Explorând efectul materialului sexual explicit asupra credințelor, înțelegerii și practicilor sexuale ale tinerilor: un studiu calitativ (2016)

CONEXIUNEA LA HÂRTIE

Charles Petera and Meyrick, Jane, Ph.D.a

a Department of Psychology, University of the West of England.

Corresponding Author – Dr Meyrick, University of the West of England, Department of Psychology, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY. Tel +44 (0) 117 21 82153. E-mail [e-mail protejat]

Cuvinte cheie: Sexual Explicit Material, Online Pornography,  Adolescent males, qualitative research, theory,

Abstract

Scop

Research suggests that exposure to Sexually Explicit Material (SEM) has negative effects on the beliefs, attitudes and actions of adolescents, especially on males. The objective of this study was to explore the effect of exposure to SEM on the sexual beliefs, understandings and behaviours of adolescent males in society today and begin to build theory around this gap in the UK literature.

Metodă

An opportunistic sample of participants of males aged between18 – 25 were recruited within one workplace (a call centre, Bristol,UK). Of 40 invited, 11 responded to a qualitative survey. Data was collected (online and paper format) and analysed for themes.

Rezultate și concluzii

Findings suggest that the key themes around SEM, that influence the sexual beliefs, understandings and behaviours of adolescent males are:- increased levels of availability of  SEM, including an escalation in extreme content (Oriunde te uiți)are seen by young men in this study as having negative effects on the sexual attitudes and behaviours of adolescents (Asta nu e bine). Family or sex education may offer some ‘protection’ or a balance to the representations of see (Tampoanele), young people see in SEM. Data suggests conflicting or confused views (Versuri reale Fantezie) around adolescents’ expectations of a healthy sex life (Viață sexuală sănătoasă) and appropriate beliefs and behaviours (Cunoașterea corectă din greșit).  Pulling the themes into an account of a causal pathway helps build theory.

Cuvinte cheie: Sexual explicit material, Adolescent males, Beliefs, Understanding, Behaviour, Qualitative research.

Implications and Contributions

  • Wide availability of SEM reported with increasingly extreme content.
  • Consumption may lead to confusion and SEM values based expectations of real sex.
  • Variation in this affect may be due to existing vulnerability or experience of ‘buffers’
  • Sex education was seen as a missed opportunity to provide a healthier counter balance.

Inroduction

The increased availability of pornography(1)particularly through digital platforms (2,3,4) has resulted in what some term a ‘pornified’ world (5).  Research is has begun an impact on the development of adolescents and youth culture in a number of unprecedented ways (6,7,5,8).

McNair, 2002(8) claims that the normalisation and mainstreaming of sexually explicit material (SEM) is not only shown by the role pornography plays in young people’s lives, relationships and the ease at which they discuss it, but also in popular culture and contemporary art.

The indiscriminate nature of modern internet-enabled technology has increased exposure to SEM in all age groups(1) but especially in young people either accidentally or intentionally (9, 10) . Levels of participation in the creation and distribution of sexually explicit content of a personal nature through social media cites has also increased (11).

Research into levels of SEM consumptionhave suggested a range of potential negative effects include;encouragement of sexual violence(12);objectification of women (13);earlier sexual debut(14, 15, 16);risky sexual behaviour(17) and sexual harassment (16). However,Luder et al. 2010 (18) using a large population of Swiss youth, (N=6054) found no link between SEM exposure and the majority of risky sexual behaviours.  The pattern may however be one of greater negative effect in vulnerable populations as found by large scale (N=1501) work in the US, (19) found that the majority of males were found to have no links between frequent SEM exposure and a higher tendency towards sexual aggression. However, among those with a predisposed level of risk towards sexual aggression who also frequently sought out SEM, levels of sexual aggression in comparison to their peers were found to be four times greater or more.  The interplay of exposure and effect require greater investigation and more importantly a theory building approach.

Theory development in this field is lacking (20). Cross sectional studies have suggested that adolescents do learn sexual behaviours from the observation of SEM (14,21)and that this may result in a distorted expectations of sexuality (22). Peter and Valkenburg, 2010 (23)found more frequent SEM exposure resulted in increased beliefs that it was similar to real-world sex (social realism) and a useful source of information about sex (utility).

