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Online Sexual Solicitation of Children and Adolescents

      Abstract

      Technological advances have exploded in the new millennium. The Internet provides many opportunities to enrich the lives of youth by providing greater access to learning opportunities, valuable resources, and positive social interactions with peers. However, the Internet is a relatively new and unregulated entity that can also place children and adolescents at risk for a variety of negative and potentially dangerous exposures. One such risk is online sexual solicitations and interactions with older adolescents, peers, and adults. This continuing education article will explore online sexual solicitation of child and adolescents in terms of definition, epidemiology, predictors, consequences, and implications for practice.

      KEY WORDS

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      OBJECTIVES

      • 1.
        Define online sexual solicitation.
      • 2.
        Discuss the epidemiology of the online sexual solicitation of children and adolescents.
      • 3.
        Describe predictors of the online sexual solicitation of children and adolescents.
      • 4.
        Discuss possible consequences to online sexual solicitation.
      • 5.
        Explore practice implications related to the online sexual solicitation of children and adolescents.
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      Technological advances have exploded in the new millennium. The use of mobile phones and the Internet has grown tremendously, transforming the lives of American youth. According to the , 95% of U.S. teens aged 13–17 years report owning a smartphone or having access to one, and 45% state that they are online on a near-constant basis. The Internet provides many opportunities to enrich the lives of youth by providing greater access to learning opportunities, valuable resources, and positive social interactions with peers (
      • Madigan S.
      • Villani V.
      • Azzopardi C.
      • Laut D.
      • Smith T.
      • Temple J.R.
      • Dimitropoulos G.
      The prevalence of unwanted online sexual exposure and solicitation among youth: A meta-analysis.
      . However, the Internet is a relatively unregulated entity that can also place children and adolescents at risk for a variety of negative and potentially dangerous exposures. One such risk is online sexual solicitations and interactions with older adolescents, peers, and adults. The disinhibitory and opportunistic nature of the Internet provides a new venue for the sexual exploitation of children and adolescents (
      • Wright P.J.
      • Donnerstein E.
      Sex online: Pornography, sexual solicitation, and sexting.
      ). Children and adolescents are more available to potential perpetrators via social networking sites, e-mails, and texting as these behaviors are largely anonymous and unsupervised by parents. In addition, perceptions of privacy and anonymity may make youth feel more comfortable talking about sex and engaging in sexual behaviors online rather than face-to-face. This continuing education article will explore online sexual solicitation of children and adolescents in terms of definition, epidemiology, predictors, consequences, and implications for practice.

