were frequent users of pornography, tended to be more sexually experienced, and to spend more time online (i.e., more than 10 consecutive hours, several times a week), having unhealthier lifestyles (e.g. overweight/ obesity), as opposed to average/low consumers of pornography.
3.4.2. Adolescents’ Sexual Behaviors
Adolescents’ sexual behavior in regards to PU was researched in 11 studies, with all studies reporting significant results. The study conducted by Doornward, et al. [31, 32] found that adolescent boys’ with compulsive sexual behaviors, including the use of explicit internet material, reported low levels of self-esteem, higher levels of depression and higher levels of excessive sexual interest. In that context, other studies have shown that boys who were found to engage in the use of sexually explicit material and social networking sites received more peer approval and indicated greater experience considering their sexual involvement [31, 32]. Furthermore, boys who demonstrated the frequent use of pornography tended to have sexual debuts at a younger age and to engage in a broader range of sexual encounters. In addition to this, being a girl, living with separated parents, having experience of sexual abuse, and having a positive perception of pornography have been interrelated with higher sexual experience during adolescence .
3.4.3. Different Types of Pornographic Content
Pornographic content in relation to PU was researched in 10 studies, indicating significant associations with adolescents’ sexual behaviors. Specifically, research conducted by  revealed that younger adolescents’ are more often exposed to affection-themed, dominance-themed and violence themed content. As opposed to this, older adolescents and adolescents with higher levels of academic achievement tend to choose dominance-themed pornography more frequently. In that line, Hald et al.  found that there was a moderate, yet significant relationship, between the content of sexually explicit material consumed and the sexual behaviors manifested by adolescents. For example, preference for violent/ degrading pornography was higher for males who had taken sexual pictures, had friends who used to buy/sell sexual services and tended to consume high amounts of alcohol. Similarly, although slightly differently, females who were consumers of violent/degrading pornography inclined to take sexual pictures of themselves, to have friends who used to buy/sell sex-related services and to smoke [42, 48].
3.4.4. Traditional Porn
Traditional pornography is defined as the use of traditional (non-online) media pornography such as magazines, television and movies . The traditional pornographic content was researched across 7 studies, suggesting likely that the research interest to the consumption of traditional pornographic material has decreased significantly compared to the consumption of online pornographic material. Shek & Ma  explain that this is due to the growing availability of inexpensive wireless broadband internet services. Subsequently, adolescents are able to access online pornography more easily and anonymously through personal computers, tablets and smartphones [28, 44].
3.5. Context Related Factors
3.5.1. Family Functioning
Family functioning was researched in 12 studies that were included in the present review. Specifically, Weber and colleagues  suggested that adolescents’ that regard themselves as less independent of their parents tend to consume pornography more frequently. This is also consistent with other findings , which also supported that adolescents’ presenting with poorer relationships with their parents, lower commitment to family, less parental care and, lower communication tended to be higher in PU. Interestingly, such factors appear to collectively influence family functioning, which has been inversely associated with PU [9, 58].
3.5.2. Peer Culture
Peer culture in relation to PU was investigated across 7 studies. Findings suggest that peer culture aspects involving gender role attitudes, sexual norms, and perception of peer approval and adolescents’ sexual behaviors interrelate with adolescent PU [7, 31, 32]. Specifically, the use of sexually explicit Internet material amongst boys, and the use of social networking sites across both genders were positively correlated with perceptions of peer approval and sexual behaviors [7, 31, 32]. In that line, studies conducted by Peter and Valkenburg [59, 60] emphasized notions of sex as primarily physical and casual rather than affectionate and relational, entitled as “social realism” and “utility” respectively. This study demonstrated that the frequent use of sexually explicit Internet material increased both “social realism” and “utility”. This may be interpreted in the context of frequent consumption of pornographic content reducing the intimacy of relationships by instigating notions of sex as primarily physical and casual. In addition to this, To and colleagues  supported that susceptibility to peer pressure also influences exposure to the explicit sexual material and sexual experiences.
Studies included in the present systematic literature review indicate that research in the field of adolescent PU has focused on three main superordinate themes involving individual (I), contextual (C) and activity (A) factors. Overall, the vast majority of the studied variables reviewed in the current work were classified as primarily related to the individual (I: 18), with emphasis on variables involving activity related factors (A: 8) following, and variables related to the context of the user being the least studied ones (C: 6). These findings demonstrate a strong tendency towards researching individual characteristics in relation to PU in adolescence, and a significantly lower research focus on activity related and contextual factors in the extant literature (Table 1). This identified imbalance in the literature should be likely addressed by future research.
4.1. Individual Related Factors
In the context of individual related factors, biological sex, attitudes towards sex, development-related factors, victimization, mental health characteristics, sensation seeking, religiosity and social bonding characteristics have captivated research interest in regards to adolescent PU. In an overview, results indicate that males, more liberated attitudes towards sex, early maturation and older age, interpersonal victimization and harassment, poorer mental health, sensation seeking tendencies and lower adherence to social bonds tend to be related to higher PU during adolescence [4, 7, 10, 11, 13, 14, 25, 27-29, 31, 32, 34, 37, 38, 45-48, 50].
4.2. Activity Related Factors
Considering activity-related factors, online usage characteristics, adolescents’ sexual behaviours, different types of pornographic content and traditional porn appear to have attracted the most significant proportion of research attention. Interestingly, higher levels of online game use, internet addictive behaviours, cyberbullying manifestations, and voluntary self-sexual exposure online appear to positively link to PU [31, 32, 49]. In regards to sexual attitudes, adolescents with compulsive sexual behaviours, earlier and more experienced sexual life present to be more prone to PU [8, 31, 32]. In reference to pornographic content, younger adolescents’ are more inclined to affection-themed, dominance-themed and violence-themed PU, whilst older adolescents and adolescents with higher levels of academic achievement preferred dominance-themed PU . Not surprisingly, research referring to the use of traditional pornographic context appears to have declined, potentially due to the continuously expanding availability of online pornographic material [44, 58].
4.3. Context Related Factors
Considering context factors tied to adolescent PU, family functioning and peer culture/ influences have dominated the research interest [9, 15, 58]. Specifically, parental independence, poorer relationships with parents, lower commitment to family, less parental care and, lower family communication tended to be higher among adolescents presenting with higher PU. In regards to peer culture, aspects involving gender role attitudes, sexual norms, the perception of peer approval and adolescents’ sexual behaviours have been associated to with adolescent PU [7, 31, 32]. In that line, conceptualizations of sex as primarily physical and casual rather than affectionate and relational, entitled as “social realism” and “utility” appeared higher among adolescent pornography users [59, 60]. Similarly, susceptibility to peer pressure also increased exposure to explicit PU during adolescence [59, 60].
Conclusively, the research interest on adolescent PU appears unevenly distributed across the three main areas identified involving individual, contextual and activity related factors. Individual factors have attracted the highest interest, significantly contributing to the available knowledge on adolescent PU. Nevertheless, more research emphasis is imperative in relation to contextual and activity PU related factors. This type of research would align with contemporary, holistic conceptualizations introduced in the broader area of developmental psychology, as well as the field of behavioral addictions, and could better inform prevention and intervention approaches involving the critical contexts of the adolescents’ family, school and the community [76-78].