Latest / Pediatrics Now: Cases Updates and Discussions for the Busy Pediatric Practitioner / Adolescent Relationships in the Digital Age: Violence, Risk, and Prevention

Transcript

Adolescent Relationships in the Digital Age: Violence, Risk, and Prevention · Pediatrics Now: Cases Updates and Discussions for the Busy Pediatric Practitioner

0:00
I'm Holly Wehmins, and this is Pediatrics Now, brought to you by the Department
0:04
of Pediatrics at UT Health San Antonio and University Health's new Women's and Children's Hospital.
0:11
Today, I'm bringing you Grand Rounds. Let's listen in. It is my great pleasure to introduce Dr.
0:17
Jeffrey Temple, who is a professor, licensed psychologist, and the Associate
0:21
Dean for Clinical Research at the School of Behavioral Health Sciences at the
0:25
UT Health Houston, where he also holds the Betty and Rose Pepper Bomb Chair
0:30
in Child Mass Trauma and Resilience.
0:32
As the director of the first CDC-funded Injury Control Research Center in Texas,
0:37
his work focuses on the prevention of interpersonal and community violence,
0:41
including firearm violence.
0:43
He has been continuously federally funded by the National Institute of Justice,
0:47
the NIH, and CDC since finishing his training.
0:50
He has over 225 peer-reviewed scholarly publications in a variety of high-impact
0:54
journals, including JAMA, JAMA Pediatrics, The Lancet Child and Adolescent Health,
0:59
Pediatrics, and the Journal of Adolescent Health.
1:01
He recently co-edited a book on adolescent dating violence, co-chaired the Texas
1:06
Task Force on Domestic Violence, and served on the Board of Directors for the
1:09
Society for Prevention, Research, and the Texas Psychological Association.
1:16
He is an inaugural fellow of the Society for the Advancement of Violence and Injury Research.
1:21
And locally, he served for seven years as the vice president of the Galveston
1:25
Independent School District Board of Trustees.
1:27
His work has been featured on Forbes, CNN, New York Times, Time Magazine,
1:32
The Washington Post, and even the satirical website, The Onion.
1:35
So ladies and gentlemen, please give a warm welcome to Dr. Jeffrey Temple.
1:39
Hey, thank you so much, Dr. Ranch, and thank you all for being here.
1:43
I want to start off by saying how much I love San Antonio and the UTSA system.
1:48
I went to undergrad at UTSA in the 90s.
1:54
I have the tattoo on my bicep to prove it of the Roadrunner,
1:58
and really loved my time there.
2:00
I met my wife. I was a Starbucks barista, and she was a customer,
2:05
and we've been together since. So thank you all again for having me.
2:12
I'm excited to present on adolescent relationships.
2:16
This is what I've devoted my work to.
2:19
When I started, I went to grad school at North Texas and was still working at
2:26
Starbucks, but needed a research job and was at orientation.
2:32
And one of the faculty rudely stood up and said, I need a research assistant.
2:39
And she talked like that because she'd been smoking since she was like four years old.
2:44
And I needed a real job and she was hiring and people told me not to work with
2:51
her because she was crazy and they were absolutely right, but she was also fantastic
2:55
and became my mentor and she studied domestic violence.
2:59
And so I worked with her for my entirety of graduate training.
3:03
And then when I went to Rhode Island to Brown to finish my internship and postdoc,
3:09
I started working with a guy by the name of Greg Stewart and he was doing some really cool work.
3:22
You have muted. Can you unmute yourself?
3:29
Dr. Temple, I think you've muted your microphone.
3:37
I don't even know how I did that. There you go. Thank you. What was the last thing I said?
3:46
You guys weren't even listening, see? it was
3:50
bad school and yeah you're still
3:53
working at starbucks okay i went to brown all right so yeah
3:56
so i wanted to do more like intervention work instead
3:59
of just looking at the consequences of violence which i was doing at north texas
4:03
and so at brown uh we went into these better intervention programs we treated
4:07
the underlying symptoms like substance use and mental health and we saw concomitant
4:12
reductions in violence but then i wanted to actually do something to prevent
4:16
violence from ever happening.
4:18
And so that's when I came to actually to UTMB for I was there for 17 years.
4:24
And that's when I started to look at dating violence and adolescence and have
4:31
been doing that ever since. And it was a really good time.
4:35
I it was sort of at the beginning of when dating violence was getting some attention.
4:41
So I was able to capitalize on that.
4:44
I started a longitudinal study, which I'm going to be talking about today,
4:49
uh, that is, uh, that we started in 2010 and we have been following the same 1000 people since then.
4:57
So for the past 15 years, and we just got a grant to continue following them.
5:01
In fact, I'll put that, uh.
5:04
That grant here, those studies that have been funded by a variety of institutions.
5:10
We've been going for a long time. And so we'll be following these people already from 15 to 30.
5:18
And again, we just got that additional funding. So from 15 years old to 35 years
5:22
old, looking at the idea originally was to look at risk and protective factors of partner violence.
5:29
And now it's expanded because of all the years we have basically anything and
5:34
everything. And I'll talk about a lot of that today.
5:38
And, you know, mental health, substance use, sexting, which we'll talk about today.
5:44
And even up until now, many of them, half of them are parents.
5:48
So now we're adding a bunch of parenting stuff. And we are in the process of
5:53
submitting an epigenetic study to collect,
5:56
send them all spit kits so we can look at SNPs and telomeres and other things
6:02
that I don't really understand and how that relates to the developmental data.
6:06
So along the way, we've done some intervention studies as well,
6:11
but today I'm primarily going to be talking about what we call dating at SAFE.
6:15
That's the name of the study that I came up with almost 17 years ago, and it stuck.
6:22
So when I first started this, there were very few studies at all on dating violence.
6:29
There was, you know, some increasing studies in the late 90s, early 2000s.
6:37
I think the first person to use the word teen dating violence was a study in 1996.
6:43
And just slowly built up. But there was really no longitudinal studies,
6:48
which was really important and not just sort of from an academic sense.
6:53
If we want to prevent something, we have to know what comes first, right?