      DEFINITIONS

      Online sexual solicitation occurs when children or adolescents are asked to engage in sexual activities, sexual talk, or to give personal sexual information on the Internet (
      • Mitchell K.J.
      • Wolak J.
      • Finkelhor D.
      Trends in youth reports of sexual solicitations, harassment and unwanted exposure to pornography on the internet.
      ). Online sexual solicitation can be wanted or unwanted. The online solicitor can be another minor or an adult. The online solicitation may or may not result in offline contact. Any online sexual solicitation of children and adolescents is concerning; when the solicitor is an adult, the level of concern is elevated, and when an offline meeting occurs, the concern is extremely heightened.
      • Baumgartner S.E.
      • Valkenburg P.M.
      • Peter J.
      Assessing causality in the relationship between adolescents’ risky sexual online behavior and their perceptions of this behavior.
      explored whether certain online sexual solicitations are riskier than others. The following four behaviors were found to be especially risky if the communication was with someone unknown to the youth: searching online for someone to talk to about sex, searching online for someone to have sex with online, sending naked and/or sexual photos or videos, and disclosing personal information (address or phone number). These behaviors are also predictive of offline encounters (
      • Noll J.G.
      • Shenk C.E.
      • Barnes J.E.
      • Haralson K.J.
      Association of maltreatment with high-risk internet behaviors and offline encounters.
      ).
      A sexual predator is defined as an individual who takes advantage of a characteristic of a victim to further sexually exploit that victim (
      • McGrath M.G.
      • Casey E.
      Forensic psychiatry and the Internet: Practical perspectives on sexual predators and obsessional harassers in cyberspace.
      ). The Internet is a powerful, potential tool for sexual predators, especially pedophiles. It provides them access to children and adolescents for extended periods, allowing them to gain the trust and control of their victims. Historically, only adults known and trusted by parents, such as relatives, teachers, and clergy, had access to children. The Internet allows for virtually anyone to communicate privately with children in their own homes, often with a parent in the same room (
      • McGrath M.G.
      • Casey E.
      Forensic psychiatry and the Internet: Practical perspectives on sexual predators and obsessional harassers in cyberspace.
      ).
      When a child or adolescent is sexually solicited online by an adult or an adolescent who, by the state law, meets the criteria for being an inappropriate sexual contact for the child or adolescent, the child or adolescent is a victim of online sexual abuse. The face-to-face sexual abuse of children typically involves grooming behaviors on the part of the perpetrator (
      • Wolf M.R.
      • Pruitt D.K.
      Grooming hurts too: The effects of types of perpetrator grooming on trauma symptoms in adult survivors of child sexual abuse.
      ). Behaviors aimed at the systematic physical and psychological desensitization of the child to the sexual acts while normalizing boundary violations (
      • Bennett N.
      • O'Donohue W.
      The construct of grooming in child sexual abuse: Conceptual and measurement issues.
      ). Perpetrators use grooming behaviors to gain access, develop trust, create opportunity, establish compliance, and secure secrecy of a victim (
      • Williams R.
      • Elliott I.A.
      • Beech A.R.
      Identifying sexual grooming themes used by internet sex offenders.
      ). Grooming behaviors can occur prior to the sexual abuse, as well as during, and even after the abuse has stopped (
      • Wolf M.R.
      • Pruitt D.K.
      Grooming hurts too: The effects of types of perpetrator grooming on trauma symptoms in adult survivors of child sexual abuse.
      ). Grooming behaviors often accompany online sexual solicitation of children and adolescents as well (
      • Gámez-Guadix M.
      • Almendros C.
      • Calvete E.
      • De Santisteban P.
      Persuasion strategies and sexual solicitations and interactions in online sexual grooming of adolescents: Modeling direct and indirect pathways.
      ;
      • Smith P.K.
      • Thompson F.
      • Davidson J.
      Cyber safety for adolescent girls: Bullying, harassment, sexting, pornography, and solicitation.
      ). Online sexual grooming involves behaviors by which an adult or older adolescent uses information and communication technology to gain access to and the confidence of the minor or younger child to engage in some sort of sexual interaction with the minor online, offline, or both (
      • Kloess J.A.
      • Beech A.R.
      • Harkins L.
      Online child sexual exploitation: Prevalence, process, and offender characteristics.
      ). Studies suggest that the Internet may alter the grooming process by providing anonymity and increased access to a potential pool of victims (
      • Smith P.K.
      • Thompson F.
      • Davidson J.
      Cyber safety for adolescent girls: Bullying, harassment, sexting, pornography, and solicitation.
      ). The online grooming process is often shortened; it is not unusual for the first conversation between the perpetrator and the child to become sexualized (
      • Jones L.M.
      • Mitchell K.J.
      • Finkelhor D.
      Trends in youth internet victimization: Findings from three youth internet safety surveys 2000–2010.
      ). A variety of manipulative techniques are used in the online grooming of children, including bribes, threats, controlling, persuasion, and deception (
      • Gámez-Guadix M.
      • De Santisteban P.
      • Alcazar M.Á
      The construction and psychometric properties of the questionnaire for online sexual solicitation and interaction of minors with adults.
      ). The perpetrator may engage in deception to make the child or adolescent think that they are interacting with a same-aged peer, thus making the child and/or adolescent feel comfortable with and closer to the perpetrator, resulting in an increased likelihood of sexual participation (
      • Quayle E.
      • Allegro S.
      • Hutton L.
      • Sheath M.
      • Lööf L.
      Rapid skill acquisition and online sexual grooming of children.
      ). As in offline sexual abuse, the online perpetrator may use nonsexual online involvement with the youth to foster feelings of deep emotional attachment on the part of the child, thus making them motivated to connect with the perpetrator sexually online as well as offline (
      • Tener D.
      • Wolak J.
      • Finkelhor D.
      A typology of offenders who use online communications to commit sex crimes against minors.
      ). The grooming techniques used are dependent on several factors, including the child and/or adolescent's response, the offenders’ personality, and the context in which the grooming takes place (
      • Smith P.K.
      • Thompson F.
      • Davidson J.
      Cyber safety for adolescent girls: Bullying, harassment, sexting, pornography, and solicitation.
      ).
      • deSantisteban P.
      • Del Hoyo J.
      • Alcázar-Córcoles M.Á
      • Gámez-Guadix M.
      Progression, maintenance, and feedback of online child sexual grooming: A qualitative analysis of online predators.
      conducted in-depth interviews of 12 incarcerated men convicted of sexual crimes against minors involving online sexual solicitation. The men described the Internet as a “facilitative environment to abuse.” The Internet assisted them in gaining access to the minor and provided them a venue for initial persuasion. The men also admitted to seeking and taking advantage of opportunities to interact with minors online, operating in multiple sites (chat rooms, social networks, and video conferencing), and interacting with many different potential victims at the same time. The convicts also expressed that the perception of anonymity afforded them the ability to establish certain strategies of persuasion to attract minors. The men reported that their online interactions allowed them to identify children's specific problems, deficiencies, and vulnerabilities (family conflict or school absenteeism and/or problems) that they then used to adapt strategies of persuasion to maximize their chances of success in sexual contact both online and offline.
      Studies suggest that there is a substantial overlap between online and offline sexual offending. Approximately half of the adults who used the Internet for sexual solicitation of minors admitted to an offline sexual offense (
      • Seto M.C.
      • Hanson R.K.
      • Babchishin K.M.
      Contact sexual offending by men with online sexual offenses.
      ).
      • Babchishin K.M.
      • Hanson R.K.
      • Hermann C.A.
      The characteristics of online sex offenders: A meta-analysis.
      described online sexual offenders of minors as more likely Caucasian men who were younger and more educated than offline offenders.

