AbstractPurpose

The purpose of the study is to assess the prevalence of pornography use and its association with a range of perceived gender norms among adolescents aged 10–14 years across five urban poor settings globally.

Methods

The study includes 9,250 adolescents aged 10–14 years from Belgium, China, the Democratic Republic of the Congo, Ecuador, and Indonesia, as part of the Global Early Adolescent Study. We examined the percentage of pornography use by sex and site and conducted multivariate logistic regressions to examine the relation between gender norm perceptions and pornography use, adjusting for individual, family, peer, and media exposures.

Results

Ever-use of pornography ranged from 14.5% in Ecuador to 33.0% in Belgium and was more common among boys than girls. Overall, boys who perceived greater permissiveness about romantic relations, adolescents who engaged in such relations, and adolescents who assumed that their friends were sexually active had greater pornography exposure. Pornography use did not systematically correlate with unequal gender norms. Such correlations only exist among boys in two Asian sites, where a supportive school environment, more caregiver awareness, and/or neighborhood cohesion were related to less pornography use.

Conclusions

Pornography use is a gendered experience that begins in early adolescence. Although factors of pornography use vary across the social context, the exposure to pornography has become a normative part of adolescent sexuality development. Young people, especially those from where sexuality remains taboo, need the ability to critically process information and avoid potential risks associated with pornographic gendered and sexual stereotypes, calling for comprehensive sexuality education programs to help them build the knowledge and confidence they need.

KeywordsImplications and Contribution

Pornography use among young adolescents is more common among boys with unequal gender norm perceptions. More research is needed to better understand this (bi)directional relationship. Comprehensive sexuality education programs are needed to equip young people with the abilities to contest gender and sexual stereotypes and promote healthy sexuality development.