The potential role of protective sex education around SEM is evidenced, (24) highlighted that the absence of education relating to the potential negative consequences of SEM may be related to  an increased rate of high risk sexual behaviours.

A study conducted by Hald and Malamuth, 2008(25) helped to identify avenues for sex education with regards to pornography, championing the incorporation of content that would increase media literacy and assist in the critical interpretation of pornographic material of young people.

However, in depth qualitative (7)work recognised that some young people recognised the unrealistic nature of SEM, again pointing tothe complexity of adolescent experience and understanding. Such in depth work is sparse in the literature but needed to piece together a richer account of how SEM is experienced in order to begin to understand both theoretical casual pathways and explore potential means of intervention.  Also noted is the lack of UK based research in the wider European dominated literature that may give voice to potential cultural variation in experience.

The aim of this research was therefore to understand the effects that exposure to SEM has on the sexual beliefs, understanding and practices of young men through their own accounts as a first step towards theory building.

Metode

Gaps in the literature around qualitative studies that could build theory and explore complexity, lead to the selection of qualitative data collection. Due to the nature of the topic, a survey tool was chosen to ensure participant anonymity and reduce social desirability.

Using an opportunistic, snowball sampling strategy, acquaintances were recruited by existing participants until data saturation was reached (26) . Males, aged between eighteen and twenty-five years were invited to participate in this study, and of the 40 invited, 11 participants completed the survey (See Appendix A).

The University of the West of England’s Health and Life Sciences ethics board provided ethical approval for this study. Participants completed either hard copy (returned via anonymous envelope)or online version (returned via email) of a qualitative survey.

Data analysis was carried out through a six-phase approach to inductive thematic analysis (27), exploring the semantic value of the data through generating initial codes (see Appendix B) before searching for and identifying main themes. Rigour of interpretation was underpinned through development of personal statement by the researcher and supervisor confirmation of themes(28).

REZULTATE                                         

Participants included 11 males between the ages of 18-25 years all working at the same Bristol based workplace. They have been given pseudonyms for anonymity.

The inductive thematic analysis applied to these qualitative surveys elicited six key themes that were present within the data. These themes are seen as essential in determining beliefs, understandings and actions of all participants. Themes have been labelled and are presented in a logical order “Everywhere You Look”, “That’s Not Good”, “Buffers, sex education and family”, “Real verses Fantasy”, “Healthy Sex Life” and “Knowing Right from Wrong?” . The themes are presented in this specific order to communicate the overarching story running throughout.

 

 

Diagram of key themes and sub themes

 

Extreme content

slef

Oriunde te uiți

Tampoanele

Asta nu e bine

Viață sexuală sănătoasă

Versuri reale Fantezie

Knowing Right from Wrong?

Educatie sexuala

Love, trust, honesty and respect

Emotional and Physical Abuse

Disponibil

Admis

 

altele

obiectivare

Understanding Fictional

Lecții învățate

 

Family Environment

 

Dependenta

 

‘Real’ Women

Așteptări

slef

Use SEM

Normal

Frecvență

Varietate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Oriunde te uiți

Această temă este definită de tiparele de expunere la SEM raportate de participanți și evidențiază ușurința și gama prin care acest conținut pare să fie accesat cu internetul ca sursă cea mai citată.

„Am văzut în principal porno hard-core pe care îl accesez de pe site-uri web gratuite de pe internet” - Sid

„Pagina 3, reviste pentru băieți (Zoo & Nuts)” – Tom

“Explicit music videos, TV girls where you call up”– Richard

              „Instagram” – Lu       

Participants seemed to demonstrate a measure of social acceptance for the viewing of SEM by adolescent males in the modern world, seeing the behaviour as part of a developmental process.

“I think that it is a part of growing up and on the whole it is considered as socially acceptable for young men to view this material.2 – Ross

However, some seemed to recognise potential detrimental results, influencing sexual experimentationand addictive behaviours in adolescent males.

“I worry about the affect it has had on young people, because of porn I have experimented             sexually trying to copy things I’ve seen and not all have been positive experiences ( sex parties, group sex etc)”. – Gaz

“When I was not so careful, I found myself getting addicted to porn because of the ease in    which I could get hold of it and the reward from chemicals in my brain”. – Alfie         

A link between social media and actual physical sexual activity was also communicated, with concerns being raised in relation to the ability to trust in the sincerity of how people portray themselves online, this newer phenomenon is raised in next theme.

