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Logo of nihpaAbout Author manuscriptsSubmit a manuscriptHHS Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
 
J Sex Res. Author manuscript; available in PMC 2012 November 20.
Published in final edited form as:
PMCID: PMC3501730
NIHMSID: NIHMS413658

A Pilot Evaluation of Older Adolescents’ Sexual Reference Displays on Facebook

Megan A. Moreno, MD, MSEd, MPH,1 Libby Brockman, BS,2 Judith Wasserheit, MD, MPH,3 and Dimitri A. Christakis, MD, MPH2,4

Abstract

Many older adolescents display sexual references on their social networking site profiles; this study investigated whether these references were associated with self-reported sexual intention, sexual experience or risky sexual behavior. We identified public Facebook profiles of undergraduate freshmen within one large US university Facebook network. Profile owners who displayed sexual references (Displayers) and did not display references (Non-Displayers) were invited to complete surveys. Surveys measured sexual intention using the Postponing Sexual Involvement (PSI) scale, and sexual experiences. A higher PSI score is inversely related to intention to initiate sexual intercourse. Of the 118 profiles that met inclusion criteria, 85 profile owners completed surveys. Profile owners were mostly female (56.5%) and Caucasian (67.1%). Mean PSI score for Displayers was 6.5+/−1.6, mean PSI score for Non-Displayers was 10.2+/−0.6 (p=0.02). There were no differences between Displayers and Non-Displayers regarding lifetime prevalence of sexual behavior, number of sexual partners or frequency of condom use. Display of sexual references on college freshmen’s Facebook profiles was positively associated with reporting intention to initiate sexual intercourse. Facebook profiles may present an innovative cultural venue to identify adolescents who are considering sexual activity and may benefit from targeted educational messages.

Keywords: Adolescent, college student, Internet, sexual behavior, social networking web sites, content analysis, internet

Social networking web sites (SNSs) are immensely popular among adolescents and young adults, the vast majority have Internet access and most report daily use (A. Lenhart, Purcell, Smith, & Zickuhr, 2010). Over 90% of US college students use the SNS Facebook (Ellison, Steinfield, & Lampe, 2007; Ross, Orr, Arseneault, Simmering, & Orr, 2009). Sexual content is part of many adolescents’ SNS profiles, approximately one quarter of older adolescents display sexual references on these publicly available profiles (M. A. Moreno, Parks, Zimmerman, Brito, & Christakis, 2009). Examples of sexual references include personally written text describing sexual experiences such as “Mark got laid last night” or revealing photographs of the profile owner, such as in lingerie. SNSs may represent a new venue in which adolescent sexual behavior is explored and displayed. The meaning of these displayed sexual references, possibly as an indicator of the profile owner’s sexual intentions or behaviors, is not well understood.

Social networking sites in the lives of adolescents and young adults

When exploring the meaning of displayed sexual references on SNSs, we must first consider the functions that SNSs serve for adolescents and young adults. SNSs combine multiple tools into one website, thus, they may serve multiple functions in an adolescent’s life. The first tool is the capacity to build an online social network via “friending.” When two profile owners accept each other as online “friends” the two profiles become linked and content is mutually accessible. These online social networks may include peers, acquaintances, family, coworkers or even college professors. SNSs are also a venue in which users may initiate and maintain romantic relationships (boyd, 2007; Correa, Hinsley, & de Zuniga; Ellison, et al., 2007).

A second tool provided by SNSs is access to three distinct methods of communication. These include profile-to-profile messages that are sent privately, similar to email. Instant messaging, or chatting, can be used if two profiles are linked as friends and both profile owners are logged onto the site at the same time. Adolescents may also display comments on their friends’ profiles, thus allowing public form of feedback from peers to be displayed on profiles.

