Clinician Views on Inhaler Substitution in the Veterans Health Administration.

Sexual image sharing has become increasingly prevalent in youth digital culture. One meta-analysis found adolescent prevalence rates of 19.3% for sending sexual photos and 34.8% for receiving, with females more frequently receiving requests and older adolescents more likely to engage in sending behaviors. Many respondents perceive sexual image sharing as a normal part of dating and see sexting as normative among their peers. Although requesting and sharing sexual images can be consensual in the context of romantic relationships, there are risks for adolescents. Sexual images may be shared without consent and threats to share the images may be used coercively after a relationship ends. Such cases are increasingly recognized as forms of image-based sexual abuse (IBSA). One study found that more than one-third of adolescents who shared sexual images reported adverse outcomes. Coercive requests for images can also be distressing experiences for adolescents and increase the chance that the exchange may not be fully consensual. Even in the absence of overt threats, many adolescents experience strong pressure to send intimate images, pressure that can be emotional, manipulative, or persistent in nature. Coercive requests for sexual images can be considered an online form of sexual harassment, which research has linked to adverse outcomes, such as sleep problems, depressive symptoms, suicidal ideation, and substance use for adolescents. It is important to understand the circumstances under which adolescents feel compelled to share a sexual image in response to coercive requests to effectively target prevention and intervention programs. Prior research has found that when asked to send a sexual image by a current boyfriend or girlfriend, 70% of adolescents comply, but it is not clear how they respond when a request is coercive. Although some may refuse to share images, others may comply due to feeling scared, ashamed, or concerned about the relational consequence of refusing. The current study examines experiences with coercive requests for sexual images received before the age of 18 years reported by a large sample of young adult survey respondents and the incident and respondent characteristics associated with sharing an image in response to coercion. The study also assesses the differential association of sharing vs not sharing with disclosure behavior and outcome of the incident for adolescents. The survey study was conducted between June 28, 2023, and April 1, 2024, in the US. A sample of 6204 young adults (aged 18-28 years) was recruited through Facebook and Instagram advertisements promoting an opportunity to share the experiences of young people in survey research. Three screening questions (measured on a 5-point Likert scale) were administered before survey administration, asking whether the respondent had ever sent a sexual image or video, been asked for a sexual image or video, or talked with friends about the risks of sending sexual images or videos. The purpose of the screening questions was to ensure an oversample of individuals with IBSA experiences. Study involvement of human participants and informed consent procedures were approved by the University of New Hampshire Institutional Review Board. All participants provided written consent to participate. The study followed the American Association for Public Opinion Research () reporting guidelines.