      EPIDEMIOLOGY

      The epidemiology of online sexual solicitation of children and adolescents is difficult to describe. It is especially difficult to quantify numbers of youth experiencing solicitation by adults because, as previously mentioned, it is not unusual for a child or adolescent victim to think that they are interacting with a peer when indeed the individual is an adult. It is also often difficult to determine if the online sexual solicitation is by a known adult or an unknown adult. Youth may make many contacts online with people that they have not met face-to-face yet feel they know, resulting in a blurring of the concept of a friend versus a stranger. According to the European Union Online survey, 30% of European 9–16-year-olds had made online contact in the previous year with someone they had not previously met face-to-face; ranging from 13% of 9–10-year-olds to 46% of 15–16-year-olds (
      • Livingstone S.
      • Haddon L.
      • Görzig A.
      • Ólafsson K.
      EU kids online II: Final report 2011.
      ). Approximately 9% of youth reported having a face-to-face meeting with someone they first met online; again, this behavior was more common in teens than in younger children (
      • Livingstone S.
      • Haddon L.
      • Görzig A.
      • Ólafsson K.
      EU kids online II: Final report 2011.
      ).
      The Crimes Against Children Research Center at the University of New Hampshire conducted a series of studies describing online sexual solicitation of children and adolescents. Three random national samples (2000, 2005, and 2010) of children aged between 10 and 17 years were interviewed regarding their online sexual solicitation (
      • Mitchell K.J.
      • Finkelhor D.
      • Jones L.M.
      • Wolak J.
      Use of social networking sites in online sex crimes against minors: An examination of national incidence and means of utilization.
      ). Approximately 19% of youth reported online sexual solicitation in 2000, and by 2010, only about 10% reported solicitation. Approximately 3% of these encounters involved the solicitor attempting to meet the youth offline. Older youth aged between 16 and 17 years were more likely to experience online sexual solicitation. However, youth aged between 13 and 15 years were more likely to be asked to meet offline. Females were solicited more frequently than males.
      • Madigan S.
      • Villani V.
      • Azzopardi C.
      • Laut D.
      • Smith T.
      • Temple J.R.
      • Dimitropoulos G.
      The prevalence of unwanted online sexual exposure and solicitation among youth: A meta-analysis.
      conducted a meta-analysis to attain a mean estimate of the prevalence of unwanted online sexual solicitation of youth. Nine samples with a total of 18,272 participants were included in the meta-analysis. A mean prevalence rate of 11.5% was noted; approximately one in nine youth. Age did not significantly alter the prevalence of unwanted sexual solicitation. North American and European youth experienced similar rates of unwanted online sexual solicitation. One fourth (25%) of youth experiencing unwanted sexual solicitation reported that they found these experiences extremely frightening or upsetting. Many youths (96%) reporting online sexual solicitation also reported experiencing offline victimization such as being sexually harassed, experiencing emotional abuse by a caregiver, assault, or rape (
      • Mitchell K.J.
      • Finkelhor D.
      • Wolak J.
      • Ybarra M.L.
      • Turner H.
      Youth internet victimization in a broader victimization context.
      ).
      • Madigan S.
      • Villani V.
      • Azzopardi C.
      • Laut D.
      • Smith T.
      • Temple J.R.
      • Dimitropoulos G.
      The prevalence of unwanted online sexual exposure and solicitation among youth: A meta-analysis.
      found male youth to be more at risk for unwanted sexual solicitation compared with females, largely because of the Internet sites visited by boys compared with those visited by girls.
      • Jones L.M.
      • Mitchell K.J.
      • Finkelhor D.
      Trends in youth internet victimization: Findings from three youth internet safety surveys 2000–2010.
      surveyed U.S. children aged between 10 and 17 years regarding online sexual solicitation. They were asked, “In the past year, did anyone on the Internet ask you for sexual information about yourself when you did not want to answer such questions? I mean very personal questions, like what your body looks like or sexual things you have done?”, “In the past year, did anyone on the Internet ever try to get you to talk online about sex when you did not want to?”, and “In the past year, did anyone on the Internet ever ask you to do something sexual that you did not want to do?” The prevalence of online sexual solicitation varied from 2% among 10-year-olds to 14% among 16–17-year-olds, with an average of 9% across the age span. Most online sexual encounters were not continued offline: only 3% of 10–17-year-olds reported offline contact with an online aggressor.