6:58
So in the case of, say, something like substance use, you know,
7:02
people would talk about how it's related to dating violence and our attitudes and behaviors.
7:08
You know, if someone has a dismissive attitude toward violence against women,
7:14
then they're more likely to abuse their partner. And that makes a whole lot of sense.
7:19
But it could also be the case that someone who abuses their partner,
7:22
in order to condone the behavior, starts to adopt those sort of justifying behaviors.
7:28
So, you know, to adopt that it's OK to beat women.
7:32
So it's not just an academic sense that we need this because we need to know
7:37
like attitudes and behaviors and risk factors if they actually predict or precede
7:44
violence if we want to design prevention programs.
7:47
So that was the we were sort of the first one to do this long term longitudinal
7:52
study. And I mentioned this earlier, you know, we started in 2010 when kids
7:57
were in the ninth or 10th grade.
8:00
And we have been conducting these surveys annually.
8:05
And since wave 10, so this was in, I guess, 2020, we started to include current
8:11
partners of participants, which means now we can do dyadic analyses so we could
8:17
see if, which is pretty rare in the field.
8:20
There's only been a few studies looking at partners, so we can see if one person's
8:25
sort of mental health affects the other person's violence or vice versa.
8:30
The mean age at the time was 15, and again, they're now about 30 years old.
8:36
So you can look at the distribution here. This was at wave 13.
8:41
When we first collected, the sample was closer to a little more females, but not this different.
8:47
I guess this shows that women are easier to follow longitudinally.
8:53
It's a really nice triethnic sample in the sense that there's a third Hispanic,
8:58
a third black, and a third white.
9:01
And then you can see here that 31% are married, but it's a little bit higher now.
9:06
Closer to 47%, 46% have kids,
9:11
17% identify as a gender, sexual minority, and it's a nice representative sample
9:17
of socioeconomic level, 40% have an income below $50,000.
9:25
So here's some of the study measures that we did, and there's a lot more than this.
9:31
This is related to a lot of the violence items, but you can see that the waves
9:37
next to it, 1 to 14, 12 to 14, when we added stuff.
9:40
But it's everything from dating violence to sexual assault, all forms of substance
9:45
use, a bunch of different mental health problems.
9:49
Firearms we added in wave eight. If you look back, that coincides with the Sandy Hook shooting.
9:57
That is the day after Sandy Hook, Obama loosened the restrictions on whether
10:03
or not researchers could study firearms.
10:06
And so we immediately added firearm questions to our longitudinal surveys and
10:11
now have been following firearm use and got actually another grant from CDC
10:16
to do in-depth interviews with known gun carriers. Was that our sample?
10:21
So we can better understand just sort of basic stuff about how people get guns,
10:25
how they store it, why they carry it, where they where they carry it,
10:31
you know, all that sort of stuff.
10:32
So it's uh uh it's now one of the longest running studies on firearm ownership
10:38
that's ever existed given the dearth of research that was uh done prior to 2013.
10:47
So here's a look at retention we've had a pretty amazing uh retention level if you look uh,
10:55
Across all these years, from 2010 till now, 25, we had 79% of the original participants.
11:03
And that includes those who have passed away, those in prison,
11:09
those who said they no longer want to participate.
11:11
So if you look at actual people that we could actually recruit,
11:15
you know, those still alive and that want to participate, it's closer to 90%,
11:21
which is pretty remarkable for a sample,
11:26
a low-income, ethnically diverse sample recruited 15 years ago.
11:31
And we did it through COVID in 2020.
11:36
We maintained a pretty high retention rate even during those crazy times.
11:43
So we did a, we have 70, a little bit more now, but from Dating It's Safe,
11:48
we've published 70 articles from it.
11:52
And one of the cool things, we actually have, I think now, 101 unique authors
11:57
have contributed to publications, which is pretty amazing.
12:03
I mean, that means 101 CVs have Dating It's Safe sample on it,
12:07
which is really, really cool.
12:09
And so we did this content analysis of the of the of the papers.
12:16
So it's, you know, basically we look for themes and coded articles and then
12:21
summarize those codes to see what we found.
12:24
And so what we found was that some of this is new.
12:31
Some of this is consistent with existing research. But we found that dating
12:36
violence, victimization, and perpetration frequently co-occur.
12:42
So that basically when you think of violent relationships, it's very rare that
12:48
one person in the couple is sort of cowering in the corner like a Lifetime movie.
12:54
In fact, it's sort of this idea that violence begets violence,
12:58
that violent relationships are typically characterized by mutual or bi-directional violence.
13:07
And you can see the numbers here.
13:10
It's been pretty consistent. The first wave, when they were 15,
13:17
16, that is lifetime prevalence.
13:21
So it started out a little bit higher for things like physical perpetration and victimization.
13:26
Every year after that was past year.
13:31
And speaking of that, we did a really cool study. So if you look at everything
13:36
that's available, it's always true.
13:40
It's always like, uh, uh, you know, a third of kids or 20% of kids by the time
13:45
they graduate high school or, um, you know,
13:49
A third of people just in general will experience some form of physical or psychological violence.
13:57
And that number is consistently reported everywhere.
14:03
Now, if you look at this, though, and the reason that is, and we showed it with
14:07
our previous slide, if you look at this, we sort of say the same thing, about 20%. saying.
14:14
Uh, now though, when you look at this, we, cause most people do like retrospective,
14:21
uh, have you ever been in a violent relationship or in the study,
14:25
they just talk about past year violence and they use that.
14:28
What we did is we looked at cumulative incidents of violence.
14:32
So, uh, we did each year, if someone was newly violent, we included them.
14:39
If they were already violent, we didn't.
14:41
So you can see that here by the time they were age 26, 27% of participants has
14:48
experienced sexual DV victimization, which is a lot higher than what the extant literature says.
14:55
46% experienced physical DV victimization.
14:59
Again, quite a bit higher than that 20, 30% that I mentioned earlier.
15:03
39% perpetrated physical dating violence. Again, all of this higher than what.
15:10
The extant literature shows.
15:12
We see also that dating violence peaks around age 20, which is fairly consistent with the literature.
