Purpose Cell phone use has become more widespread over the past decade. Young adults are frequently early adopters of new technologies, including cell phones. Most prior research examining sexting, the act of sending sexually explicit or suggestive images via text message, has focused on the legal or social consequences of this behavior. The current study focused on the public health implications of sexting by examining associations between sexting, substance use, and sexual risk behavior in youth. Methods Young adults (N=763) completed online questionnaires assessing demographics, cell phone use (e.g., texting, sexting), substance use, and sexual risk behaviors. Results Sexting was reported by a substantial minority of participants (44%). Compared to their non-sexting counterparts, participants who engaged in sexting were more likely to report recent substance use and high-risk sexual behaviors, including unprotected sex and sex with multiple partners. Of those who engaged in sexting, a considerable percentage (31.8%) reported having sex with a new partner for the first time after sexting with that person. In multivariate analyses, sexting was associated with high-risk sexual behavior after accounting for demographic factors, total texting behaviors, and substance use. Conclusions Results suggest that sexting is robustly associated with high-risk sexual behavior. Many individuals exchange explicit or provocative photos with long-term sexual partners, but at least some participants in this study were incurring new sexual risks subsequent to sexting. Additional research is needed to understand the contexts in which sexting occurs, motivations for sexting, and relationship of sexting to risk behavior.

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We tested the feasibility and effectiveness of an alcohol counseling intervention delivered via personalized text messages for college students with problem alcohol use. College students aged 18-23 completed online substance use and mental health questionnaires that served as a screening tool for problem alcohol use. We invited students who screened positive to be randomized to intervention (n = 8) or control groups (n = 10) and assessed them at 1 month after they received their last text message. The intervention group received between four and six text messages daily for 4 days that required brief participant responses during the week following the web-based baseline assessment. Participants in the intervention group could also request booster texts for additional support. We personalized all texts, using data collected at baseline. Using a repeated measures ANOVA, we found that compared to the control group, the intervention group increased in readiness to change from baseline to follow-up (p < .01). Other promising trends were an increase in the intervention relative to the control group's confidence in their ability to change drinking behavior, and an increase in intentions to reduce alcohol use. These exploratory results indicate that the automated texting program we developed works well with college students and that text messaging as a means to deliver preventive interventions is a promising delivery platform.

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