      PREDICTORS

      Societal factors exist that influence the potential risk of children and adolescents to exposure to an online sexual solicitation. Levels of socioeconomic stratification, Internet regulatory framework (more or less stringent), technological infrastructure (more or less developed), and educational systems (number of years, and inclusion of education technology) have all been found to influence risk for online sexual solicitation (
      • 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.
      ). Certain neuro-developmental factors increase adolescent vulnerability to an online sexual solicitation.
      As children enter adolescence, their brains are bombarded by a surge of hormones—driven by the hypothalamic-pituitary-gonadal axis—which essentially “flips a switch” underlying youths’ transition from general disinterest into a fascination with sex (
      • Feldstein Ewing S.W.
      • Ryman S.G.
      • Gillman A.S.
      • Weiland B.J.
      • Thayer R.E.
      • Bryan A.D.
      Developmental cognitive neuroscience of adolescent sexual risk and alcohol use.
      ). Thus, both online and offline adolescent sexual behaviors are hormonally influenced. Other behavioral changes that can increase the risk for online sexual solicitation also accompany adolescence. Impulsivity, risk-taking, and sensation-seeking peak in adolescence, resulting in a heightened attraction to novel and exciting experiences despite the evident risk (
      • Romer D.
      • Reyna V.F.
      • Satterthwaite T.D.
      Beyond stereotypes of adolescent risk taking: Placing the adolescent brain in developmental context.
      ). Gender differences exist when considering potential risk for online sexual solicitation. Although boys are more likely to view online pornography than girls (
      • Livingstone S.
      • Kalmus V.
      • Talves K.
      Girls’ and boys’ experiences of online risk and safety.
      ), it appears that adolescent girls are more at risk for online sexual solicitation (
      • Baumgartner S.E.
      • Valkenburg P.M.
      • Peter J.
      Assessing causality in the relationship between adolescents’ risky sexual online behavior and their perceptions of this behavior.
      ;
      • Jonsson L.S.
      • Fredlund C.
      • Priebe G.
      • Wadsby M.
      • Svedin C.G.
      Online sexual abuse of adolescents by a perpetrator met online: A cross-sectional study.
      ).
      • Pujazon-Zazik M.A.
      • Manasse S.M.
      • Orrell-Valente J.K.
      Adolescents’ self-presentation on a teen dating web site: A risk-content analysis.
      , in a content analysis of personal information posted on social networking sites, found that girls posted more risky and sexual content than boys.
      Although societal, developmental, and gender factors can influence potential risk for online sexual solicitation, individual predictors are more important to consider (Box 1). Individual socioeconomic background does not appear to influence risk; however, other individual factors do (
      • Jonsson L.S.
      • Fredlund C.
      • Priebe G.
      • Wadsby M.
      • Svedin C.G.
      Online sexual abuse of adolescents by a perpetrator met online: A cross-sectional study.
      ). Psychological and social problems, behavior problems, poor parent–child relationships, lower self-esteem, lower sense of coherence, and low cognitive ability place individuals at increased risk for online sexual solicitation as well as subsequent offline sexual meetings (
      • Jonsson L.S.
      • Bladh M.
      • Priebe G.
      • Svedin C.
      Online sexual behaviors among Swedish youth: Associations to background factors, behaviors and abuse.
      ). Depression is a predictor of online sexual solicitation (
      • de Santisteban P.
      • Gámez-Guadix M.
      Longitudinal and reciprocal relationships of depression among minors with online sexual solicitations and interactions with adults.
      ). Adolescents with depression have fewer coping skills to identify potential sexual offenders in their online interactions (
      • de Santisteban P.
      • Gámez-Guadix M.
      Longitudinal and reciprocal relationships of depression among minors with online sexual solicitations and interactions with adults.
      ). Depressed adolescents have more difficulties socializing and establishing adequate offline as well as online relationships, thus increasing vulnerability.
      Predictors of online sexual solicitation
       Psychological and/or emotional concerns
       Affective disorders
       Depression
       Low self-esteem
       Low sense of coherence
      Behavioral factors
      Lesbian and/or gay and/or bisexual and/or transgender
      Low cognitive ability
      Child maltreatment victimization
       Sexual abuse
       Physical abuse
       Neglect
      High levels online game use
      High levels pornography exposure
      Bullying and/or cyberbullying victimization
      Other high-risk online behavior
      Poor parental relationship and/or low level parental monitoring
      Sexual assault victimization
      Physical assault victimization
      Note.
      • Mitchell K.J.
      • Finkelhor D.
      • Wolak J.
      • Ybarra M.L.
      • Turner H.
      Youth internet victimization in a broader victimization context.
      .