15:19
But one thing that I think that's really important is it still increases after that.
15:25
So if you look at, for example, age 22 to age 25, it went from 33.7 to 36.7.
15:33
That's an additional 3% of people that are in newly violent relationships,
15:38
Which means that we still need to be talking about prevention programs into
15:43
the 20s with new couples.
15:48
Some findings that we found, which is pretty neat, and I won't go through all
15:52
of these, but I'll pick up some examples. We had parental IPV predicted.
16:00
So if kids witnessed their parents violent toward each other,
16:03
it increased their likelihood of being violent themselves.
16:07
That in itself wasn't a novel finding. What was novel with ours is that we actually
16:12
looked at whether they observed mother-to-father violence or father-to-mother violence.
16:17
And what was cool, or well, not cool, but cool from a data standpoint,
16:22
is that witnessing moms be violent toward dads was most predictive of kids'
16:30
own violence, regardless of whether it was a boy or a girl witnessing the violence.
16:34
Which was different and new to the literature and suggests that maybe when mom
16:39
uses violence, there's just overall
16:41
more violence in the relationship that causes them to use violence.
16:44
Or it's that kids identify with their mothers more because they spend more time with their mom.
16:50
And so if she's using violence, they're more likely to model that behavior.
16:55
So that's important from an intervention standpoint.
16:59
But it's also important from realizing that females also use violence and that
17:06
their violence, even if it is resistance or protective.
17:11
That it still is important because of the idea that violence begets violence.
17:16
We also found in this study that was also cool is that acceptance of dating
17:23
violence mediated the relationship between exposure to violence and perpetrating violence,
17:29
which is neat because we often can't do anything about what happens at the home.
17:34
You know, the parents will try, but parents are unfortunately going to steal
17:39
and be violent toward each other.
17:42
But if we can change attitudes about violence, then maybe we can stave that off a little bit.
17:49
Second study that I want to talk here is this childhood corporal punishment study.
17:54
And the reason I want to talk about that is it was one of the first studies
17:58
to show that spanking your kid in and of itself above child physical abuse was
18:06
predictive of later dating violence perpetration,
18:11
which means that and people have been lobbying for this to include spanking
18:16
and childhood corporal punishment as an adverse childhood experience.
18:21
And I realized that several people on this call, including me,
18:25
were spanked as kids. And some of us may even spank our own kids.
18:29
And this is not demeaning any of us that do that.
18:33
In fact, when I talked to the media about it, I sort of screwed up.
18:38
And what happened in the media was I published on everything from,
18:42
you know, sex to violence, to drugs, to firearms.
18:46
And what I got the most criticism and literally death threats from was when
18:53
I published this paper saying that spanking was related to dating violence perpetration.
18:59
In fact, there was a article, if you guys remember, I don't know if it still
19:04
exists, but the Facebook site, I Fing Love Science, they posted this paper.
19:09
And within literally within 30 minutes, there were 30,000 comments and 29,000
19:16
of them were bullshit, bullshit, bullshit, bullshit.
19:19
And several was this, the author of this study needs to be spanked and stuff like that.
19:24
So, uh, anyway, all that to say, I really screwed up and this is a good lesson
19:28
for y'all on how I talked to the media, uh, for this one, you know,
19:33
I was, uh, pretty upfront about it.
19:35
You know, if you spank your kids, uh, they are more likely, and the media sort of ran with that.
19:40
But what I should have said is, you know.
19:44
If you have 10 kids and none of them were spanked, let's say one of those kids
19:50
are going to go on to perpetrate dating violence.
19:52
And then you have 10 kids, all of whom were spanked, and two of those kids are
19:57
going to go on to perpetrate dating violence.
19:59
So still eight of the kids are not going to perpetrate dating violence who are
20:02
spanked, but it's 100% different from the kids who weren't spanked.
20:06
So if I would have done it like that, it doesn't mean that your kid's going to.
20:10
It's just more likely than if they weren't. That would have been a lot better.
20:13
All right. So other things we have bullying, substance use, gender minority youth.
20:19
We were one of the first groups to look at dating violence and same sex relationships.
20:25
Found that it was for those that identify as sort of homosexual.
20:30
They were pretty similar to heterosexual. It was those that identified as bisexual
20:35
are questioning that it was more likely that they were in a violent relationship.
20:40
But that tracks with a lot of the research out there that those kids are most
20:45
susceptible to negative consequences. And it probably goes back to that,
20:50
you know, they're not accepted by either side, so to speak.
20:54
So a lot of uh kids that are born into mixed families that uh they get they
21:01
get stressed from both sides if.
21:03
Uh, victimization, similar, uh, uh, uh, correlates and predictors of victimization,
21:11
uh, risky sexual behavior.
21:14
Uh, we've looked at personality disorder. One of the biggest,
21:17
uh, predictors is prior dating violence.
21:20
And, uh, you know, that shouldn't be of any surprise to anyone here.
21:24
Uh, but from an, uh, long-term standpoint,
21:28
what's scary is dating violence predicts adult
21:32
partner violence and we know the negative consequences and
21:36
the fact that it costs us you know billions of
21:38
literally billions of dollars uh every year
21:41
as a nation in uh in uh
21:44
lost time at work and uh criminal uh uh crime uh uh why can't i think of the
21:53
word anyway the money it takes to investigate crimes and put people away and
21:58
uh uh and then sickness as well and and health, uh, use.
22:04
So we look at what it causes and perpetration, you know, everything,
22:09
a host of mental health problems, worsening physical health, poor sleep,
22:15
substance use, and then most recently saw that it increased the risk for parenting
22:19
stress and child maltreatment.
22:21
Similar things with victimization, suicidal ideation, risky sexual behavior,
22:27
poor sleep, parenting stress, and child maltreatment.
22:30
And of course, we talked a little bit about this, but the multi-generational impacts.
22:35
And one of the cool things we're going to be doing with this study as we move
22:38
forward, you know, I'm going to hopefully continue to get funding until I die
22:43
or retire so that we'll follow these kids from, you know, when they're age 15
22:48
to when they're age 50 or 60.
