Cyber Sexual Harassment among Adolescent Girls: A Qualitative Analysis

: Background: Research efforts are increasingly recognizing young girls’ experiences of technology facilitated sexual harassment, which includes sexual harassment via electronic technology and social networking sites. The current study aimed to qualitatively describe experiences of cyber sexual harassment (CSH), as well as its effects, among a sample of sexually active adolescent girls. Methods: Qualitative interviews (n = 25) were conducted among a sub-group of adolescent girls at risk for CSH (those who reported experiencing sexual or dating violence) who participated in a larger cross-sectional clinic-based study on sexual health. Participants were asked to describe their experiences or peers’ experiences of CSH. Interviews were transcribed, coded, and a thematic analysis approach was used to analyze qualitative ﬁndings. Results: Participants reported experiencing several different types of CSH, including (a) being forced or pressured to send sexual photos, (b) receiving unwanted sexual messages/photos, and (c) having sexual photos posted or shared without the sender’s permission. Findings also highlighted the consequences of experiencing CSH, including social isolation and negative effects on girls’ education. Conclusions: These scenarios of CSH described by participants highlight the multiple ways in which girls experience CSH. Our ﬁndings begin to inform the development of quantitative survey measures that reﬂect these speciﬁc types of CSH experiences reported by adolescents. The consistent use of such measures will be critical to establish the prevalence and consequences of CSH in future studies on this topic.


Introduction
In the United States, adolescent and young adult females between the ages of 16 and 24 experience the highest per-capita rates of sexual violence and harassment [1]. While face-to-face sexual harassment has been studied extensively, research efforts are also increasingly recognizing young girls' experiences of cyber sexual harassment (CSH; e.g., sexual harassment that occurs via electronic communication technology and social networking sites) [2]. The emphasis on young populations who experience sexual harassment is of particular importance, especially given that these experiences have been found to have negative, long-lasting impacts on health and psychosocial outcomes among girls [3][4][5].
The prevalence of girls experiencing CSH has been found to be as low as 4% to as high as 70% [6][7][8][9][10][11][12]. Common forms of CSH include being coerced to send sexual images/messages, unwanted sharing of sexual images, and being harassed via social networking sites to meet in person [2,[10][11][12][13][14]; however, few studies have looked at these multiple scenarios of CSH together. This wide range in prevalence is largely a result of varying definitions used across studies [2,6,7,12,13]. For example, some studies only assess coercive sexting outside of a romantic relationship, while others assess coercive sexting without measuring relationship status, and others focus on unwanted photo sharing [2,[6][7][8][9][10][11][12][13][14]. Therefore, the current study aims to qualitatively assess the various contexts and scenarios in which CSH occurs to inform consistent and comprehensive measurement development.
In addition to gaps in measuring the multiple scenarios in which CSH occurs across relationship contexts, there has been a scarcity of research to examine the multiple poor health outcomes associated with CSH. A few quantitative studies have found that CSH is associated with similar poor health outcomes to in-person experiences of sexual harassment, such as substance use and poor mental health [10,[15][16][17], yet there is little qualitative research exploring the consequences of CSH. Notably, multiple studies on sexting have documented an association between sexting and increased reports of substance use and poor mental health outcomes; however, these negative health outcomes may be because a substantial proportion of the sexting reported by participants is non-consensual [8,9,15,17]. In addition, recent research on sexting (sending or receiving of sexual words, photos, and videos via technology) has documented the occurrence of nonconsensual sexting, a form of CSH that includes being pressured to sext or receive unwanted sexts [15,16,18]. Overall, qualitative work is needed to better understand the range of possible health and social consequences of CSH.
To address these current gaps in the literature, the present study qualitatively described (1) common scenarios in which adolescents experience CSH, including identifying perpetrators of CSH, and (2) the reported social effects of experiencing CSH among a sample of sexually active adolescent girls (n = 25).

Study Setting and Participants
The current qualitative study is part of a larger cross-sectional study aimed at assessing STI risk and spatial mobility among adolescent girls residing in a San Diego neighborhood near the US-Mexico border. Participants were recruited from a health clinic situated across from a high school. The clinic provides free or low-cost health care for all ages, and utilizes the Family Planning, Access, Care, and Treatment (Family PACT) program for individuals seeking family planning services. Eligibility criteria for the larger, quantitative study on STI risk included being (a) biologically female, (b) between the ages of 15-19, (c) sexually active in the past 6 months, and (d) willing to provide a urine sample for STI testing. The quantitative survey assessed participants' demographics, social media use, experiences with violence, sexual health, substance use, depression, and anxiety. Intensity sampling was then used to recruit a subset (n = 25) of interview participants who identified as high-risk for CSH in the quantitative survey (e.g., reported experiencing other forms of sexual or dating violence, or having ever sent or received sexual photos). The specific interview eligibility criteria were not disclosed to interview participants. Eligible participants from the larger quantitative study were invited by study staff to participate in the qualitative interview upon the completion of their quantitative survey. Interviews were completed at the participants' convenience; either immediately after completing the quantitative survey or at a later date.