Finally, a major developmental task in the transition between adolescent and adult lives is the development of one’s identity. As adolescents navigate this developmental process, SNSs provide a technological tool and cultural venue for adolescents and emergent adults to express their identities. Social networking Web sites allow users to create a personal Web profile that may contain audio, images (e.g. downloaded images and icons, personal photographs and video) and text (e.g. blogs and personal descriptions). Adolescents often use online tools to express their identity, as has been supported by previous studies examining adolescents’ use of blogs (Ren & Brown, 2000). A widely used feature of some SNSs such as Facebook is called “status updates” which allow a user to share a short text description of one’s current location, emotion or activity. SNSs also allow profile owners to create online photo albums and to share photographs with other profile owners. Profiles can be updated or changed at any time. Through developing and modifying a SNS profile, users choose what pieces of their identity to publicly display at a given moment.

The identity that is displayed on SNS profiles is thus a public online identity. Social networking sites present opportunities for adolescents and young adults to decide how much of that identity to reveal publicly. At the time of the data collection in this study, profiles were either publicly available to the Facebook network at large, or privately available only to other friends whose profiles were linked. Facebook has undergone numerous privacy setting changes over the past few years. Currently, privacy settings include options to set pieces of the profile to public or private audiences. Just as privacy settings for the website itself may change, privacy settings for individual profile owners are not static, they are fluid over time and can be changed at any point. For example a profile owner may choose to change her profile security from privately accessible to publicly available after a romantic relationship ends in order to allow access by new potential suitors. Thus, profile security settings are best viewed as a dynamic process rather than a permanent state.

Displayed sexual content on SNS profiles

Adolescence is frequently a time of behavioral experimentation concomitant with identity development (Neinstein & Anderson, 2002). This experimentation may also become part of the displayed identity that is presented on SNS profiles. A previous study found that approximately 41% of adolescents’ profiles displayed references to substance use and 24% displayed references to sex (M. A. Moreno, Parks, et al., 2009). Online sexual references may include personally written descriptions of sexual behaviors or perceived sexual identity in that moment, examples may include status updates such as “Erika is goin’ whoring” or “Mary is ready to go out and get naked.” Sexual references may also include intimate personal photographs, such as a picture of the profile owner posed provocatively.

References to sex that are displayed in a public online venue may raise concern. Previous work among younger adolescents has shown that increased amounts of personal or sexual information increases risk for unwanted sexual solicitation or cyberbullying (Amanda Lenhart, 2007; Mitchell, Finkelhor, & Wolak, 2007; Ybarra, Espelage, & Mitchell, 2007). These references may also lead to negative consequences by sending unintended messages to potential romantic partners. A recent study investigated male college students’ views of displayed sexual references by females on SNS profiles (M. A. Moreno, Swanson, Royer, & Roberts, 2010). Males who viewed displayed sexual references on a woman’s SNS profile felt a heightened expectation for sexual activity from these women, but stated they were less interested in pursuing a romantic relationship. It is unclear whether women who display sexual content are impacted by these heightened sexual expectations in positive or negative ways.

In examining these online sexual displays on SNS profiles, two points are worthy of consideration. First, these sexual displays may influence other peers or romantic partners who view the SNS profiles. Second, the validity of the sexual reference presented by the profile owner remains unknown.