22:51
And in the next round, we're going to recruit children of parents so we can
22:57
really look at intergenerational impacts of things like violence and substance use and mental health.
23:03
There's a lot of beginning research out there that shows things like adverse
23:09
childhood experiences are heritable in a sense,
23:14
probably through social aspects like poverty and stress.
23:23
All right, so just to nail it down, You see that all these studies,
23:29
we see that it impacts across generations,
23:34
strong multigenerational relationship between risk and impact and underscore
23:39
the interconnected nature of risk behaviors.
23:42
We're starting to add more about protective factors because that in the research
23:48
in general is less knowledgeable about what mitigates or protects kids from
23:54
the harmful effects of violence or preventing violence from the beginning to begin with.
23:58
So other areas of things that we've started to look at.
24:04
Uh, on its own, uh, apart from violence necessarily is, um, mental health,
24:10
substance use, firearms.
24:12
And, uh, this last thing is what we're going to get into now,
24:16
which I think is the more fun part of the talk.
24:19
So if you've been bored so far, I promise it's going to get a lot more exciting,
24:22
not, not a lot more, but maybe minimum, minimally exciting.
24:26
So sexting is what we, uh, have, I, in 2012, um, I put out a,
24:33
uh, article on, on sexting, teen sexting specifically.
24:37
And it was, uh, uh, at the time it had reached like every major,
24:43
uh, print outlet in the world. It was covered internationally.
24:48
UTMB, uh, said that it had reached, I think it was close to 600, 700 million people.
24:55
At the time, it was the, uh, most, uh, highly cited, uh, uh,
25:01
talked about, uh, uh, research that had ever come out of UTMB.
25:08
And then, uh, uh, just about two
25:10
months after that study and all that 15 minutes of fame that I had, uh,
25:15
we, uh, UTMB started to accept, uh,
25:19
ebola patients and uh that sort
25:22
of cornered the market so uh you know
25:25
whatever i guess ebola is more more important than sexting uh
25:28
the other fun uh thing that i had with sexting
25:31
is i was on i literally did like two days straight of uh of of talking to news
25:39
reporters about sexting i mean it was it was for the a while there because it
25:43
was the first paper to ever come out about this Like you could Google my name
25:47
and pictures of naked people would come up.
25:49
Like it was a kind of a safe way to look at porn at work.
25:53
Just by Googling my name. It's not that way anymore, unfortunately.
25:58
But, you know, so anyway, I was on the live call with a radio station in Atlanta.
26:06
And the guy introduces, you know, introduces the topic and starts talking about
26:13
a kid that fell on a basketball court.
26:18
Has got a pretty bad cut on his leg, has got sick, his mom took him to the doctor,
26:25
doctor sent him home, and he ended up dying.
26:28
And he goes on and on about this, and I'm sitting on the phone,
26:32
live radio, thinking, what the hell does this have to do with sexting?
26:36
Like, oh my God, what is he doing?
26:37
What am I talking about? And then it clicked that he thought I was on to talk
26:42
about sepsis and not sexting, and he came back to me and he said,
26:46
And so, Doc, you know, what do you think about that story?
26:49
And I, you know, I'm like, well, sir, I mean, that's terrible.
26:54
But it sounds like you're that's sexist. I'm here to talk about sexting.
26:58
And it was, you know, awkwardness ensued from there. But it was a fun little thing.
27:05
Also, the New York Times, the Statement of Record, had claims that I am the
27:11
one who came up with the word teen sexting or sexting.
27:16
That is not true, but it is the paper of record So I'm going to go in to claim it until I die,
27:22
That's the second time I mentioned I'm going to die. Hopefully it's a really long time away from now.
27:26
But now that I said it, it's probably going to be today and you guys are going
27:29
to learn about it tomorrow. All right.
27:32
So why this research matters on sexting and social media and,
27:37
you know, quote unquote kids these days.
27:42
And I think we tend to see every new invention as we get scared for the kids, right?
27:50
Like, what is this going to do to our kids? And we saw this with the telephone.
27:54
We saw it with the automobile. We saw it with the Internet.
27:58
And now we see it with smartphones. And you can see my example there,
28:02
this picture of everyone says that these kids don't know how to form relationships.
28:07
They don't talk to anyone anymore.
28:10
We've always been the same social beings. And you can see that from that photo
28:14
from it looks like the early 1900s where no one's talking to each other.
28:19
They're reading the newspaper. And it's it's newspapers just been replaced with
28:24
the phone. And I'm not naive.
28:25
I get that we spend way too much time with our phones and all that.
28:29
But, you know, it's not destroying kids is not destroying us.
28:33
We'll talk a little bit about that here in a second.
28:36
It's just a different way that we communicate with each other.
28:40
And there's research, you know, there's a lot of people out there that the psychologists
28:45
in particular that want to get their their day and day in the sunlight.
28:49
And they talk about how smartphones are just destroying everything and relationships.
28:54
But if you actually look at the data, substance use is down among teens.
29:00
Pregnancy is down. Drinking and driving is down.
29:04
Relationships are maybe not harmed as much as people think.
29:09
And in fact, some of that stuff that I mentioned about substance use and sex
29:14
and drinking and driving is a direct result of social media,
29:19
for better and worse, right?
29:21
Like we kids are getting their driver's license longer. They're staying at home more.
29:27
And you can see some problems with that. They're not establishing their autonomy,
29:31
their independence. They're not hanging out in different friend groups.
29:35
They're not making the same mistakes that I made as a kid that that shaped me
29:40
into who I am, but they're also safer. So there's a little bit of back and forth there.
29:44
Now, there is increasing research that shows that kids are lonelier,
29:50
more depressed, suicidality is up and there
29:53
there's been a lot of people that link it to smartphones and that
29:56
probably does play a role but you
29:59
got to also remember that this generation has just
30:02
gone through a world-changing pandemic that this generation and previous generations
30:08
have had to worry about school shootings there's geopolitical strife there is
30:14
a climate change That is quite literally making people move here in Houston.
30:20
We have something every couple of years that floods and and people die and people
30:25
have to move and it affects low income people the most.
30:28
So, you know, yeah, it probably does impact kids, but I don't think it is as
30:35
much the boogeyman as people say it is.