2. That’s Not Good

Views and attitudes portrayed in SEM content seemed to be replicated in comments made by participants. Gender hierarchies and the objectification of females were especially present throughout, with some awareness reported, that his might be a problem.

“I would also say it reinforces dangerous ideas of gender hierarchy. Women are usually depicted as submissive and easily influenced by men. Men are usually depicted as the ones in control and as the stronger gender. I believe this has affected susceptible individuals in our society, reinforcing the patriarchy within our society, making strong female attitudes less    desirable.”– Bob

“Sex as a product that can be easily accessed and purchased. Changes the way they viewgirls and women, objectification, girls not as people” – Mo

In this group, the gender stereotypes shown in SEM also seemed to effect the way in which young males perceive themselves.

“It can make some men feel insecure about their sexual ability as they can’t necessarily lastas long as some male pornstars”. – Richard

“Porn has made me feel less adequate as a man – has a negative effect on my ownperception of myself.” – Tom

In addition, participants talked about the ever increasing levels of extremity within SEM content online . SEM could therefore be seen as an influential force in the moulding of more extreme sexual preferences into the fabric of an adolescents consciousness.

“due to the ever increasing availability of porn, the videos are becoming more and more  adventurous and shocking in order to keep up with the demand for it to still be deemed exciting. – Jay

„Probabil m-a făcut să mă întăresc. Este nevoie de mult pentru a mă șoca acum, din cauza cantității pe care am văzut-o, nu mă afectează atât de mult ca înainte ”- Tom

This increased need for a higher levels of stimulation may effect the level of expectations on an individual’s sexual partner to participate, as well as on the individual themselves to conform with what may be regarded as a ‘the norm’.

3. Tampoanele

Balancing or alternative sexual models provided by e.g. family behaviour or sex education were reported in terms of having a positive contribution or a missed opportunity.

„Educația mea sexuală la școală a fost groaznică. Pornografia nu era deloc acoperită și părea că făceau strictul minim... Ei au trecut peste orice detalii care ți-ar oferi de fapt o perspectivă utilă despre cum ar fi de fapt să fii activ sexual „- Jay

„Forma umană nu era tabu în casa mea când eram copil, așa că cred că asta mi-a oferit un avantaj pe care nu l-ar avea toți. Opera de artă a mamei mele cu siguranță mi-a dat o idee foarte bună despre cum arată o femeie adevărată”. – Bob

Family make act as a ‘’buffer’ against the negative effects of SEM viewing and sex education a missed opportunity to provide a balancing source of healthy ‘norms’.  The action of such a ‘buffer’ could be in helping adolescents distinguish between real and fantasy sexual behaviour.

 

 

 

4. Versuri reale Fantezie

Participants reported viewing the use of pornography as now being much less stigmatised, regarding it as a normal part of life that is discussed openly within relationships.

              „Acum este normalizat. Mai puțin tabu. Se poate vorbi despre asta cu partenerii”. – Tom

This normalisation was variously represented as a ‘trustworthy’ educational source of information, but some participants reported a the negative effect of SEM ‘norms’.

              „Am învățat multe din porno – mișcări – ceea ce se așteaptă de la mine ca bărbat”. – Tom

“I would say it gives young men a very dangerous idea of what sex is and what it provides”. –            Bob

“It also affects body image and my view of how someone should look and how sex should         look and be”. – Harry

„Aceste materiale explicite au avut un impact mult mai mic asupra perspectivei mele asupra formei umane și cred că acest lucru se datorează în principal științei că descrie o lume fictivă, în care oamenii reprezentați sunt aproape personaje ale lumii reale”. – Bob

SEM consumed as the norm may be contributing to confusion around sexual expectations.  In this group, different levels of understanding or insight into whether it represented real sexual behaviour were reported.

5. Viață sexuală sănătoasă

Participants were asked about what a healthy sex life might be.  Frequency and quality were common threads within the data set when describing a health sex life.

„Frecvent și împlinit cu cineva care are aceleași interese sexuale ca tine” – Jay

A variety of sexual experience was reported by participants as important in the avoidance of a boring sex life,

              “Being adventurous in the bedroom and having sex regularly”– Richard

În schimb, alți respondenți au ridicat aspecte care au luat în considerare partenerii și relațiile.