Pornography, defined as videos or pictures intended to sexually arouse the viewer [[1]Adolescents and pornography: A review of 20 Years of research.], is a controversial issue in adolescence (ages 10–19 years), which continues to raise concerns because of its increased accessibility and mainstreaming online as well as offline [[1]Adolescents and pornography: A review of 20 Years of research.,[2]Kyriaki A. Vasileios S. Emma A. et al.Adolescent pornography Use: A systematic Literature review of research Trends 2000-2017.]. Global evidence indicates that pornography use is common across countries with large regional variations, ranging from 2% among girls in Cambodia to more than 90% among boys in Sweden and Germany [[1]Adolescents and pornography: A review of 20 Years of research.,[3]Weber M. Quiring O. Daschmann G. Peers, parents and pornography: Exploring adolescents’ exposure to sexually explicit material and its developmental correlates.]. However, most studies that originate from Europe and North America rarely address intercultural and cross-cultural issues, and even though some have been carried out in Asia, data on adolescents' pornography use in Africa and Islamic countries remain scant [[1]Adolescents and pornography: A review of 20 Years of research.,[4]The Internet’s impact on sexuality: A critical review of 15 years of research.].The predominant lack of perspectives about pornography use among young people outside of the Western world is problematic for several reasons. First, it is based on the assumption that pornography use is mostly a Western issue due to the relative freedom of information and access to the Internet [5Brown J.D. X-Rated L'Engle K.L. Sexual attitudes and behaviors associated with U.S. Early adolescents' exposure to sexually explicit media., 6Doornwaard S.M. Bickham D.S. Rich M. et al.Adolescents' use of sexually explicit Internet material and their sexual attitudes and behavior: Parallel development and directional effects., 7Martyniuk U. Stulhofer A. A longitudinal exploration of the relationship between pornography use and sexual permissiveness in female and male adolescents., 8Dombrowski S.C. Gischlar K.L. Durst T. Safeguarding young people from cyber pornography and cyber sexual predation: A major dilemma of the internet.]. However, the global rise of the Internet and mobile use among young people has made pornography more accessible in low- and middle-income settings [[9]Pluhar E. Kavanaugh J.R. Levinson J.A. et al.Problematic interactive media use in teens: Comorbidities, assessment, and treatment.,[10]Ma C.M.S. Shek D.T.L. Lai C.C.W. Individual and family protective factors of intentional and unintentional consumption of online pornography in Hong Kong.], thereby increasing adolescents' exposure to different forms of sexually explicit media, intentionally or unintentionally, through pop-ups or misleading site labels [[11]Livingstone S. Smith P.K. Annual research review: Harms experienced by child users of online and mobile technologies: The nature, prevalence and management of sexual and aggressive risks in the digital age.,[12]Collins R.L. Strasburger V.C. Brown J.D. et al.Sexual media and childhood well-being and health.]. Second, it fails to understand how pornography consumption relates to sexual and gender attitudes in societies where sexuality may be more taboo and where young people lack access to comprehensive sexuality education—as a means of critically reviewing pornography messages [[1]Adolescents and pornography: A review of 20 Years of research.].Evidence about the influence and consequences of pornography during this period of life is mixed [[1]Adolescents and pornography: A review of 20 Years of research.,[4]The Internet’s impact on sexuality: A critical review of 15 years of research.]. On the one hand, studies indicate that pornography may be problematic for adolescents' healthy sexuality development. These concerns, generally grounded in moral ideas around the “innocence” and vulnerability of children and adults' responsibility to protect them [[13]Childhood and the cultural constitution of vulnerable bodies.], are particularly salient for adolescents who often lack the media literacy and related critical thinking skills as well as the experiences to properly evaluate the content of pornographic materials [[11]Livingstone S. Smith P.K. Annual research review: Harms experienced by child users of online and mobile technologies: The nature, prevalence and management of sexual and aggressive risks in the digital age.,[12]Collins R.L. Strasburger V.C. Brown J.D. et al.Sexual media and childhood well-being and health.]. Some studies suggest that by portraying the primacy of heterosexual men's sexual pleasure, dominance, and aggression [[14]Gender (In)equality in internet pornography: A content analysis of Popular pornographic internet videos.], pornography may favor re-enactment and aggravation of gender power imbalances in sexual interactions [[1]Adolescents and pornography: A review of 20 Years of research.,[15]Wright P.J. Tokunaga R.S. Kraus A. A Meta-analysis of pornography consumption and Actual Acts of sexual aggression in general Population studies.,[16]The use of pornography and the relationship between pornography exposure and sexual offending in males: A systematic review.]. Likewise, the display of unsafe sexual practices (either heterosexual or homosexual) may further promote sexual risk taking, exposing young people to unintended pregnancy and/or sexually transmitted infections [[17]Grudzen C.R. Elliott M.N. Kerndt P.R. et al.Condom Use and high-risk sexual Acts in adult Films: A comparison of heterosexual and homosexual Films.]. On the other hand, evidence indicates that in spite of its potentially negative consequences, pornography itself does not constitute a “public health crisis” [[18]Should public health Professionals consider pornography a public health crisis?.] and that its specific consequences depend on the nature and circumstances associated with consumption [[19]Malamuth N.M. Hald G.M. Koss M. Pornography, individual differences in risk and men’s acceptance of Violence against women in a Representative sample.,[20]Bridges A.J. Wosnitzer R. Scharrer E. et al.Aggression and sexual behavior in best-selling pornography videos: A content analysis update.]. For example, studies among young adults in high-income countries indicate that watching pornography might have a positive effect on body satisfaction, self-exploration, and self-esteem as well as foster more gender-equal attitudes [21Loving Oneself: The associations among sexually explicit media, body image, and perceived realism., 22Olmstead S.B. Negash S. Pasley K. et al.Emerging adults’ expectations for pornography Use in the context of Future Committed romantic relationships: A qualitative study., 23Kohut T. Baer J.L. Watts B. Is pornography really about "making hate to women"? Pornography users Hold more gender Egalitarian attitudes than Nonusers in a Representative American sample.].Irrespective of its effect, pornography use is highly gendered, with boys reporting earlier and more frequent exposure to pornography than girls [[1]Adolescents and pornography: A review of 20 Years of research.], reflecting both social norms that encourage male consumption as well as mainstream production mechanisms [[14]Gender (In)equality in internet pornography: A content analysis of Popular pornographic internet videos.]