Study Procedure and Measures
The project manager and research assistants trained in qualitative interviewing conducted open-ended, semi-structured 45-60 min interviews to understand the specific contexts and scenarios of CSH reported among adolescent girls, among a variety of other topics. Participants were asked to describe general aspects of their lives, including family relationships, living situation, and relationships with male partners and friends, thoughts on pregnancy intentions, where they spend their time, and educational/career goals. Interviews included questions on electronic communication technology, including types used, who participants communicate with and how. An example of a question on electronic communication is: "What social media site do you prefer to use to communicate with friends?" Follow-up probing questions included: "Have you or your friends ever met someone online? If yes: on what platform?" Questions also asked girls to describe unwanted experiences related to sexting, sexual solicitation, or other unwanted communication that is sexual in nature, and identify their relationship to the perpetrator. Given the sensitive nature of the questions, participants who did not report experiences of sexting or sexual solicitation were asked to describe scenarios in which their friends may have experienced sexting or sexual solicitation. An example of questions around sexting and sexual solicitation is: "Has anyone ever sent you an unwanted photo that was sexual in nature?" Follow-up probing questions include: "Can you describe what happened when this occurred?" Indirect experiences of CSH, as well as the specific perpetrators of CSH, were also explored. Follow-up probing questions included: "How does this come about in conversation? Do girls and boys do this equally?" Research staff informed participants that their participation was completely voluntary and confidential, and they had the right to refuse to answer any interview questions or stop the interview at any time. Throughout the interview, the interviewer would check in with the participant and use respondent validation in order to ensure correct interpretation of the findings. Interviews were digitally recorded, and audio files were identified using only a unique study ID number. Demographic data, including age, race, education, relationship status, and questions on social media use collected from the quantitative survey were used to characterize the subsample. Interview participants received a $20 gift card. The UCSD Human Research Protections Program approved all study procedures.

Data Analysis
Quantitative data from the larger survey, including age, race, relationship status, and social media use, were analyzed to provide descriptive statistics (e.g., frequencies) using the Statistical Package for the Social Sciences (SPSS), Version 21.
Transcribed and de-identified interviews were analyzed based on principles of thematic analysis [19] to explore the various scenarios in which CSH occurs. The project manager, principal investigator, and two research assistants initially read three complete interview transcripts to identify and define the various scenarios of CSH, and develop a preliminary coding scheme. A final coding scheme was created based on coder consensus. The final coding scheme had 14 different main categories/parent codes, and between 5 and 8 subcodes for each category. For example, if a participant discussed being sent an unwanted sexual photo by a friend and then being asked to send a photo in return, this would be coded as two different categories of CSH, and the relationship to the perpetrator would also be coded. No new codes emerged after two-thirds of the interviews were coded suggesting that saturation was achieved. Using the final coding scheme, two research staff trained in qualitative data analysis coded interviews independently, compared any inconsistencies, and discussed for agreement. Additions of new codes or changes in code definitions were determined via consensus among the research team. We assessed intercoder reliability and a Kappa score of 0.79 was achieved [19]. Interviews were coded and analyzed using Atlas TI.

Sample Characteristics
Among the 25 participants who completed the interview, the majority (n = 17) were between the ages of 15 and 17. Most participants (n = 22) were still attending high school or another training program leading to a degree, and three participants had graduated from high school. Over half (18) identified as Hispanic or Latina. Almost two-thirds of participants (n = 16) reported being in a relationship, three reported going out with more than one person or just "hooking up", and four were single. All participants (n = 25) reported having access to some type of electronic device (e.g., smartphone, computer, or tablet), and 24 reported using their phone to access social media sites (e.g., Facebook, Instagram, Twitter).

Qualitative Findings
Qualitative interviews shed light on the various ways in which participants experienced CSH. Adolescents experienced CSH in a variety of ways, including (a) being forced or pressured to send sexual photos, (b) receiving unwanted sexual messages/photos, and (c) having sexual photos posted or shared without the sender's permission. Findings also highlighted the consequences of experiencing CSH, including social isolation, negative effects on girls' education, and online solicitation that led to in-person sexual harassment and violence. We have included each of these themes and supporting quotes from interviews.