„Comunicarea este cheia sexului, iar pornografia învață adesea metode de a provoca plăcere care nu reflectă ceea ce își dorește un partener”. – Harry

„A fi într-o relație dedicată sau a fi sincer despre cine ești atunci când vine vorba de angajarea în activitate sexuală. Arată că ai un respect sănătos pentru celălalt sex”. – Ross

              „Când există un atașament emoțional – uit sexul fără sens”. – Tom  

Communication, honesty, respect and a need for emotional attachments are all reportedin describing a healthy sex life.The gap between these and sex depicted in SEM is clear, the degree to which young men in this group demonstrated insight into this varied.

6. Knowing Right from Wrong?

The data provided numerous examples of contradiction and derogatory views and opinions in relation women,gender stereotypes are clearly evidenced with varying degrees of insight.

“May have desensitised me to certain aspects of sex. I do not feel that has had any negative impact on me and it is not something that I have viewed or do view on a regular basis”. -Ross

“perhaps gender inequalities could arise from seeing women prostitute themselves in front of a camera”. – Alfie

“A man should take the time to make sure his women is satisfied before he blows his load if      he is to have any chance of a good lasting sex life”. – Alfie

The manifestation of abusive behaviour stemming from the objectification of females was also displayed on a conscious level.

“When men drop their personal standards to the point where the female becomes a standing joke amongst friends, this is abuse in my opinion. (I’ve fucked some absolute rotters for a good story for my friends and this is unacceptable) – Gaz

Discuție

The results highlight some potentially important findings in relation to the effect SEM consumption has on the sexual beliefs, understanding and practices of young men, an under researched field.  Within the limitations of a qualitative and therefore non generalizable sample, themes would benefit from large sample confirmation but still contribute to the beginnings of a theoretical account of how SEM can shape attitudes and behaviour.Consumption and acceptance SEM was reported as growing, as confirmed in other research (2,3,4,16,10)., including more extreme content as  adolescents reported becoming desensitised to SEM content, requiring evermore extreme exposure in order to feel stimulated or shocked.  

Young men in this study, acknowledged negative effects on the sexual attitudes and behaviours of adolescents. Family or sex education may offer some ‘protection’ or a balance to SEM representations of sex. Data suggests conflicting or confused views around adolescents’ expectations of a healthy sex life and appropriate beliefs and behaviours.  The pattern of SEM values being internalised may be variable and the experience of ‘buffers’ could be a mediator of vulnerability to SEM as a source of information.

Increased availability may have increased the social acceptance of SEM as simply ‘part of the modern age’(29, 5, 1). Data suggests a pathway of internalising SEM sexual norms leading to confusion and unrealistic expectation, but the perception of SEM as ‘real’ varied.  Variation previously found in the research seemed to revolve around some form of vulnerability (30). The data suggest the role of ‘buffers’ such as family role models or the potential of sex education may be areas for intervention.Data refers to theincreasing use of ‘active’ or self-produced forms of SEM within social media (e.g Instagram) to create or consume pornographic images (31).  How does this home grown approach play into the ideas of real and fantasy behaviour?Collins’ et al, 2011 (20) useful research overview certainly notes that social media can result in increased requests of online sexual interaction being made or received by youths.

Young men in this study themselves raised the possibilitythat SEM exposure maylead to an addiction model of consumption with increasing need for more extreme content. Some report feeling the need to constantly push their boundaries for stimulation, with individuals no longer being shocked by some content, a pattern found in previous research(32, 33, 34, 35, 36) linking it to premature sexual experiences; objectification of females , unrealistic expectations and  increased incidence of sexual harassment (16).

Understand the links better – theoretical pathways, vulnerability and buffers.

Further research should investigate mediators of susceptibility to SEM influence and this work, although based on one group of young men, begins to piece together the pathway of how increasing volume and extreme content of SEM may translate into enacted attitudes and behaviour. 

Securitatea internetului

Work by the UK Council for Child Internet Safety’s and the Department of Culture, Media and Sport’s guidelines (37)recommend that service providers for social networking and interactive services have measures in place to minimise risk, but also make safety advice available for young people, parents and caregivers.  Schools themselves are increasingly addressing internet safety amongst children as young as primary school age.

Sex Education and family communication around sex

The findings may highlight the importance of addressing possible inadequacies in current sex education (24).  Data in this study confirms the widely established relationship (20), to role modelling of appropriate behaviours, attitudes and opinions by primary caregivers but this requires more research.