Sexual reference displays on SNSs: Impact on viewers

In considering the potential impact of sexual reference displays on viewers, it is helpful to consider other sources of sexual information that an adolescent typically encounters. Two important influences on adolescent and young adult sexual attitudes and behaviors are peers and the media (Onyeonoro et al., 2011). Adolescents’ perceptions that peers are sexually active has been shown to influence adolescents’ intentions to initiate sexual intercourse (Kinsman, Romer, Furstenberg, & Schwarz, 1998). Intention to initiate intercourse is one of the strongest predictors of initiating sexual intercourse (Gray et al., 2008). In one study, adolescents who reported intention to become sexually active in the next 6 months were significantly more likely to do so, compared to peers who were uncertain or did not intend to initiate intercourse (Stanton et al., 1996). Numerous studies have illustrated the powerful role of perceived peer norms in shaping attitudes towards sexual behavior among adolescents (Lim, Aitken, Hocking, & Hellard, 2009; Skinner, Smith, Fenwick, Fyfe, & Hendriks, 2008; Wetherill, Neal, & Fromme, 2009). Social learning theory predicts that teens who see characters displaying references to behaviors such as risky sex without experiencing negative consequences will be more likely to adopt the behaviors portrayed (Bandura, 1977, 1986). It has further been argued that a key element of effective sexual education for adolescents is addressing social influences in adolescents’ sexual decision-making (Peters, Kok, Ten Dam, Buijs, & Paulussen, 2009). While among older adolescents these associations have been understudied, it is likely that peer influence remains influential as adolescents get older and become more independent from family and more immersed in peer networks.

Another source of influence on adolescents’ intention to initiate intercourse is the media. The most studied media in the area of sexual behavior is television (Collins et al., 2004; Kunkel, Eyal, & Donnerstein, 2007). Findings from one study support a model in which the relationship between exposure to television’s sexual content and intercourse initiation is mediated by safe-sex self-efficacy among African American and White adolescents (Martino, Collins, Kanouse, Elliott, & Berry, 2005). Another study examining television viewing and adolescent sexual initiation found that among young adolescents who reported strong parental disapproval of sex, watching television for two or more hours each day and a lack of parental regulation of television programming were each associated with increased risk of initiating sexual intercourse within a year (Ashby, Arcari, & Edmonson, 2006). It has been hypothesized, on the basis of Social-cognitive Theory, that exposure to televised sexual content could influence adolescents’ safe-sex self-efficacy, sex-related outcome expectancies, and perceived peer norms regarding sex, and that each of these could influence intercourse initiation (Escobar-Chaves et al., 2005). Overall trends indicate that media exposure is linked to sexual outcomes, especially for women (Ward, 2003).

Exposure to sexual media content likely increases adolescent sexual behavior by increasing their perceptions of social pressure to have sex (Bleakley, Hennessy, Fishbein, & Jordan, 2011) . More specifically, exposure to sex content leads to increased beliefs that people like them, including their friends and peers their age, are having sex. Because perceived normative pressure is not the primary determinant of one’s intention to engage in sex, these changes likely produce only relatively small increments in intention and behavior. Further, it could be argued that no single medium can have enormous impact given the range of media outlets accessible to today’s youth.

While many studies in this field focus on the amount of media exposure, several gaps in the literature exist. First, few studies have focused on older adolescent populations, though previous work suggests that first-year college students grapple with the role of media influence in their expectations for sexual behavior (Siebold, 2011). Second, as much of the early media influence literature has focused on venues such as television, music and movies, less is known about newer venues such as the Internet and Facebook. One study found that among African American adolescents, greater frequency of Internet use was associated with a history of oral, vaginal or anal sex as well as sexual sensation seeking (Onyeonoro, et al., 2011). Finally, fewer studies have addressed aspects of viewer involvement such as identification and perceived realism, which may be more influential compared to absolute viewer exposure. These are salient considerations in considering the potential of Facebook influence, as one may consider that perceived realism and identification may be more profound in this media outlet given that most content is created by an adolescent’s peers. These websites may function as a media superpeer, promoting and establishing norms of behavior among other adolescents (Strasburger & Wilson, 2002). A previous study found that adolescents viewed displayed alcohol references on SNS profiles as accurate and influential representations of alcohol use (M. A. Moreno, Briner, Williams, Walker, & Christakis, 2009).

Displayed health risk behaviors such as sexual references may have influence on the attitudes, intentions and potential behaviors of adolescents who view them. It has been argued that Facebook may have greater influence than traditional media, as Facebook combines the power of interpersonal persuasion with the reach of mass media (Fogg, 2008). The power of interpersonal persuasion cannot be underestimated among adolescents, for whom peers are such an important source of influence (Neinstein & Anderson, 2002; Sacerdote, 2001). Facebook has been described as “the most significant advance in persuasion since the radio was invented in the 1890s” and initiated a new form of persuasion labeled “mass interpersonal persuasion” (Fogg, 2008).