      A high degree of parent–child conflict often leads to less supervision of children, placing them at increased risk (
      • Wright P.J.
      • Donnerstein E.
      Sex online: Pornography, sexual solicitation, and sexting.
      ). Youth identifying as gay, lesbian, bisexual, or questioning are also at increased vulnerability (
      • Jonsson L.S.
      • Fredlund C.
      • Priebe G.
      • Wadsby M.
      • Svedin C.G.
      Online sexual abuse of adolescents by a perpetrator met online: A cross-sectional study.
      ). The Internet affords them a seemingly anonymous venue for exploring their alternative sexuality, thereby placing them at risk for online sexual solicitation.
      • Chang F.C.
      • Chiu C.H.
      • Miao N.F.
      • Chen P.H.
      • Lee C.M.
      • Chiang J.T.
      Predictors of unwanted exposure to online pornography and online sexual solicitation of youth.
      explored predictors of unwanted online sexual solicitation in 2,315 adolescents from 26 high schools in Taiwan. Higher levels of online game use, online pornography media exposure, Internet risk behaviors, depression, and cyberbullying victimization were predictive of online sexual solicitation victimization.
      Experiencing child maltreatment (sexual abuse, physical abuse, and/or neglect) is a risk factor for engaging in a variety of sexual risk-taking behaviors, including sexual solicitation, both offline and online (
      • Maas M.K.
      • Bray B.C.
      • Noll J.G.
      A latent class analysis of online sexual experiences and offline sexual behaviors among female adolescents.
      ). Adolescent females who have experienced child maltreatment, compared with their peers who have not experienced child maltreatment, are more likely to present as sexually provocative online and are more likely to agree to meet with someone offline, whose identity has never been confirmed (
      • Noll J.G.
      • Shenk C.E.
      • Barnes J.E.
      • Haralson K.J.
      Association of maltreatment with high-risk internet behaviors and offline encounters.
      ). The link between online sexual solicitation victimization and child maltreatment may vary on the basis of the type of child maltreatment experienced (
      • Wright P.J.
      • Donnerstein E.
      Sex online: Pornography, sexual solicitation, and sexting.
      ). Sexual abuse victimization can distort the victim's perceptions of their sexual selves, leading them to engage in sexual experiences that are likely to result in negative outcomes (
      • Noll J.G.
      • Trickett P.K.
      • Putnam F.W.
      A prospective investigation of the impact of childhood sexual abuse on the development of sexuality.
      ).
      • Wright P.J.
      • Donnerstein E.
      Sex online: Pornography, sexual solicitation, and sexting.
      found sexual abuse or sexual assault victimization to be a significant risk factor for online sexual solicitation.
      • Jonsson L.S.
      • Fredlund C.
      • Priebe G.
      • Wadsby M.
      • Svedin C.G.
      Online sexual abuse of adolescents by a perpetrator met online: A cross-sectional study.
      found victims of penetrative sexual abuse or sexual assault (oral, anal, or vaginal penetration by a penis or other object) to be five times more likely to experience online sexual solicitation compared with their non-sexually abused peers. Physical abuse victimization may lower an individual's self-esteem and self-efficacy, which can lead to a path of general self-destruction and risk-taking, including sexual risk-taking (
      • Norman R.E.
      • Byambaa M.
      • De R.
      • Butchart A.
      • Scott J.
      • Vos T.
      The long-term health consequences of child physical abuse, emotional abuse, and neglect: A systematic review and meta-analysis.
      ).
      • Jonsson L.S.
      • Fredlund C.
      • Priebe G.
      • Wadsby M.
      • Svedin C.G.
      Online sexual abuse of adolescents by a perpetrator met online: A cross-sectional study.
      found victims of physical abuse to be two times more likely to experience online sexual solicitation when compared with their non-physically abused peers. Children who experience neglect often live in environments lacking in parental warmth and monitoring, and parent–child relationships are often weak (
      • Maas M.K.
      • Bray B.C.
      • Noll J.G.
      A latent class analysis of online sexual experiences and offline sexual behaviors among female adolescents.
      ), thus placing them at increased risk for online sexual solicitation.
      • Noll J.G.
      • Shenk C.E.
      • Barnes J.E.
      • Haralson K.J.
      Association of maltreatment with high-risk internet behaviors and offline encounters.
      studied high-risk Internet behaviors in girls aged 14–17 years; girls experiencing child maltreatment (n = 130) and those not experiencing child maltreatment (n = 121) were studied. Experiencing child maltreatment, adolescent behavior problems, and low cognitive ability placed adolescents at increased vulnerability for high-risk Internet behaviors, including online sexual solicitation. Nearly one third of the teens in the study reported having offline meetings with individuals they met online. Exposure to sexual content, creating high-risk social networking profiles, and receiving online sexual solicitations were predictive of meeting offline.