Pressure to Send Sexual Photos
Multiple participants reported being pressured by males who were viewed as potential romantic partners and other males met online to send sexual photos: "Like I've had guys ask me on Facebook for nudes. And I'm like "What? I don't even know you." But I think it just starts like "Hey" like Hey . . . conversation, and then it keeps going down and then sooner or later they ask for the picture." [male met online] "Like I didn't want to [text a sexually explicit photo]... I felt pressured to do it [send a sexually explicit photo]. Like I was just more afraid like, I was more afraid he was gonna tell people that like I'm a wuss or something like that." [potential male romantic partner] Participants also reported that girls are sometimes talked into sending a sexual photo if they think the male likes them and there is a possibility that the male may become a potential romantic partner: " . . . They [guys] ask [girls to send photos] and you think this guy likes me so you're like, "Oh my god, okay [I will send a photo.]"

Receiving Unwanted Sexual Photos
Participants reported that males (often people they know) would send unwanted sexual photos, sometimes using this tactic to coerce participants to send a sexual photo in return: "A guy [friend], just randomly sent me a [picture of his penis] and he was like, 'you like it? Send me one.' And I was like, 'Umm . . . no, thank you," and he was like, 'Come on . . . we're just friends." So . . . we were really close . . . but I didn't want to do that because he was [like] my brother." Male strangers also sent participants unwanted sexual photos and participants complained of feeling uncomfortable in these scenarios: "Some creepy guy on Facebook, I don't know who he was and he just kind of messaged me and he sent me a picture of his penis, which is wrong! And I just felt really like . . . I don't know, it just felt so awkward so I kind of like blocked the person."

Unwanted Photo Sharing
Upon sending sexual photos, several participants reported males would show or threaten to show the photos to other people without the sender's permission: "I guess this girl, . . . she sent a [sexual] picture out to one of the football team members and got all around the football team. From the football team it went to the whole school." In one scenario, a participant described that a male partner threatened to publicly post sexual pictures as a tactic to coerce the sender to have sex with him: " . . . I read the conversation of a friend and she sent the [sexual] picture and the guy started like bullying her like he was gonna post the pictures if she didn't have sex with him . . . and she was crying . . . 'Cause everybody from school knows me . . . she was like, "Oh, go talk to him, please." So I went and I was like, "You better erase the photos or the office is gonna know and stuff." And then he was like, "No, I'm not gonna erase anything." . . . And he . . . [eventually] deleted the pictures in front of her . . . "

Solicitation Online That Led to In-Person Sexual Harassment and Violence
Participants reported scenarios where males attempted to meet participants online with the intent to engage in sexual activity. Males met online were often a few years older, usually out of high school. Once an online relationship was established, participants reported being pressured to meet face-to-face. Upon meeting in person, participants reported sexual harassment and sexual assault: "We started talking through Facebook. . . . [when we met in person] at the end . . . , he took me to like the corner and he was like "Oh, you don't want to give me a kiss." And I was like 'What the hell.'" "I met someone online . . . then he picked me up from school . . . We had sex . . . and we never talked again. I didn't want [to have sex, I didn't know we were going to have sex], we just talked about chilling and watching a movie."

Other Consequences of Experiencing CSH
While researchers did not explicitly ask about the adverse consequences of experiencing CSH, given that the interview covered a variety of topics, these themes naturally emerged in the interviews. Participants discussed the social and emotional consequences of CSH, particularly regarding when photos are shared without their permission.
Participants recalled adverse social consequences related to unwanted public photo sharing, including social isolation: "[After a participant's acquaintance's sexually explicit pictures were posted online by her sexual partner] . . . everyone calls her like things . . . so she barely gets out to the halls or anything . . . a lot of her close friends don't talk to her anymore [because of these pictures] . . . because they say that hanging around with her would make them seem like they're like her, so they just stopped talking to her." Switching schools due to reputational damage as a result of unwanted photo sharing was also discussed: "There was this one girl in middle school that had sent a [sexual] picture [to a male partner] and it got around...I think it affected her like dramatically cuz' she stopped going to school."