Sexual reference displays on SNSs: Validity of displays

SNS data is both created and consumed by adolescents, and has the reach of mass media. Thus, it may combine elements from both peer and media influence. As displayed sexual references on SNSs have potential to influence their viewers, we now consider what these displays mean to the adolescents who choose to display them. Prior studies suggest that SNS displays are likely to represent the beliefs, attitudes or actions of the profile owners (Back et al., 2011). Thus, there are several hypothesized explanations for the meaning behind displayed sexual references on Facebook. First, sexual references may represent intention to become sexually active. It is possible that the display of sexual references on Facebook is a developmental marker of the emergence of the older adolescent as a sexual person. Facebook may be a venue in which adolescents who intend to become sexually active may present this message to others. This hypothesis is supported by the Media Practice Model, which states that adolescents choose and interact with media based on who they are, or who they want to be, at the moment (Brown, 2000). Facebook may represent a new tool by which adolescents experiment with and develop their sexual identities.

A second hypothesis is that sexual references may represent current sexual behavior. These references may reflect sexual expression or pleasure related to sexual behaviors. Prior studies have shown that computer use encourages high levels of self-disclosure and uninhibited personal expression, thus supporting the validity of Internet self-report (Fleming, 1990; Wallace, Linke, Murray, McCambridge, & Thompson, 2006; Walther & Parks, 2002). A recent study of college students found that students reported disclosing more information about themselves on Facebook than in their day-to-day offline life (Christofides, Muise, & Desmarais, 2009) . Further, patterns of display on SNSs may also give clues to the validity of the displayed information. References to health risk behaviors are often displayed in patterns consistent with those seen in self-report studies (M. A. Moreno, Parks, et al., 2009). For example, profiles that display references to one risk behavior, such as substance use, are more likely to display references to other risk behaviors, such as sex. Further, references to health risk behaviors are displayed in similar patterns among adolescents’ online “friend” groups (M.A. Moreno, Brockman, Rogers, & Christakis, 2010).

Third, display of sexual references may represent risky sexual behavior. We would not expect all sexually active adolescents to display sexual information on a public Web site. However, given that over 60% of adolescents are sexually active by the end of high school and only 25% of 18-year-olds display sexual references on SNS profiles, the population of adolescents who display such information online may represent a higher risk population that is willing to showcase sexual behaviors in a public venue (Eaton et al., 2008; M. A. Moreno, Parks, et al., 2009).

Fourth, these displays may represent experimentation with identity based on curiosity or other motivations. These displays may represent a public self and public performance that may be wholly different from their private self. However, it is worth considering that Facebook is a publicly constructed identity in which peers also provide commentary and support to the constructed identity. It is likely that a profile owner cannot stray too far from their identity without being called out by friends.

The validity of these displayed sexual references remains unknown and findings could enhance our understanding sexual behaviors among adolescents. The transition to college is frequently a time of sexual initiation among adolescents; however, very few college students report seeking contraception counseling or a medical visit prior to sexual initiation (Association, 2009). As intention to initiate sex is among the strongest predictors of sexual initiation, a better understanding of predictors to identify young college students who are intending to become sexually active would be useful as it would allow an opportunity to provide anticipatory guidance prior to sexual initiation (Kinsman, et al., 1998; Stanton, et al., 1996). While sexual initiation among college students is considered far less concerning or risky compared to younger adolescents, sexual behavior during the college years is often marked by patterns of sexual behavior such as frequent casual partners or “hooking up,” as well as with inconsistent rates of condom use and low levels of knowledge about sexual health resources available to them (Miller, 2011; Owen, Fincham, & Moore, 2011). This older adolescent population could benefit from information and resources to assist them in maintaining healthy sexual practices that avoid negative health outcomes. A better understanding of predictors of sexual activity, particularly risky sexual behavior, among college students would also have value as it may ensure that clinicians conduct appropriate routine sexually transmitted infection testing. The purpose of this study was to evaluate whether sexual reference display by older adolescents on a SNS was associated with sexual intention, sexual experience or risky sexual behavior. For this study we focused on publicly available profiles in order to understand what these references may mean when they are purposely displayed to a global online audience.