      CONSEQUENCES

      It is important to note that although many online sexual contacts may be viewed by youth as positive experiences (
      • Jonsson L.S.
      • Fredlund C.
      • Priebe G.
      • Wadsby M.
      • Svedin C.G.
      Online sexual abuse of adolescents by a perpetrator met online: A cross-sectional study.
      ), engaging in online sexual solicitation can be associated with a variety of negative consequences for children and adolescents (Box 2). When the online sexual solicitation involves an adult or an older adolescent who by the law is an inappropriate sexual partner, that youth is a victim of online sexual abuse. Online sexual solicitation by an adult, older adolescent, or a peer can result in psychological trauma for the victim and is associated with a variety of negative psychological outcomes which can be both predictors of engagement in online sexual solicitation and consequences of online sexual solicitation, such as depression and poor self-esteem. Victims often feel shame, guilt, and embarrassment (
      • Baumgartner S.E.
      • Valkenburg P.M.
      • Peter J.
      Assessing causality in the relationship between adolescents’ risky sexual online behavior and their perceptions of this behavior.
      ). Experiencing sexual abuse and other forms of trauma can be risk factors for online sexual solicitation; in trauma-exposed youth, online sexual solicitation can exacerbate existing trauma symptoms (
      • Maas M.K.
      • Bray B.C.
      • Noll J.G.
      A latent class analysis of online sexual experiences and offline sexual behaviors among female adolescents.
      ). Trauma symptoms can also develop in youth engaging in online solicitation who have not previously been exposed to trauma. Trauma symptoms can include anxiety, depression, externalizing problems, psychosomatic complaints, self-harm, and even suicide (
      • de Haan A.
      • Landolt M.A.
      • Fried E.I.
      • Kleinke K.
      • Alisic E.
      • Bryant R.
      • Meiser-Stedman R.
      Dysfunctional posttraumatic cognitions, posttraumatic stress and depression in children and adolescents exposed to trauma: A network analysis.
      ;
      • Ossa F.C.
      • Pietrowsky R.
      • Bering R.
      • Kaess M.
      Symptoms of posttraumatic stress disorder among targets of school bullying.
      ). Online sexual exploitation is indeed a trauma exposure and can result in the development of posttraumatic stress disorder (
      • Maas M.K.
      • Bray B.C.
      • Noll J.G.
      A latent class analysis of online sexual experiences and offline sexual behaviors among female adolescents.
      ).
      Consequences of online sexual solicitation
       Negative psychological outcomes
       Trauma symptoms and/or posttraumatic stress disorder
       Depression
       Low self-esteem
      High-risk sexual behaviors
       Multiple sexual partners
       Low condom use
       Anal sex
       Earlier onset sexual activity
       Use of drugs and/or alcohol with sex
      Sexual assault and/or sexual abuse victimization (online and offline)
       Revictimization (online and offline)
       Commercial sexual exploitation of children
      Intimate partner violence victimization
      Sexually transmitted infections
      Other victimization
       Stalking
       Harassment
      Note.
      • Maas M.K.
      • Bray B.C.
      • Noll J.G.
      Online sexual experiences predict subsequent sexual health and victimization outcomes among female adolescents: A latent class analysis.
      .
      Engaging in online sexual solicitation can predict engagement in other high-risk offline sexual behaviors such as multiple sexual partners and inconsistent condom use (
      • Maas M.K.
      • Bray B.C.
      • Noll J.G.
      Online sexual experiences predict subsequent sexual health and victimization outcomes among female adolescents: A latent class analysis.
      ). Having an offline partner during adolescence who was met online is associated with having more lifetime sexual partners, sex before the age of 14 years, using drugs and alcohol with sexual experiences (
      • Buhi E.R.
      • Klinkenberger N.
      • McFarlane M.
      • Kachur R.
      • Daley E.M.
      • Baldwin J.
      • Rietmeijer C.
      Evaluating the Internet as a sexually transmitted disease risk environment for teens: Findings from the communication, health, and teens study.
      ), and decreased condom use (
      • Rice E.
      • Winetrobe H.
      • Holloway I.W.
      • Montoya J.
      • Plant A.
      • Kordic T.
      Cell phone internet access, online sexual solicitation, partner seeking, and sexual risk behavior among adolescents.
      ). Thus, youth engaged in online sexual solicitation are at increased risk for sexually transmitted infections, including HIV and pregnancy (
      • Maas M.K.
      • Bray B.C.
      • Noll J.G.
      Online sexual experiences predict subsequent sexual health and victimization outcomes among female adolescents: A latent class analysis.
      ;
      • McFarlane M.
      • Bull S.S.
      • Rietmeijer C.A.
      Young adults on the Internet: Risk behaviors for sexually transmitted diseases and HIV(1).
      ). Youth engaged in online sexual solicitation are more likely to experience other forms of victimization such as physical and sexual violence in their intimate relationships (
      • Stanley N.
      • Barter C.
      • Wood M.
      • Aghtaie N.
      • Larkins C.
      • Lanau A.
      • Överlien C.
      Pornography, sexual coercion and abuse and sexting in young people's intimate relationships: A European study.
      ), stalking (
      • Southworth C.
      • Finn J.
      • Dawson S.
      • Fraser C.
      • Tucker S.
      Intimate partner violence, technology, and stalking.
      ), harassment, and entry into the commercial sexual exploitation of children (CSEC;
      • Mitchell K.J.
      • Finkelhor D.
      • Jones L.M.
      • Wolak J.
      Use of social networking sites in online sex crimes against minors: An examination of national incidence and means of utilization.
      ). The Internet can serve as a vehicle for the recruitment of vulnerable youth into CSEC (
      • Mitchell K.J.
      • Finkelhor D.
      • Jones L.M.
      • Wolak J.
      Use of social networking sites in online sex crimes against minors: An examination of national incidence and means of utilization.
      ). The online grooming of CSEC victims is similar to the offline grooming processes. Traffickers canvass online for vulnerable youth, woo them online with promises of love, gifts, and caring, and then convince them to meet offline to continue the relationship (
      • Moore J.L.
      • Kaplan D.M.
      • Barron C.E.
      Sex trafficking of minors.
      ). Engaging in online sexual solicitation and sending sexual photos or videos can also be used as blackmail against the youth to force them into CSEC, to avoid the exposure of their online sexual behaviors (
      • Goldberg A.
      • Moore J.
      Domestic minor sex trafficking.
      ).
      Teens engaged in online sexual solicitation behaviors also place themselves at risk for later sexual revictimization, both online and offline (
      • de Santisteban P.
      • Gámez-Guadix M.
      Longitudinal and reciprocal relationships of depression among minors with online sexual solicitations and interactions with adults.
      ;
      • Maas M.K.
      • Bray B.C.
      • Noll J.G.
      Online sexual experiences predict subsequent sexual health and victimization outcomes among female adolescents: A latent class analysis.
      ). Sexual perpetrators may approach potential victims based on their profile pictures, other emotional vulnerabilities, and sexual readiness cues gleaned via online communications. Youth posting sexual pictures of themselves and engaging in sexual talk and acts online are determined by the perpetrator to be more likely to play the role of sex object resulting in an increased risk of both online and offline sexual abuse and/or assault (
      • Maas M.K.
      • Bray B.C.
      • Noll J.G.
      Online sexual experiences predict subsequent sexual health and victimization outcomes among female adolescents: A latent class analysis.
      ). Victims of online sexual solicitation frequently coexperience offline sexual victimization (
      • Mitchell K.J.
      • Finkelhor D.
      • Wolak J.
      • Ybarra M.L.
      • Turner H.
      Youth internet victimization in a broader victimization context.
      ).