The value of sex education is well documented throughout current literature (38,39, 24) and participants reported their sex education as inadequate in general but not covering the issue of SEM.  This seems a missed opportunity in prevention of some of the distorted perceptions and confusion young men may be vulnerable to from viewing SEM through provision guidance around what SEM means.  Furthermore, the source of such information would logically be more accessible through the same medium SEM is accessed, online (20).  More research around this field is needed.

Limitări ale studiului

A survey based tool limits the potential to explore topics raised and findings are not generalizable with themes requiring larger sample confirmation. The interpretation of themes from the data can be influenced by the researchers own life experience, establishing reflexive practice, triangulation and using supervision to confirm interpretation are all methods that were used to improve qualitative rigour (28).

This work begins to address gaps in the literature around in-depth qualitative research in a UK setting and research that builds theory around SEM exposure and behaviour.  Increasing availability and the recognition by young men themselves of the negative effects of SEM point to the need for intervention.  Data around key buffers confirm potential avenues of intervention widely recognised in research around teenage pregnancy and STI prevention, i.e. sex education and family communication. Only through raising awareness of possible risks, and then by providing the tools necessary and implementing appropriate safety measures will it then be possible for young people to manage their experiences in life and protect themselves from any potential harm.

 

 

 

Referinte

  1. Træen B, Toril Sørheim Nilsen, Hein Stigum. Use of pornography in traditional media and on the internet in norway. Jurnalul de Sex Research. 2006;43(3):245-247,249-254. http://search.proquest.com/docview/215280373?accountid=14785.
  2. Cooper A, McLoughlin IP, Campbell KM. Sexuality in cyberspace: Update for the 21st century. CyberPsychology & Comportament. 2000;3(4):521-536. http://search.ebscohost.com/login.aspx?direct=true&db=buh&AN=5323505&site=ehost-live. doi: 10.1089 / 109493100420142.
  3. Binik YM. Sexuality and the internet: Lots of hyp(otheses)—only a little data. The Journal of sex research. 11;38(4):281; 281-282; 282.
  4. Fisher WA, Barak A. Internet pornography: A social psychological perspective on internet sexuality. The Journal of sex research. 11;38(4):312; 312-323; 323.
  5. Pornified by Pamela Paul. People (Chicago.1974). 12;64(11):61; 61.
  6. Peter, J. Valekenburg, P.M. (2007) Adolescents exposure to a sexualized media environment and notions of women as sex objects. Sex Roles. 56; 381-660.
  7. Löfgren-Mårtenson L. Lust, love, and life: A qualitative study of swedish adolescents’ perceptions and experiences with pornography. The Journal of sex research. 11;47(6):568; 568-579; 579.
  8. McNair B. Striptease culture: Sex, media and the democratization of desire. Psychology Press; 2002.
  9. Wolak J, Mitchell K, Finkelhor D. Unwanted and wanted exposure to online pornography in a national sample of youth internet users. Pediatrie. 2007;119(2):247-257. doi: 119/2/247 [pii].
  10. Mitchell KJ, Finkelhor D, Wolak J. The exposure of youth to unwanted sexual material on the internet a national survey of risk, impact, and prevention. Youth & Society. 2003;34(3):330-358.
  11. Moreno MA, Parks MR, Zimmerman FJ, Brito TE, Christakis DA. Display of health risk behaviors on MySpace by adolescents: Prevalence and associations. Arch Pediatr Adolesc Med. 2009;163(1):27-34.
  12. Russell DE. Pornography causes harm to women. In: Walsh MR, ed. Women, men and gender: Ongoing debates. Yale: New Haven: Yale University Press; 1997:158-169.
  13. Dines G, Jensen R, Russo A. Pornografie. Routledge; 1998.
  14. Häggström‐Nordin E, Sandberg J, Hanson U, Tydén T.(2005) Association between pornography consumption and sexual practices among adolescents in Sweden. International Journal of STD & AIDS. 16: 102-107. 
  15. Kraus SW, Russell B. Early sexual experiences: The role of internet access and sexually explicit material. CyberPsychology & Comportament. 2008;11(2):162-168.