Methods

Study setting and participants

This study was conducted between November 1, 2008 and January 15, 2011 and received IRB approval from the University of Wisconsin and the University of Washington.

This study was conducted using the SNS Facebook (www.Facebook.com). This SNS was selected for several reasons. First, Facebook is the most popular SNS among our target population of college freshmen (Ellison, et al., 2007; Ross, et al., 2009). Second, Facebook profiles are identified by the profile owner’s full name, leading to the expectation that the profile represents an individual (Ortutay, 2009). Third, at the time of this study Facebook was organized into “networks” which typically represent a city or university. Profile owners could join up to six networks and viewers could access individuals’ profiles within one’s network as well as any profile linked as an online “friend.” We investigated publicly available Facebook profiles of freshmen undergraduate students within a large state university Facebook network. We selected college freshmen as our target population because the transition to college and associated independence can lead to increased likelihood of sexual initiation, as well as risks of negative sexual consequences such as sexually transmitted infections (Fromme, Corbin, & Kruse, 2008; McGuire, Shega, Nicholls, Deese, & Landefeld, 1992).

Profiles were eligible for inclusion in this study if the following criteria were met: (1) the profile was publicly available, (2) the profile owner self-reported residence in the United States, (3) the profile owner indicated their age as 18 or 19 old, and (4) the profile was currently updated in the past 30 days. We only analyzed profiles for which we could confirm the profile owner’s identity by calling a personal cell phone listed on the university directory or the Facebook page.

Measurements and procedure

Definition of a sexual behavior reference

To define a “sexual reference” we used criteria established by the Kaiser Family Foundation (Kunkel, Eyal, Finnerty, Biely, & Donnerstein, 2005). These criteria include any depiction of sexual activity or sexually suggestive behavior. Examples of sexual references in Kaiser criteria could include discussion of personal sexual experiences or images suggesting sexual acts. Kaiser criteria also consider “any talk about sexuality” as a sexual reference. Because Facebook provides a specific text field to describe the profile owner’s sexual orientation and many adolescents provide this information, such responses were not included as sexual references.

Coder training

Facebook profiles were evaluated by one trained investigator (LB). Training included review of sexual reference criteria from Kaiser Family Foundation and evaluation of a separate set of approximately 100 profiles. All sexual references coded in this practice dataset were then discussed with another investigator (MM) to determine consensus in coding based on Kaiser criteria (Kunkel, et al., 2007; Kunkel, et al., 2005). After training was completed the investigator began evaluating profiles used in this study.

Data collection

For this study we calculated a sample size requirement of approximately 70 participants given our previous data on prevalence of displayed sexual on SNSs and current data regarding rates of college student sexual behavior (Eaton, et al., 2008; M. A. Moreno, Parks, et al., 2009). We used the Facebook search engine to search for profiles within our selected university network that displayed a college graduation year of 2012 and high school graduation year of 2008. This search yielded 330 profiles, all of which we assessed for eligibility. The majority of excluded profiles did not provide a working cell phone number on Facebook or within the online university directory for us, which was required to both confirm profile owner identity and recruit participants to the online survey (n=147). The investigators viewed all publicly accessible elements of the Facebook profile to determine if sexual references were present including status updates, information section, photographs, profile pictures and bumper stickers. Each profile that displayed one or more sexual references was then labeled as a “Displayer.” Profiles without sexual references were labeled as “Non-Displayers.”