Discussion
Study findings build on the expanding literature examining CSH by identifying the scenarios and contexts in which adolescent girls commonly experience this form of sexual harassment. The current study identified several prominent elements of CSH including (a) pressure to send sexual messages/photos, (b) being sent unwanted sexual messages/photos, and (c) unwanted photo sharing. Findings also highlighted the consequences of experiencing CSH, including online solicitation that led to in-person sexual harassment and violence, social isolation, and negative effects on girls' education. Findings may inform the development of comprehensive CSH measures for use in future quantitative studies (i.e., studies assessing the prevalence and consequences of CSH), as well as begin to inform prevention efforts, while noting the relatively homogenous nature of the sample.
While previous quantitative work has documented the common occurrence of being pressured or coerced to sext [6][7][8][9][10][11][12][13][14], our study builds on this previous work and highlights some of the mechanisms used to facilitate this specific type of CSH. Participants reported that male friends, strangers, and acquaintances often sent a sexual photo first to establish trust and to make girls feel like they "owed" them a sexual photo in return. The promise of a romantic relationship was another tactic used to pressure participants to send a sexual photo, often from perpetrators participants already knew. Understanding the ways in which perpetrators pressure or coerce girls to send a sexual image will be important in the development of intervention and prevention efforts. Furthermore, while we found that being pressured to sext was most reported by girls, many previous studies on CSH have not assessed being pressured or coerced to sext. Thus, future studies should include being pressured or coerced to sext as a form of CSH.
While participants rarely reported that they experienced unwanted photo sharing themselves, many of them reported this occurring among other classmates. Previous studies have found that boys are more likely than girls to share a sexual photo they received with others [20][21][22][23]. The scenarios discussed in the present study involved photos that were shared with multiple people. However, future survey studies are needed to better understand how often sexual photos are shared without permission, and the context of how photos are shared (e.g., whether they are shared more privately with a friend or publicly over social media). One scenario reported by a participant in our study indicated that CSH (in this case, threats of sharing sexual photos) may be perpetrated by male partners as a means of gaining control in the relationship. Thus, greater consideration of CSH may be needed within the field of dating violence as well.
Prior work among adolescent girls that has documented online sexual solicitation has commonly focused on perpetration by adult males [12,15,20,21]. Findings from the current study revealed participants reported experiencing sexual solicitation from adolescent males that girls knew or met online, particularly on dating websites. Scenarios most reported by girls in our study involved girls being pressured to meet in person and, subsequently, being sexually harassed or assaulted in person from the males met online. More research is needed to better understand how often online solicitation leads to unwanted experiences of in-person sexual harassment and assault. Findings suggest that future research should consider how online and in-person experiences may intersect when examining incidents of sexual harassment.
Participants reported other negative outcomes of CSH, including social isolation, shame, and interference with girls' education. These findings are aligned with the few existing studies that have found CSH to be associated with negative health outcomes, such as substance use and poor mental health [15,17]. Our study findings indicate that more work is needed to evaluate the impact of various forms of CSH on health consequences, but also on the social consequences of CSH, including having to leave school or becoming socially isolated. Our study also builds on previous work by describing the perpetrators of CSH, indicating that girls report experiencing CSH by a range of different perpetrators, including males met online, relationship partners, as well as casual partners and acquaintances. Only a small number of studies have begun to identify perpetrators of CSH [12,15,21,23]. Our findings suggest that future studies are needed to better understand the types of perpetrators that may be most common across the various forms of CSH. Understanding the perpetrators of CSH will be critical to intervention and prevention efforts.
Our study has several limitations. Although we made every effort to build rapport and ensure participants that their responses were confidential, many study participants did not report experiencing CSH themselves and instead reported the experiences of their friends. This is consistent with prior qualitative work examining sexting among adolescents [6][7][8][9][10], in that participants often report scenarios that occur among their peers as opposed to providing firsthand accounts. The stigmatized nature of both sexting and experiencing CSH among adolescents likely underlies this pattern of second-hand reporting, the result of which would be the underreporting of personal experiences. Additionally, we used intensity sampling to recruit "high-risk" participants (e.g., respondents from the quantitative survey who had ever been pregnant, tested positive for an STI, or experienced dating violence) living in an area with high rates of gender-based violence, thus our findings may not be generalizable to broader samples of adolescent girls. The unique nature of our sample, as well as the small sample size, may also impact generalizability. Participants of the larger study on STI risk were sexually active and most participants identified as Hispanic/Latina, therefore affecting the generalizability of findings. Finally, the study was conducted in a low-income area of San Diego County, near the US-Mexico border, in an area with high rates of violence. Therefore, we may have had greater reports of experiences of CSH compared to other settings, affecting the generalizability of our findings.
Despite these limitations, the current study highlighted the unique scenarios and contexts in which CSH occurs among a sample of adolescent girls who were at high risk for experiencing CSH. Of particular concern, some scenarios of CSH included incidents when CSH involved and/or led to severe interference in girls' education, as well as girls experiencing sexual violence in person. Our study findings suggest that CSH measures need to be inclusive of (a) pressure to send sexual messages/photos, (b) being sent unwanted sexual messages/photos, and (c) unwanted photo sharing. Understanding the range of CSH scenarios will be critical for assessing prevalence and consequences in future research, and may aid in the development of prevention programs among adolescents to promote awareness of the specific scenarios of CSH, as well as to guide the prevention of the perpetration of CSH. Findings highlight the need to consider CSH as part of ongoing research and programmatic work related to sexual violence among adolescent and young girls.  Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.

Data Availability Statement:
The data presented in this study are available upon request from the corresponding author. The data are not publicly available due to confidentiality of participant information.

Conflicts of Interest:
The authors declare no conflict of interest.