  16. Brown JD, L’Engle KL. X-rated sexual attitudes and behaviors associated with US early adolescents’ exposure to sexually explicit media. Cercetare de comunicare. 2009;36(1):129-151.
  17. Braun-Courville DK, Rojas M. Exposure to sexually explicit web sites and adolescent sexual attitudes and behaviors. Journal of Adolescent Health. 2009;45(2):156-162.
  18. Luder M, Pittet I, Berchtold A, Akré C, Michaud P, Surís J. Associations between online pornography and sexual behavior among adolescents: Myth or reality? Arch Sex Behav. 2011;40(5):1027-1035.
  19. Ybarra ML, Mitchell KJ. Exposure to internet pornography among children and adolescents: A national survey. Cyberpsychology & behavior. 2005;8(5):473-486.
  20. Collins RL, Martino SC, Shaw R. Influence of new media on adolescent sexual health: Evidence and opportunities. RAND Corporation. 2011.
  21. Alexy EM, Burgess AW, Prentky RA. Pornography use as a risk marker for an aggressive pattern of behavior among sexually reactive children and adolescents. J Am Psychiatr Nurses Conf. 2009;14(6):442-453. doi: 10.1177/1078390308327137 [doi].
  22. Tsitsika A, Critselis E, Kormas G, Konstantoulaki E, Constantopoulos A, Kafetzis D. Adolescent pornographic internet site use: A multivariate regression analysis of the predictive factors of use and psychosocial implications. CyberPsychology & Comportament. 2009;12(5):545-550.
  23. Peter J, Valkenburg PM.(2010) Processes underlying the effects of adolescents’ use of sexually explicit internet material: The role of perceived realism. Cercetare de comunicare. 2010;37(3):375-399.
  24. Brown J, Keller S, Stern S. Sex, sexuality, sexting, and sexed: Adolescents and the media.prevention researcher. Prevention Researcher. 2009;16(4):12-16.
  25. Malamuth NM, Addison T, Koss M. Pornography and sexual aggression: Are there reliable effects and can we understand them? Annu Rev Sex Res. 2000;11(1):26-91.
  26. Strauss A, Corbin J. Basics of qualitative research: Procedures and techniques for developing grounded theory.  1998.
  27. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative research in psychology. 2006;3(2):77-101.
  28. Meyrick J. What is good qualitative research? A first step towards a comprehensive approach to judging rigour/quality. J Health Psychol. 2006;11(5):799-808. doi: 11/5/799 [pii].
  29. Cooper A, Griffin-Shelley E. A quick tour of online sexuality: Part 1. Annals of the American Psychotherapy Association. 2002;5(6):11-13.
  30. Peter, J. Valekenburg, P.M. (2006) Adolescents exposure to a sexualized material on the internet. Cercetare de comunicare. 33(2); 178-204.
  31. Subrahmanyam K, Greenfield PM, Tynes B. Constructing sexuality and identity in an online teen chat room. Journal of applied developmental psychology. 2004;25(6):651-666.
  32. Lam LT, Peng Z, Mai J, Jing J. Factors associated with internet addiction among adolescents. CyberPsychology & Comportament. 2009;12(5):551-555.
  33. Delmonico DL, Griffin EJ. Cybersex and the E‐teen: What marriage and family therapists should know. J Marital Fam Ther. 2008;34(4):431-444.
  34. van Den Eijnden, Regina JJM, Spijkerman R, Vermulst AA, van Rooij TJ, Engels RC. Compulsive internet use among adolescents: Bidirectional parent–child relationships. J Abnorm Child Psychol. 2010;38(1):77-89.
  35. Rimington DD, Gast J. Cybersex use and abuse: Implications for health education. American Journal of Health Education. 2007;38(1):34-40.
  36. Peter J, Valkenburt PM. (2008)Adolescents’ exposure to sexually explicit internet material and sexual preoccupancy: A three-wave panel study. Media psychology. 06;11(2):207; 207-234; 234.
  37. Department of Culture, Media and Sport. Child safety online: A practical guide for providers of social media and interactive services. . 2016.
  38. Evans AE, Edmundson-Drane EW, Harris KK. Computer-assisted instruction: An effective instructional method for HIV prevention education? Journal of adolescent health. 2000;26(4):244-251.
  39. Owens EW, Behun RJ, Manning JC, Reid RC. The impact of internet pornography on adolescents: A review of the research. Dependență sexuală și compulsivitate. 2012;19(1-2):99-122.