Survey

Recruitment to online survey

For profiles that met inclusion criteria (N=118), profile owners were called on their cell phone. After verifying identity, one investigator (LB) briefly explained the study and requested permission to send an email with further information and a link to the online survey. If the participant expressed interest in the study, an email was sent to the profile owner’s university email account that provided detailed information about the study and a link to the online survey.

We used two different links to identical surveys so as to obtain aggregate results without requiring personal identifiers. Subjects in the Displayer group were emailed a link to one survey; subjects in the Non-Displayer group were emailed a link to a separate but identical survey.

Survey measures

The survey was administered online via a Catalyst WebQ online survey engine. Our survey evaluated sexual intention, sexual experience and risky sexual behavior. First, for survey respondents who reported no lifetime sexual intercourse experience, we assessed sexual intention using the Postponing Sexual Intercourse (PSI) scale. The PSI is a 12-item scale based on Social Cognitive Theory and the Theory of Planned Behavior that was developed to assess intention to initiate sexual intercourse (Baranowski & Parcel, 2002; Gray, et al., 2008; Kahn et al., 2004; Montano, 2002). The PSI has been shown to have reliability and construct validity among adolescents who have not yet initiated sexual intercourse (Gray, et al., 2008; Kahn, et al., 2004). Only participants who indicated that they had never engaged in sexual intercourse were asked to respond to the following item: “Many teenagers have decided not to have sexual intercourse yet. Please read the following list of reasons why teenagers have not had sexual intercourse, and rate how important each is for you.” The 12 reasons listed were each scored on a 3-point scale, from 0=“not important/does not apply” to 1=“somewhat important” to 2=“very important.” PSI scores theoretically range from 0 to 24; a lower PSI score is associated with greater intention to initiate sexual intercourse.

Second, survey questions assessed sexual experience, including three yes/no questions about lifetime experience of oral, vaginal and anal sex. Third, for survey respondents who answered yes to one or more questions regarding these three sexual experiences, we assessed risky sexual behavior by asking about lifetime number of sexual partners and frequency of condom use (always, usually, sometimes, occasionally, never). These measures were obtained individually for each type of sex in which a subject reported previous experience.

The survey asked participants for demographic information including age, gender and ethnic identity. Survey questions also included an assessment of current relationship status (e.g. single, in a relationship), sexual orientation, and a 13-item scale measuring social desirability bias using the Marlowe-Crowne Social Desirability Scale (Crowne & Marlowe, 1960; Robinette, 1991). For participants who completed the survey, we provided a $15 iTunes gift card as compensation.

Analysis

All statistical analyses were conducted using STATA version 9.0 (Statacorp, College Station, TX). First, to evaluate whether displayed sexual references were associated with increased likelihood of initiating sexual activity we used Students t test to evaluate differences in mean PSI score between Displayers and Non-Displayers. We then regressed the PSI score with Displayer versus Non-Displayer status. This model included our a priori variables of interest: Displayer versus Non-Displayer, relationship status, sexual orientation and adjusted for gender, ethnicity and social desirability bias using the Marlowe-Crowne social desirability scale (Crowne & Marlowe, 1960). These analyses included participants who reported no lifetime vaginal sex experience, regardless of reported oral or anal sex experience, consistent with the PSI scale design. Second, to investigate associations between Displayers’ and Non-Displayers’ lifetime sexual experience (oral, vaginal or anal sex) we used Chi square tests. Third, to assess whether sexual display was associated with risky sexual behavior we used Student’s t tests to compare the mean reported number of sexual partners between Displayers and Non-Displayers. We then used Chi square tests to compare proportion of subjects who reported that they “always” or “usually” used condoms between Displayers and Non-Displayers. These final analyses were limited to those who reported oral, vaginal or anal sex.