      IMPLICATIONS FOR PRACTICE

      The online sexual solicitation of children and adolescents is a serious pediatric health care problem; a problem that pediatric nurse practitioners (PNP) must feel confident addressing. All children and adolescents are at potential risk. Preventing online sexual solicitation begins with the basics, encouraging positive parenting practices, and open communication between parent and child. Parents need to be a presence in their children's lives, both online and offline. Encourage parents to monitor their children's online use. Provide parents with up-to-date information on Internet technologies and online safety (Box 3). Although preventive software has been found to decrease exposure to unwanted sexual material, studies suggest that it is most effective when coupled with parental monitoring and healthy communication between parents and children (
      • Mitchell K.J.
      • Finkelhor D.
      • Wolak J.
      • Ybarra M.L.
      • Turner H.
      Youth internet victimization in a broader victimization context.
      ;
      • Ybarra M.L.
      • Finkelhor D.
      • Mitchell K.J.
      • Wolak J.
      Associations between blocking, monitoring, and filtering software on the home computer and youth-reported unwanted exposure to sexual material online.
      ). Encourage parents to talk to their children about their Internet use emphasizing the dangers of communicating with strangers online, especially about sexual matters, and discuss risks associated with meeting Internet contacts offline (
      • Genuis S.J.
      • Genuis S.K.
      Internet interactions: Adolescent health and cyberspace.
      ). Educate parents regarding the importance of being calm and supportive, should their child disclose online sexual solicitation. Help parents understand the profound sense of shame, embarrassment, and self-blame that their child may be experiencing (
      • Madigan S.
      • Villani V.
      • Azzopardi C.
      • Laut D.
      • Smith T.
      • Temple J.R.
      • Dimitropoulos G.
      The prevalence of unwanted online sexual exposure and solicitation among youth: A meta-analysis.
      ).
      Tips for parents: Online safety
       Technologies cannot catch everything: communicate with your child
       Risks of sharing personal information
        Identity theft
        Online scams
        Hacking
        Online sexual solicitation
        Sextortion
       Address sexting
        Talk about consequences (legal)
        Never forward sexual images
        Discuss healthy relationships
        Discuss ways an image can spread online
        Report sexting to cybertipline.org
       Address sexual solicitation
        Discuss healthy relationships
        Talk about risks of offline meetings and set rules
        Know your child's online friends
        Discuss warning signs of online grooming
        Call the police if online sexual solicitation occurs
        Report to cybertipline.org
      Note.
      National Center for Missing and Exploited Children
      Internet safety: Parents, guardians and community members.
      .
      Pediatric health care providers need to incorporate preventive interventions that educate youth about healthy relationships (Box 4). Understanding the prevalence of social media use by today's youth, coupled with its potential risks, PNPs must talk to youth about their online behaviors and provide anticipatory guidance. Ask a few general screening questions such as: Do you talk to anyone online that you do not know in real life (have never met face-to-face)? If yes, is that person older than you (quantify how much older)? Do you talk online about personal information such as sex or share sexual photos? If the answer to any of these questions is yes, a few additional screening questions are indicated (Box 5). Educate youth regarding the link between online sexual solicitation and offline sexual assault or recruitment into CSEC (
      • Madigan S.
      • Villani V.
      • Azzopardi C.
      • Laut D.
      • Smith T.
      • Temple J.R.
      • Dimitropoulos G.
      The prevalence of unwanted online sexual exposure and solicitation among youth: A meta-analysis.
      ). Discussions should also include information about online grooming behaviors, ranging from flattery, professions of love, or even threats of harm to the teen or their family, to solicit adolescents to engage in online sexual talk or interactions (
      • Black P.J.
      • Wollis M.
      • Woodworth M.
      • Hancock J.T.
      A linguistic analysis of grooming strategies of online child sex offenders: Implications for our understanding of predatory sexual behavior in an increasingly computer-mediated world.
      ).
      Healthy relationships education
       Healthy
        Freedom to be yourself
