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Though still limited, research on teen sexting (defined herein as electronically sending sexually explicit images from 1 adolescent to another) has grown substantially in the past 3 years.

Studies composed of middle school and high school students, ethnically diverse youth, community and at-risk adolescents, and regional and national samples have begun answering important questions about this emerging public health issue.

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The question of what comes first is not merely academic.If sexting precedes sexual behavior (especially risky sexual behavior), then safe sex interventions could be designed to specifically target sexting youth, and prevention programs could aim to reduce sexting as a means of reducing risky sex.Another gap in existing knowledge is whether passive sexting (receiving, asking for, or being asked for a nude picture) differs from active sexting (sending a nude picture) as an indicator of sexual behavior.BACKGROUND: This study examines the temporal sequencing of sexting and sexual intercourse and the role of active sexting (sending a nude picture) in mediating the relationship between passive sexting (asking or being asked for a nude picture) and sexual behaviors.METHODS: Data are from Wave 2 (spring 2011) and Wave 3 (spring 2012) of an ongoing 6-year longitudinal study of high school students in southeast Texas.

Participants included 964 ethnically diverse adolescents with a mean age of 16.09 years (56% female; 31% African American, 29% Caucasian, 28% Hispanic, 12% other). Participants self-reported history of sexual activity (intercourse, risky sex) and sexting (sent, asked, been asked).

Using path analysis, we examined whether teen sexting at baseline predicted sexual behavior at 1-year follow-up and whether active sexting mediated the relationship between passive sexting and sexual behavior.

CONCLUSIONS: This study extends cross-sectional literature and supports the notion that sexting fits within the context of adolescent sexual development and may be a viable indicator of adolescent sexual activity.

Cross-sectional research indicates that teen sexting is common, may be associated with other adolescent behaviors such as substance use, does not appear to be a marker of mental well being, and is probably an indicator of actual sexual behaviors.

Although mounting evidence links teen sexting to sexual behavior, little is known about the temporal sequencing of these 2 behaviors.

Knowing which comes first will aid tween- and teen-focused health care providers in their interaction with patients and patients’ parents.