Results

Sample population

All 118 eligible profile owners were contacted via cell phone and 85 (72%) of these college freshmen completed the survey. Of subjects who did not complete the survey, 11 stated they were not interested and 22 agreed to participate but failed to complete the survey. Survey respondents were mostly female (56.5%), Caucasian (67.1%), single (60%) and heterosexual (91.7%). (Table 1) There were no differences in Facebook data regarding reported age, gender, race or displayer/non-displayer status between those who responded to the survey and those who did not.

Table 1
Descriptive characteristics of survey respondents (N=85)

Of the 85 included profiles, 18 (21.2%) displayed sexual references and were considered Displayers. The 67 (78.8%) profiles that did not display such references were considered Non-Displayers. Of the 18 Displayers, there were more males (66.7%) than females (33.3%) (p=0.03). There were no significant differences between Displayers and Non-Displayers regarding age, ethnicity, current relationship status or sexual orientation. There was no difference in mean score on the Marlowe Crowne Social Desirability Bias Scale between Displayers and Non-Displayers. Table 1 illustrates these data.

Intention to initiate vaginal sex

Forty of the 85 respondents (47.1%) reported no vaginal sex experience and completed the PSI scale. Displayers demonstrated greater intention to initiate sexual intercourse, with a mean PSI score of 6.5 (SD:1.6) compared to Non-Displayers whose mean PSI score was 10.2 (SD:0.6) (p=0.02). Table 2 illustrates these data. In multivariate analysis, a lower PSI score (increased intention to initiate sexual intercourse) was associated with Displayer status (beta=5.2, p<0.001). There were no differences in PSI score by gender, age, current relationship status or sexual orientation.

Table thumbnail

Sexual experience

Almost 70% of our survey respondents reported having had oral, vaginal or anal sex. Most reported oral sex experience (63.5%), approximately half reported vaginal sex experience (52.9%) and a minority reported anal sex experience (16.5%). Table 3 illustrates these data. There were no differences between Displayer or Non-Displayer status for any of these reported sexual experiences. We noted a trend that Displayers were approximately twice as likely to report oral sex experience [OR=2.2, 95% CI=0.66-7.48, p=0.19].

Table 3
Self-reported sexual experience and sexual risk by college freshmen

Risky sexual behavior

The average number of sexual partners for oral sex was 2.5 (SD: 2.2), vaginal sex was 2.4 (SD: 1.9) and anal sex was 1.1 (SD: 0.5). Few subjects reported that they always or usually used a condom for oral sex (11.1%), while most reported that they always or usually used a condom for vaginal sex (68.8%) and many reported that they always or usually used a condom for anal sex (42.8%). Table 4 illustrates these data. There were no statistically significant differences in sexual risk between sexually experienced Displayers and Non-Displayers.

Table 4
Self-reported sexual risk among college freshmen

Discussion

Our findings suggest that sexual references displayed on Facebook profiles of college freshmen were associated with intention to become sexually active. We did not find a significant association between the online display of sexual references and either sexual experience or risky sexual behavior, though we noted a trend that suggested an association between Displayer status and likelihood of having engaged in oral sex. These findings suggest that the display of sexual references on Facebook is a developmental marker of the emergent adult as a sexual person. The Media Practice Model suggests that adolescents choose and interact with media based on who they are, or who they want to be, at the moment (Brown, 2000). Since transition to college involves significant efforts towards identity development, Facebook may provide a novel means for developing one’s sexual identity (Neinstein & Anderson, 2002). It is possible that the display of sexual references on a Facebook profile is associated with the emergence of the adolescent as a sexual person, representing consideration of sexual intercourse or precursors to vaginal sexual activity such as oral sex.

Our findings are consistent with previous work that found that adolescents frequently use online venues to display clues about their romantic intentions and experiment with romantic communication (Smahel & Subrahmanyam, 2007; Young, Dutta, & Dommety, 2009). Just as adolescents’ offline sexual development progresses through predictable stages, their online sexual development may also be marked by certain online displays (Hoadley, Xu, Lee, & Rosson). It is possible that as adolescents mature in their sexual relationships, these displays are no longer maintained on the Facebook profile.