30:39
Um, so this is another example, you know, at first someone could say,
30:44
oh my God, look at the bright, sunny day.
30:46
These two baseball players are just playing on their phones.
30:49
But what you have to look at closer is that this is a Dominican player and a
30:53
kid from South Dakota, and they're
30:56
using the translate function on their phones to talk to each other.
30:59
Something that couldn't have happened 10 years ago.
31:02
And here, just to hammer it home a little bit, these things are confusing and
31:07
harmful, create forgetfulness in the litter's souls because they will not use their memories.
31:12
This could have been said about smartphone, but in fact, it was said about the
31:15
printing press and literacy.
31:18
And you can see the same thing throughout development on radio,
31:22
developed a habit of dividing the tension between the humdrum preparation of
31:25
their school assignments and the compelling excitement of the loudspeaker.
31:29
On movies, corrupted morals of children or adults are in sight to crime.
31:33
Might be a little bit true.
31:35
On television, Hurt Radio, conversation, reading.
31:38
And then I think the funniest ones are the email.
31:43
Hurt's IQ more than pot. That is from C. These are actual headlines.
31:47
Twitter and Facebook could harm moral values.
31:49
Facebook and MySpace generation cannot form relationships. So all these things have been said.
31:56
No research points to that these are accurate.
32:01
None. And you can see the same thing about AI. Same things being said about AI.
32:06
And, you know, eventually I'm going to be wrong, but, you know,
32:09
we've been saying the same thing about everything forever.
32:12
There's a news article talking about baseball from 1860-something and some older
32:21
generation complaining about the way the younger generation is playing baseball.
32:26
So it's just something that we like to do with younger generations.
32:30
They're different from us. They're not as cool as us.
32:33
They don't study as much. They whatever.
32:36
In reality, this generation that's coming up is the smartest,
32:40
most well-connected generation that's ever existed. And the generation after
32:44
them will be smarter than them.
32:47
All right. So getting to, you know, the word that I invented sexting, you can see this.
32:54
Do you, Jackie, how are you? I'm fine. What are you wearing? I am horny.
32:57
Fondest regards, Dickie. P.S. Super horny.
33:00
I put that on here to actually say that we've always sexted.
33:03
You look at some of the the, you know, 1600s and letters back and forth to people.
33:10
They're quite graphic and uh and sexting
33:14
if they had smartphones they would have done the same thing
33:17
that the current generation is doing uh when
33:20
i was a kid i certainly you know did the polaroid pictures uh and all that it's
33:27
just the the difference is you know the polaroid picture would get to make worst
33:31
case scenario maybe like 10 people would see it now the worst case scenario
33:35
is literally billions of people can see it.
33:38
All right, so we did this study.
33:42
This is a meta-analysis that we did a few years back.
33:50
It's actually my most cited paper. I think there's a thousand different papers that cited this paper.
33:57
And it's looking at the prevalence of multiple forms of sextine.
34:01
And what we found here was that 15% and 27% have sent and received a sext, respectively.
34:15
So that's quite high. And then the prevalence of forwarding a sext without consent
34:20
and having a sext forwarded without consent was 12% and 8% respectively.
34:25
High, but not crazy high. We also had a mix of ages, and you saw as 12-year-olds
34:33
were less likely than 17-year-olds.
34:36
And if you looked at 17-, 18-year-olds, it's closer to half.
34:41
So should we care about sexting? So this goes back to what I was talking about,
34:45
what I like to call and others have called juvenile, right? Paranoid about juvenile actions.
34:50
And, you know, I don't want my, my kids are 20 and 22 now, but when I was doing
34:57
this research, they were in middle school and high school.
35:00
And I would, you know, I don't want, I didn't want them saying they probably
35:03
did. I didn't want them sexting.
35:04
I would tell them that if they sext, you know, I'm going to give a talk at their
35:08
school about sexting to hopefully scare them out of it.
35:12
But should we care about it? And, you know, I think the easy,
35:16
obvious answer is yes, of course, we don't want these kids sending naked pictures.
35:20
It's going to hurt their chances to get into college and they're never going
35:24
to have a job and all that sort of stuff.
35:26
You know, we know that that is not necessarily true.
35:30
And when we tell kids that, they know it's not true because they know their
35:34
friends are sexting and nothing's happening to them.
35:37
Uh, in fact, when I talk to kids about it, I usually say, uh,
35:41
I introduce it as how many of y'all will wear a seatbelt on your way home.
35:46
They, you know, a hundred percent of them raised their hands,
35:49
uh, which is a public health miracle, by the way, because when I was a kid,
35:53
that was, uh, uh, that was like wearing a mask and people, no one wanted to
35:57
wear a seatbelt. Anyway.
35:59
Um, so, uh, you know, they'll all raise their hands and I,
36:03
and I'll say, you know, the chance of any of you getting in an accident on the
36:05
way home is negligible so why why
36:09
are you wearing your seat belt and they say just in case and so then i um take
36:14
it back to sexting and try to at least speak their language a little bit uh
36:19
when pokemon go came out uh there was a huge literally If you Google Pokemon,
36:28
even now, Pokemon Go and police,
36:31
you'll see that just about every city.
36:35
Every media market in the country had a story,
36:39
about how Pokemon Go was going to lead to kidnappings and, you know,
36:44
stranger danger and people were going to, you know, die chasing these things and all that.
36:50
And so really, no one, no one was kidnapped from Pokemon Go,
36:55
despite all the news headlines about it.
36:58
I think one person died. They were they were trying to catch a Pokemon on a
37:05
cliff and fell off the cliff and died.
37:07
And, you know, that's terribly sad, but the truth is they probably deserve to
37:11
die. And it's probably good that they're out of our gene pool.
37:15
I'm kidding, of course. And I say that I said that joke at a conference one
37:19
time dryly and, you know, got the expected reaction, some laughs, some groans.
37:25
And after the fact, some woman came up to me just totally, totally like just
37:31
looked mortified with dry.
37:33
And she said, you know, that was that was my cousin who died.