. Pornography can also reinforce unequal gender norms that in turn hinder adolescent well-being and constrain girls' and boys' life opportunities [24Hardy S.A. Hurst J.L. Price J. et al.The socialization of attitudes about sex and their role in adolescent pornography use., 25Cheng S. Ma J. Missari S. The effects of Internet use on adolescents’ first romantic and sexual relationships in Taiwan., 26Adolescents' exposure to sexually explicit internet material and Notions of women as sex Objects: Assessing Causality and Underlying Processes., 27Heise L. Greene M.E. Opper N. et al.Gender inequality and restrictive gender norms: Framing the challenges to health.]. Studies indicate how pornography use is linked with more permissive sexual attitudes [[1]Adolescents and pornography: A review of 20 Years of research.,[5]Brown J.D. X-Rated L'Engle K.L. Sexual attitudes and behaviors associated with U.S. Early adolescents' exposure to sexually explicit media.,[7]Martyniuk U. Stulhofer A. A longitudinal exploration of the relationship between pornography use and sexual permissiveness in female and male adolescents.,[28]Baams L. Overbeek G. Dubas J.S. et al.Perceived realism moderates the relation between sexualized media consumption and permissive sexual attitudes in Dutch adolescents.], stereotypical attitudes about the different attributes, roles, opportunities, and power of men and women [[1]Adolescents and pornography: A review of 20 Years of research.,[27]Heise L. Greene M.E. Opper N. et al.Gender inequality and restrictive gender norms: Framing the challenges to health.], and sexual objectification of women [[26]Adolescents' exposure to sexually explicit internet material and Notions of women as sex Objects: Assessing Causality and Underlying Processes.]. For example, a longitudinal study among 967 adolescents aged 12–14 years at baseline in the United States found that girls who were exposed to sexually explicit materials at early ages developed more stereotypical gender attitudes over time [[5]Brown J.D. X-Rated L'Engle K.L. Sexual attitudes and behaviors associated with U.S. Early adolescents' exposure to sexually explicit media.]. The available evidence also points to the ways gender moderates the influence of pornography on attitudes, with boys and girls experiencing different gender socialization mechanisms [[29]Longitudinal associations between the use of sexually explicit material and adolescents' attitudes and behaviors: A narrative review of studies.].Beyond gender (attitudes), pornography use and its potential consequences are shaped by young people's broader social-ecological context [[30]Pulerwitz J. Blum R. Cislaghi B. et al.Proposing a conceptual framework to address social norms that influence adolescent sexual and reproductive health.,[31]Blum R.W. Astone N.M. Decker M.R. et al.A conceptual framework for early adolescence: A platform for research.], including their individual attributes (such as age, pubertal onset, sensation seeking) [[2]Kyriaki A. Vasileios S. Emma A. et al.Adolescent pornography Use: A systematic Literature review of research Trends 2000-2017.,[11]Livingstone S. Smith P.K. Annual research review: Harms experienced by child users of online and mobile technologies: The nature, prevalence and management of sexual and aggressive risks in the digital age.,[32]Nieh H.P. Chang L.Y. Chang H.Y. et al.Pubertal timing, parenting Style, and Trajectories of pornography Use in adolescence: Peer pornography Use as the Mediator.], family influences (parents being key in preventing negative consequences related to pornography) [[3]Weber M. Quiring O. Daschmann G. Peers, parents and pornography: Exploring adolescents’ exposure to sexually explicit material and its developmental correlates.,[32]Nieh H.P. Chang L.Y. Chang H.Y. et al.Pubertal timing, parenting Style, and Trajectories of pornography Use in adolescence: Peer pornography Use as the Mediator.,[33]Boniel-Nissim M. Efrati Y. Dolev-Cohen M. Parental Mediation Regarding Children’s pornography exposure: The role of parenting Style, protection Motivation and gender.], peer networks (as a source of access and normalization of consumption) [[2]Kyriaki A. Vasileios S. Emma A. et al.Adolescent pornography Use: A systematic Literature review of research Trends 2000-2017.,[32]Nieh H.P. Chang L.Y. Chang H.Y. et al.Pubertal timing, parenting Style, and Trajectories of pornography Use in adolescence: Peer pornography Use as the Mediator.], and broader societal factors (such as school, neighborhood and social institutions, and norms) [[34]Brooks F.M. Magnusson J. Spencer N. et al.Adolescent multiple risk behaviour: An asset approach to the role of family, school and community.].The fact that most data come from Western societies provides little insight into the ways that different social-ecological forces interact to inform pornography consumption and its implications for adolescent sexuality development in different cultural and economic settings [[2]Kyriaki A. Vasileios S. Emma A. et al.Adolescent pornography Use: A systematic Literature review of research Trends 2000-2017.]. In addition, most research focuses on older youth or young adults. Evidence on early adolescence (ages 10–14 years), which is a particularly critical time of physical, emotional, cognitive, and social development, is largely missing. This lack of perspective is a critical gap as early adolescence is a time when young people start to develop their sexual selfhood and become increasingly aware of socially constructed gender roles and norms associated with being a boy, man, woman, or girl [[35]Tolman D.L. McClelland S.I. Normative sexuality development in adolescence: A decade in review, 2000–2009.,[36]Blum R.W. Mmari K. Moreau C. It begins at 10: How gender expectations shape early adolescence around the World.]. It is a period when attitudes and beliefs are constantly evolving and influenced by—as well as influencing—young people's emerging (sexual) identity and experiences as they transit through adolescence [[36]Blum R.W. Mmari K. Moreau C. It begins at 10: How gender expectations shape early adolescence around the World.].In response to the abovementioned gaps, this study aims to assess the prevalence and correlates of pornography use among young adolescents (aged 10–14 years) across five geographically and culturally diverse urban poor settings. We focus on the gendered patterns of pornography consumption, which we hypothesize to be more common among boys than girls and more common among adolescents who perceive greater gender-unequal norms and those with greater permissiveness toward adolescent romantic relationships [[1]Adolescents and pornography: A review of 20 Years of research.].Methods Study designThis is a cross-sectional study using data from the Global Early Adolescent Study (GEAS), a multicountry investigation of how gender socialization affects early adolescent health and well-being. The GEAS operates in 11 urban poor sites across five continents, chosen to represent a diversity of geographical, cultural, economic, and social contexts and because of existing research partnerships. The focus on urban poor adolescents was a deliberate choice to shed light on the emerging but understudied urban poor penalty among adolescents [[37]Mmari K. Blum R. Sonenstein F. et al.Adolescents' perceptions of health from disadvantaged urban communities: Findings from the WAVE study.].For the present study, we used data from five sites which had collected baseline data at the time of this analysis: Ecuador (Cuenca), Belgium (nine cities in Flanders), the Democratic Republic of the Congo, DRC (Kinshasa), China (Shanghai), and Indonesia (Semarang, Denpasar, and Lampung). All sites shared the same study protocol and core survey instruments, although sampling and data collection modes (described in detail elsewhere) were adapted to the local context [[38]Mmari K. Cooper D. Moreau C. et al.The social context of early adolescents in the global early adolescent study.].