This information may be useful to college student health providers and researchers in two important ways. First, given the rising popularity of new media among adolescents, health care providers and researchers may be increasingly called upon to provide interpretation or education regarding the content of SNS profiles. Educators and health care providers who work with adolescents may find an enhanced understanding of the possible meaning and impact of displayed sexual content on SNSs useful for tailoring related educational messages about contraception.

Second, these findings suggest new opportunities to promote targeted education about safe sex practices among college students. Given that Facebook advertising is triggered by keywords present on the SNS profile, it is possible that keywords related to sex could trigger targeted messages promoting campus resources for contraception or STI testing. Previous work has illustrated that college students have low levels of knowledge about availability of sexual health resources, such as emergency contraception (Miller, 2011). At present, profile owners already receive “pop-up” advertisements tailored to their displayed status updates, which may include advertisements for diet programs or online educational programs. The “intention interval” between display of sexual content on Facebook and engagement in sexual intercourse may represent a critical time period during which clinicians, health educators, or even Facebook itself could deliver targeted education or prevention messages. Some previous work has suggested that adults were receptive to public health education campaigns about safer sex practices (Evans, Davis, Umanzor, Patel, & Khan, 2011).

There are several potential limitations to this evaluation. We evaluated profiles from only one SNS and one university and participants were limited to those who maintain public Facebook profiles and allowed their phone number to be listed either in the university directory or on Facebook. The extent to which findings could be generalized to other SNSs or other adolescent populations is not known; however, our findings parallel those of our prior study of 18-year-olds on MySpace regarding the overall presence of sexual reference display (M. A. Moreno, Parks, et al., 2009). Because we focused on 18-year-olds, generalizing results to younger adolescents may not be warranted. Our goal for this study was to illustrate associations between displayed sexual references and sexual intentions or experiences among college students during their transition to college. Further evaluation is needed among younger adolescents who are at higher risk of consequences relating to sexual initiation. It is possible that among younger adolescents sexual reference display may be more strongly associated with sexual intention, and the consequences of early sexual initiation are often more serious (O’Donnell, O’Donnell, & Stueve, 2001). Additionally, it could be argued that Non-Displayers may be more privacy-oriented and less likely to report sexual intention or experience. In order to address potential differences in social desirability bias between Displayers and Non-Displayers we used the Marlowe Crowne Social Desirability Bias scale and found no differences between these two groups (Crowne & Marlowe, 1960). In addition, we administered the PSI scale to those had reported no vaginal sexual experience, which is the population for which the scale was developed and evaluated. This provided us limited opportunities to evaluate adolescents regarding oral or anal sex, or to evaluate participants’differences in profile display among young men and women who are seeking/interacting with same sex partners. Researchers could consider adapting the PSI instrument to include intentions towards sexual activity other than vaginal sex. Given our small sample size and findings that only 20% of profile owners were in the Displayer category, future studies with larger sample sizes to further explore these findings are warranted. Further, because this study was cross sectional in design, we cannot infer causality or directionality in the relationship between intention to initiate intercourse and displaying sexual references on Facebook. Finally, to preserve the anonymity of our participant’s information, we provide links to the online survey and collected data in aggregate. Thus, we were unable to assess particular participant’s Facebook data and survey responses.

To our knowledge, this is the first study to demonstrate a relationship between displayed SNS sexual references and reported sexual intention. Further studies should evaluate SNS displays among younger teens, and consider how to communicate effectively with adolescents regarding health information displayed on SNSs.

Acknowledgments

Support for this project was provided by an Emerging Opportunity Grant from the Center for AIDS Research at the University of Washington, as well as by award K12HD055894 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The authors wish to acknowledge the contributions of Fred Rivara, MD, MPH, King Holmes, MD, PhD, Elizabeth Cox MD, PhD and Henry Young, PhD to this project.

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