37:38
And she'd like carry it forward for like two minutes and I'm sitting there red-faced
37:43
and apologizing and then she breaks out in laughter.
37:46
She was joking, of course, but that was a great... So hopefully you guys don't
37:51
know the person who died.
37:52
All right, so teens, they think about sex.
37:56
This goes back to whether or not we care about sexting. They have sex quite a bit.
38:02
They're going to continue having sex and one thing that we all know is that
38:06
us telling them not to have sex does not work. In fact, might be iatrogenic
38:12
and increase the likelihood of them having sex.
38:14
You know, we tell kids not to do stuff, not to drink, not to have sex.
38:19
All the while talking about how great drinking is and how great sex is.
38:23
So we have to do a better job of communicating to them.
38:27
And so our focus should be less on preventing sex at all costs and more on preventing unwanted,
38:36
trafficked, and unsafe sex, preventing forward and non-consensual sex,
38:40
and you'll see that as a theme in the next 10 minutes,
38:43
and then promote healthy relationships, including sex-positive relationships,
38:47
obviously not with young adolescents you know
38:50
but you know when kids get 16 17 18
38:53
uh we again still don't
38:56
necessarily want them to have sex i didn't want my
38:59
kids to have sex i hope they didn't but i was also not stupid and i put condoms
39:02
in the bathroom and also plan b uh all right so again going back to do we care
39:09
there was there is some uh consequences to things like this and you can You
39:14
see there's a Netflix documentary.
39:17
I think it's called The Worst Person on the Internet or something like that.
39:20
And it is very disturbing.
39:23
It's all about sexting and about revenge porn and people using sext against
39:28
them, sextortion, or bully them until it drives them to, in the case of Jessica Logan, suicide.
39:37
So we see this with Trevor, the Trevor Project.
39:42
I can't remember his last name. the college student who was bullied for being gay.
39:49
So there are potential consequences, but we don't know them.
39:53
So what we did was we did a meta-analysis to look at things,
39:59
whether or not it was related to sexting.
40:01
So there was some research out there that shows that it's related to sexual
40:05
behavior, to substance use, to delinquency, and to depression and anxiety.
40:10
There were also studies that showed that it was not related to these things.
40:14
So we did a meta-analysis of, I can't remember how many studies it was.
40:20
It was like 31 studies, 29 studies or something, but basically of about 40,000 participants.
40:26
And what we found was pretty interesting.
40:29
And you're going to think when I first do this that I thought you were trying
40:34
to dispel some of the alarm around sexting.
40:38
And I'll get to that in a second. But if you see this, sexual activity is highly related to sexting.
40:46
Delinquent behavior is related to sexting. Depression and anxiety is related to sexting.
40:51
Alcohol use, drug use, smoking related to sexting.
40:54
Now, what this study has is now a bit dated.
40:59
And what we know now that it reflects a lot of like in-person real life behavior.
41:07
That unwanted sex we know is related.
41:13
So a kid has unwanted sex as a 16 or 17-year-old.
41:18
We know that that's related to bad outcomes. A kid is raped as a 16-year-old, 17-year-old.
41:25
We know that's related to bad outcomes.
41:27
A 14-year-old has sex. We know that is related to bad outcomes.
41:32
And when we start to tease apart this data, We find remarkably similar experiences
41:40
to in-person, real-life sex.
41:43
So when sexting was non-consensual, when it was forced, when the kid was younger,
41:49
that's when we see the negative outcomes.
41:52
Two 17-year-olds having consensual sex, our two 17-year-olds consenting to sexting
41:59
each other, is not related to bad outcomes.
42:02
So that's sort of the nuanced difference.
42:05
All right. The study that started this all, this was the study that I published
42:10
in 2012. You see Brian W. Temple there. That's my brother.
42:16
He's a pediatrician. He did not do anything for the study.
42:20
I just thought I needed an MD on there to get it published in JAMA Pediatrics. And it worked.
42:26
He read the page. I was ethical, you know, whatever. Anyway,
42:30
he's a great pediatrician. If you ever get a chance to work with him, he's in Austin.
42:35
He's a good dude. All right, so we published this paper, and what we found was
42:40
a lot higher than what people were reporting at the time or thought at the time.
42:45
And when I say people, I mean people that didn't know kids.
42:48
If you looked at, if you asked teachers, they thought these numbers were low.
42:52
But basically, a third of kids had sent a picture, asked 46% males asked,
42:59
and then had been asked 68% of females.
43:02
Now this was 2012.
43:05
Smartphones were only in existence for four years at that point.
43:09
These numbers are remarkably higher in terms of being asked.
43:13
Basically 100% of girls have been asked to send a naked picture and a lot of boys too.
43:20
Then I asked about bothered. I have a couple of good stories about that,
43:23
but I'm going to skip it for the sake of time.
43:26
But basically what we found here was those who sexted were more likely to have
43:33
sex than those who had not sexted, which isn't totally surprising. Right.
43:38
I mean, if you're already having sex, you're probably likely sexting and maybe vice versa.
43:44
But we didn't really know, which has really important points.
43:47
Like if we're wanting to prevent unsafe sex and sexting is predictive of sex,
43:53
well, then we would want to prevent sexting to prevent sex. So it's not just an academic question.
43:59
So to do that, and I'll give you just a couple seconds to digest this best cartoon ever.
44:06
Yeah. So sometimes I choose to put this on and sometimes I choose not to.
44:11
But I thought you guys were a good crowd.
44:14
Anyway, so we looked at this longitudinally to see if sexting came first or sex came first.
44:21
And what we found was that actually being asked and asking for a sex was not related to actual sex,
44:30
but it was related to sending a sex and sending a sex was related to having sex.
44:36
So it preceded sex, which is really important from a prevention standpoint if
44:42
we want to prevent unsafe sex.
44:44
And so a lot of kids in the United States hate me because when this study came
44:49
out, I did my media tour and, you know, someone on the radio would ask.
44:55
So what obviously, invariably rather, would ask what advice I have for parents.
45:01
And I would say, if you're with your kid right now, pull over and talk to your
45:06
kids about sex and safe sex and healthy relationships and keep talking to them about it.