        Mutual respect
        Limited jealousy
        Support
        Privacy
        Boundaries
       Good communication
       Warning signs
        Angry when you do not do everything with them
        Criticize the way you look or dress
        Say no one else would want to date and/or be with you
        Keep you from seeing friends or talking to other guys and/or girls
        Wants you to quit an activity that you love
        Physical violence or threats
        Sexual violence and/or force and/or coercion
      Pediatric health care providers must possess a basic understanding of the state laws defining age-appropriate sexual partners. They must also understand that Internet-related sexual solicitation of a minor by an adult or an age-inappropriate adolescent is sexual abuse and must be reported to law enforcement and child protective services, even when no physical contact has transpired. As with other forms of sexual abuse, referral to a mental health provider skilled in evidence-based treatments such as trauma-informed cognitive-behavioral therapy or eye movement desensitization and reprocessing may be clinically indicated (
      • Gillies D.
      • Maiocchi L.
      • Bhandari A.P.
      • Taylor F.
      • Gray C.
      • O'Brien L.
      Psychological therapies for children and adolescents exposed to trauma.
      ). Teens engaging in online sexual solicitation could benefit from specific interventions to better ward off unwanted online sexual advances such as sexual refusal and assertiveness training (
      • Schry A.R.
      • White S.W.
      Sexual assertiveness mediates the effect of social interaction anxiety on sexual victimization risk among college women.
      ).
      Screening questions for online sexual solicitation
      • 1
        Have you been asked for online pictures or videos of yourself with sexual contact?
        • a
          Adult and/or older youth (legally inappropriate sexual partner)
        • b
          Peer
      • 2
        Have you been asked questions about sex via the Internet or mobile device?
        • a
          Adult and/or older youth
        • b
          Peer
      • 3
        Have you been asked to have cybersex (i.e., webcam)?
        • a
          Adult and/or older youth
        • b
          Peer
      • 4
        Has anyone you met online asked you to have sex offline?
        • a
          Adult and/or older youth
        • b
          Peer
      • 5
        Has anyone sent you photos or videos of themselves with sexual contact?
        • a
          Adult and/or older youth
        • b
          Peer
      • 6
        Have you sent photos or videos of yourself with sexual contact?
        • a
          Adult and/or older youth
        • b
          Peer
      • 7
        Have you met a person offline who you met online?
        • a
          Adult and/or older youth
        • b
          Peer
      • 8
        Have you had offline sexual contact with someone you met online?
        • a
          Adult and/or older youth
        • b
          Peer
      Note.
      • Gámez-Guadix M.
      • De Santisteban P.
      • Alcazar M.Á
      The construction and psychometric properties of the questionnaire for online sexual solicitation and interaction of minors with adults.
      .
      American children and adolescents live in a virtual world, and it is a reality that they are potential victims of online sexual solicitation. Online sexual solicitation can result in a variety of negative mental and physical health consequences. PNPs should urge schools to provide comprehensive sex education programs that include principles of healthy intimate relationships as well as basic principles of Internet literacy (
      Council on Communications and Media
      American Academy of Pediatrics. Policy statement—Sexuality, contraception, and the media.
      ). PNPs should also encourage and participate in research into the impact of online sexual contact on children and adolescents. By participating in governmental advocacy, PNPs can lobby for the implementation of stricter Internet regulation to better control potential online perpetrators’ access to children and adolescents. Finally, PNPs can make immediate differences in the lives of children and adolescents by incorporating practice behaviors to assess for online sexual solicitation exposure better and provide appropriate intervention as needed. Online sexual solicitation is indeed a pediatric health care problem, and PNPs must feel comfortable and confident in addressing the problem.

      Appendix. SUPPLEMENTARY MATERIALS

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      Biography

      Gail Hornor, Pediatric Nurse Practitioner, Center for Family Safety and Healing, Nationwide Children's Hospital, Columbus, OH.