The study received ethical approval from each site and was also approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board.

 Participants and samplingParticipants included young adolescents aged 10–14 years, recruited using different strategies across sites. These strategies, described in detail elsewhere [[38]Mmari K. Cooper D. Moreau C. et al.The social context of early adolescents in the global early adolescent study.], included random cluster sampling in Cuenca, a combination of exhaustive and convenient sampling in Flanders, multistage random sampling in Kinshasa, stratified cluster sampling in Shanghai, and a combination of clustered sampling and random sampling in three cities of Indonesia. Participants were recruited from schools in all sites, with the exception for Kinshasa, where a random sample of out-of-school adolescents from the same commune was selected to complement the in-school sample because of high school drop-out rates in this setting.

Altogether, 10,841 young adolescents aged 10–14 years were included. After excluding observations that did not reach the preset data quality criteria (<25% missing values for Belgium and <15% for other countries) (n = 490) and observations with missing information on the key dependent and independent variables (n = 1,101), our final analytical sample included 9,250 observations (89.4% of the original sample): N = 532 in Ecuador (85.3% of the original sample), N = 808 in Belgium (79.8% of the original sample), N = 2,720 in the DRC (96.5% of the original sample), N = 1,571 in China (89.7% of the original sample), and N = 3,619 in Indonesia (79.6% of the original sample).

 ProceduresData collection took place between June 2017 and June 2019 and involved a 1–2 hour survey using audio-computer/computer-assisted self-interview completed on tablets, with the exception of Kinshasa, where the survey was conducted face-to-face because of the low literacy rate in that setting. All participants provided active parental consent as well as their own assent before data collection began. The survey collected information on a range of topics including sociodemographics, family, peer, school and neighborhood circumstances, as well as perceptions of gender norms, knowledge, and practices related to physical, mental, sexual, and reproductive health. The survey instrument (translated, back translated in sites where English is not the primary language) was tested in 14 urban poor cities around the globe, refined, and validated among adolescents in six sites of the GEAS [[39]Moreau C. Li M. De Meyer S. et al.Measuring gender norms about relationships in early adolescence: Results from the global early adolescent study.]. A more detailed description of the GEAS instruments is