45:13
So that, you know, that was my hope that that this research came out of this research.
45:19
All right. So shouldn't we care about sexting?
45:22
And, uh, the, the, what I come back to is maybe, I, you know,
45:26
I, I don't care if two 17 year olds are sexting each other.
45:30
Uh, I, you know, who cares? I also don't care if two 17 year olds are consensually
45:36
having sex, uh, from a public health standpoint, I just don't care.
45:40
Also, that's me in the picture when I used to have, uh, hair like that.
45:45
I have hair, really pretty hair now, but when I had hair that was,
45:48
uh, that sort of, uh, up in the front.
45:52
Yeah, that was me. But we should care about it when it's younger kids,
45:57
when it is forced or non-consensual or coerced. That's when we should care about it.
46:05
All right. So all this stuff, we talked about dating violence.
46:08
We talked about unsafe sex and non-consensual sexting. And so what do we do about it?
46:15
I want to have time for questions and we have about five more minutes to talk
46:19
about this uh we have a program that uh we,
46:24
adapted from canada it's called fourth r reading
46:27
writing arithmetic and relationships the fourth r stands for relationships and
46:32
so uh what this does is teaches kids how to be in a relationship and if i were
46:37
to ask y'all how if you were taught how to be in a relationship i assume none
46:41
of you would raise your hands because we're not taught this really essential human skill, right?
46:47
We're taught how to play music, how to be creative, how to write,
46:53
how to read, all that stuff. But we're not taught how to be in a relationship.
46:57
So this is the idea is to teach these relationship skills like we teach other things.
47:02
And it's really focused on what I really like is that it's not just on preventing violence.
47:10
What I think and what some of our research is bearing out is that we can target
47:16
relationships as a sort of protective factor to prevent a lot of bad outcomes.
47:23
Uh, and you know, it makes sense, you know, if, uh, and, and how do kids learn
47:28
how to be in a relationship now?
47:30
Well, they learn from their, their friends who equally suck at it.
47:33
They learn from the media, which sucks. They learn from their parents, which may be good.
47:38
And, but even well-intentioned parents, they might argue in front of their kids,
47:42
uh, and then make up elsewhere, uh, or they learn from trial and error.
47:46
So the fact that most kids do okay, uh, is impressive.
47:50
Uh, but we want them to do better than okay. Right. We want them to to excel
47:56
and to be healthy and happy and have those positive relationships,
48:00
not just a nonviolent relationship.
48:03
So we talked to we have different lessons. So this is taught in class.
48:08
We teach the coaches because our health teachers who are usually coaches and
48:12
especially in Texas, we give them the lesson plans and there's these different
48:18
themes and they take it over.
48:20
And we also have one on healthy eating.
48:23
Going back to some of the things I like about it, it targets multiple problem behaviors.
48:29
I mentioned that earlier, which is great because, you know, the way schools
48:34
have it now is they have an assembly on bullying, our Red Ribbon Week to talk
48:38
about substance use, maybe a guest speaker to talk about violence,
48:41
all that sort of stuff. Those don't work.
48:43
We know that those one offs do not work.
48:46
We know that there's a dose response. The higher the dose, the better the response.
48:50
So this program replaces again, replaces health class and is a semester or a
48:55
year long and gives them these skills to be healthy relationships.
49:00
So it's universally focused, which is great, because then there's,
49:04
you know, no stigma by taking out the bad kids, quote unquote,
49:09
and then putting them with other bad kids, which only teaches them how to be
49:12
good criminals. Alternative schools.
49:15
Juvenile detention centers are just stupid. They don't work,
49:19
and they actually are iatrogenic.
49:22
So anyway, the whole class or whole school is involved is great.
49:27
And it's, again, about positive youth development. It's not just about avoid,
49:32
avoid, avoid, but how to be happy and healthy.
49:35
We also show that it works. So you can ignore that consort diagram.
49:39
But basically, what we what we found with the initial year is that it reduced violence.
49:45
People that receive we did a randomized controlled trial 12 middle schools got
49:49
the intervention 12 schools had health class as usual and we saw that the intervention
49:54
schools kids and those did better in terms of reduced violence a year later.
50:00
We also saw that it continued to prevent violence three years later and then
50:05
in our most recent study which I guess I don't have a slide for just came out
50:10
was that five years later,
50:13
so we implemented this in seventh grade,
50:15
five years later when they were seniors in high school, kids that received the
50:19
program were less depressed than kids who did not, which is amazing.
50:24
This fairly cheap, cheap, not fairly cheap, cheap program implemented in seventh
50:31
grade had kids less depressed five years later.
50:35
If we can do this nationwide, imagine the impressive results that we can have.
50:43
Uh, we've been doing a lot of work with 4th R. We're still studying it.
50:47
We're adapting it for a juvenile detention population. We're adapting it for,
50:51
uh, uh, kids in foster homes. We're looking at it with community colleges and
50:57
colleges. So we're doing a lot of work with this.
51:00
I'm going to skip this side, but know that we have a texting,
51:03
uh, um, intervention as well. That, uh, is pretty cool.
51:10
This is my favorite quote. If you're going to do anything to the common man,
51:13
you have to start before he becomes a man.
51:15
It's a little sexist, but you get what it's saying.
51:21
Here's my team and my contact information. Feel free to email me with data requests
51:27
or anything else. My data is your data.
51:31
Taxpayers fund our research, and they should get to use it. So I am going to
51:36
stop sharing and open it up for questions.
51:41
Dr. Temple, thank you for that just outstanding presentation and amazing data.
51:46
And also for reminding us not to Google your name.
51:50
But as Dr. Temple said, open up for questions. You can either raise your hand
51:54
and unmute yourself or go ahead and enter it into the chat. Don't be shy.
52:04
I was told at the beginning of this that there's sometimes a lot of questions
52:09
when it's an engaging talk.
52:11
So not having any questions is deeply hurting my feelings.
52:17
I guess while we're waiting, I'll start. Early on in your talk,
52:20
you talked about how dating violence was basically like a two-way street,
52:26
which is amazing to me. I'd never come across that.
52:29
So were you able to stand on, I guess, the data that showed that or supported that?
52:34
Yeah. So we and I actually started this when I was at North Texas.
52:38
We were some of the we I say we it was my my mentor was one of the first people
52:44
to look at sort of bi-directional relationships because at that time,
52:48
you know, you weren't like and I'm not kidding when I say you could not talk
52:52
about female to male violence.
52:54
I did that at one early talk and I got basically thrown people through tomatoes at me there.
53:01
People did not want to think about the fact that women can be violent as well,
53:07
uh, because it was like, we were blaming them, but you know, it's not blaming them.
53:13
It's just the fact that violence begets violence.
53:16
So one of the reasons we know that, uh, batter intervention programs for the
53:20
longest time didn't work is because they didn't get these dudes in there who
53:25
were violent and needed to be in there.
53:28
And then they would give them some tools to not be violent.
53:31
And then they would go back to the same relationship and the woman would use
53:36
violence and then he would use violence because his tools were run out or they
53:40
would continue drinking together.
53:42
And that's not blaming the victim here, the woman here. They're smaller.
53:47
They're the ones that end up in the emergency room. They're the ones that are
53:50
psychologically abused and sexually abused. They're the real victims in this.
53:55
But by ignoring their use of violence, we do a disservice to them as well.
54:01
And so that's what our data shows, is that it is a two-way street.
54:05
But please don't mistake that as that men are, that there should be a battered
54:12
husband syndrome or something like that.
54:14
That's not what we're saying with this data. We're just saying we can't ignore it.
54:20
Thank you. There is a question in the chat from Dr. Gong. She asks,
54:23
have you looked at rates of premature births in your cohort?
54:26
You know, that's a fantastic question. And we have not with this.
54:31
And I'm kind of surprised because I've worked with the Premature Birth Network
54:36
on some other studies, and I'm surprised I haven't thought of that.
54:40
Uh, and I, I don't know, I wonder if kids them, you know, now they're 30,
54:47
I wonder if they know if they were premature births.
54:49
Uh, but that is such a good question that we are designing our survey right now for the next wave.
54:56
And I think it's definitely worth the real estate to ask them that.
55:01
Uh, that's, that's really cool. And especially with our future studies where
55:06
we're going to include their children, we should, we'll definitely ask the parents
55:10
about their children because they'll definitely know, right?
55:13
So that's a, that's a really cool question. Thank you for asking that.
55:18
In fact, I'm going to copy it so I don't forget. And Dr.
55:24
Gong, if you're interested in the data, you know, hit us up and you can,
55:28
you can have first doctor.
55:32
Thank you. This is Dr. Gong. Actually, I'm looking at it from the perspective
55:37
of the recent article about the causes of maternal mortality being more related
55:45
to what you're talking about.
55:46
And so in one of the things that I'm interested in is how to prevent prematurity.
55:52
So if we have people that have more violence, do they have more babies that are born premature?
55:59
Or would they themselves premature, which also talks about history of violence,
56:05
because then you have violence at birth as well.
56:08
So it's fascinating. I love it. And Dr.
56:13
Gong, I was in the department of OBGYN at UTMB for 17 years,
56:16
and it used to piss me off that what you said is the main causes of premature death,
56:24
maternal mortality was stuff that was preventable.
56:29
Right. So violence, homicide, suicide, drug use, substance use.
56:34
And we got such, and I say we being a psychologist and a behavioral health researcher,
56:40
if you look at the amount of funding for those types of things versus, you know,
56:47
ectopic pregnancy or whatever causes bad stuff on the physical side,
56:51
you know, it dwarfed it.
56:54
And so I'm glad you brought that up. Well, there was just New England Journal
56:59
article that reported that data,
57:03
which everybody works on cardiovascular and pre-enclampsia and so forth,
57:07
but actually violence and way overshadows those numbers.
57:15
And as an enatologist, you see that there's a lot of dysfunctionality in families
57:22
that have premature babies.
57:24
So it would be great to look into that and hopefully that can prevent other
57:31
things when we understand the role that violence plays. Yep, absolutely.
57:38
I'm looking at this recently. There's been a lot of news and concerns about
57:41
the online groups promoting misogyny, nihilism and violence in general.
57:45
Data connectedness, more extreme online behavior to sexting gateway risky online
57:49
behavior. So it's a really good question.
57:52
And and, you know, with incels and everything else.
57:56
And if you look at mass shootings, this is to your point.
57:59
If you look at mass shootings you see
58:02
one common denominator and it's typically some sort
58:06
of misogyny or racism or hatred
58:09
that seems to be the the underlying factor
58:12
so you see i think it's like 60 percent of mass shooters have a history of uh
58:18
family violence so yeah this point is fantastic now whether or not sexing is
58:23
a gateway i doubt it and i and i say this as well let me let me Let me couch
58:29
that a little bit differently.
58:31
I think it is, and data starts to bear this out, is that it is someone who consensually
58:38
sexed is probably no more likely
58:41
to have any of these other types of stuff than someone who does not.
58:46
Now, if someone is sextorting someone or posting revenge porn or coercing someone
58:54
or sending dick pics without consent, Absolutely.
58:59
I bet that that is related to, you know, that sort of antisocial behavior is
59:04
related to these other antisocial behaviors.
59:07
So, yes, but consenting the vast majority of people who kids who sex probably no more likely.
59:19
No one even asked about my onion article.
59:23
But if you look at Google onion and sex figures. Maybe they're Googling it.
59:28
Yeah, I've had like three different. That's when I knew I made it,
59:32
is when three different onion pieces talked about my research. And it's pretty good.
59:39
All right. Any final questions before we finish up with Dr. Temple here?
59:47
And I know most of you aren't. UTSA necessarily, but fear the beak.
59:52
Go Roadrunners. Thank you all so much for having me. Dr. Ranch,
59:56
thank you very much. I appreciate all that y'all do for kids.
1:00:01
Thank you for listening to that fascinating talk. Click on the link in this
1:00:06
podcast for free credit that may include CME, MOC, or ethics credit,
1:00:10
depending on the topic or podcast.
1:00:13
I'm Holly Wehmut, and I'll see you next week.