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Health education's role in framing pornography as a public health issue: Local

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 Promotion & Education
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Health education's role in framing ography as a public health issue: local and national
strategies with international implications
Paul C. Perrin, Hala N. Madanat, Michael D. Barnes, Athena Carolan, Robert B. Clark, Natasha Ivins, Steven R.
Tuttle, Heidi A. Vogeler and Patrick N. Williams
Promot Educ 2008; 15; 11
DOI: 10.1177/1025382307088093

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Vol 15(1), pp. 11-18
DOI: 10.1177/1025382307088093

Original article

Health education’s role in framing pornography as a public health

issue: local and national strategies with international implications
Paul C. Perrin1, Hala N. Madanat2, Michael D. Barnes3, Athena Carolan4*, Robert B. Clark2*, Natasha Ivins5*, Steven R. Tuttle4*,
Heidi A. Vogeler2* and Patrick N. Williams6*

Abstract: Pornography is a public health issue. However, since the US Surgeon General’s workshop on pornography and
public health reached a consensus statement about the impacts of pornography in 1986, few policy actions have been taken
to deal with this public health problem, and intense discussion surrounding the regulation of pornography has continued. This
debate spans a continuum between individual rights on one extreme and complete restriction of such material for society’s
good on the other extreme. However, during this same period much research has been done on the impacts of pornography
on children and adults. This paper focuses on reviewing the effects of pornography on society including women, children, and
consumers, and includes discussion on the current and failed policies aimed at regulating pornography. The growing phe-
nomenon of Internet pornography use is discussed in depth, and specific policy ideas pertaining to Internet pornography are
presented from a public health perspective. (Promot Educ, 2008; 15 (1): pp. 11-18)
Key words: adult material, health education, pornography, Internet, regulation

Introduction use, largely due to limitations imposed by

KEY POINTS
• The effects of pornography on society,
especially on women and children,
have prompted the need for it to be
recognized as a global public health
issue. This designation encourages
policy actions that primarily view
pornography according to the good of
society and less from an individual
rights perspective.
• While the impact and reach of porno-
graphy affects populations around the
world, primarily through the Internet,
the most significant corrective policy
actions occur best at local and national
levels.
• Current, failed and proposed
regulations are discussed to help
health promotion practitioners be
able to sort through ideal and real
mobilization and policy solutions.
Pornography has been defined as a
public health issue over the span of
20 years (1–3). However, perhaps due to
challenges inherently related to the nature
of pornography, the health promotion
response has been limited. Cooper et al.
(4) cite several reasons why this ‘hidden
public health hazard’ (p. 5) remains
inadequately addressed. First, the effects
of pornography are difficult to study,
because assessing the effects of pornogra-
phy on behavior in controlled experi-
ments ignores the element of choice in the
real-life pornographic situation; study par-
ticipants are presented with pornography,
whereas in real life it must be actively
sought out (5). Second, defining pornogra-
phy may depend on an individual’s per-
sonal experience (5). Third, questions
raised by the pornography industry about
free speech continue to surface despite
the general consensus that pornography
endangers the well-being of others and
that free speech issues could be worked
out. Finally, it is difficult to prove causality
between pornography use and certain
behaviors, such as whether porno-
graphy leads to sexual deviance, or innate
sexual deviance leads to pornography
methodology, ethics, and sample bias (6, 7).
Perhaps as a direct result of these chal-
lenges, the only absolute in responding to
pornography as a public health issue is
that it is a highly polarized and often polit-
ically charged issue. However, because
pornography has been defined as a social
issue (3), the health promotion response
should no longer be postponed. Therefore,
the purpose of this paper is to provide
health educators with some proposed
policies and present implications for fram-
ing pornography as a public health issue.
As we present the issue of pornography,
we focus our information on data and poli-
cies from the United States since it has
been regarded as the largest market for
pornography production, distribution and
consumption especially in regards to child
pornography, although international
implications are notable. The size of the
global pornography industry is 97.1 billion
dollars, with 13.3 billion in the United
States alone. This amount in the United
States is larger than the combined rev-
enues of professional football, basketball,
and baseball franchises, and exceeds the
revenues of the three largest broadcast
networks (Top Ten Reviews, no date).

1. Johns Hopkins Bloomberg School of Public Health, Doctoral Candidate, Baltimore, MD, USA.
2. Department of Health, Utah Valley University, Orem, Utah, USA.
3. Department of Health Science, Brigham Young University, Provo, Utah, USA. Correspondence to: Michael D. Barnes, Department of Health Science, 213 Richards
Building, Brigham Young University, Provo, Utah, 84602, USA. (michael_barnes@byu.edu)
4. Utah Department of Public Health, Salt Lake City, Utah, USA.
5. Columbia University, Mailman School of Public Health, New York, USA.
6. Sanofi-Aventis Pharmaceuticals, Paris, France; Bridgewater, New Jersey, USA.
*These authors have contributed equally to this paper.
(This manuscript was submitted on May 5, 2005. Following blind peer review, it was accepted for publication on September 28, 2007.)
Copyright © 2008 IUHPE

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© 2008 International Union for Health Promotion and Education. All rights reserved. Not for commercial use or unauthorized distribution.
Original article
Pornography as
Individual Right
• Free speech is exercised
• Responsibility held by person
• Expression controlled by consumer
• Pornography is recreational, innocent
Figure 1. Determining responsibility for pornography in society: accountability
continuum
Background
One study recently identified two
social benefits for coupling technology
and sexuality – providing greater access
to information regarding sexuality educa-
tion and sexual health, and opening new
options for connecting with romantic
partners (9). However, much of the sexual
portrayal through the Internet and other
media is oriented to providing sexual fan-
tasies or enhancing sexual pleasure, with
most of that material being classified as
pornographic (10). To some, pornography
is harmless, nothing more than a few pic-
tures of scantily clad women in seductive
poses. To others, pornography comprises
only objectifying derogatory sexual acts
(11). The moderate, oft-cited 1986
Attorney General Commission on Porno-
graphy defined pornography as any
material that ‘is predominantly sexually
explicit and intended primarily for the
purpose of sexual arousal’ (2, p. 8). For
this paper, we will use the definition from
the Attorney General Commission. This
definition has the strongest ties to public
health due to pornography’s adverse
effects as they will be presented below.
Wherever deep philosophical differ-
ences exist, it is important to be realistic
and examine both sides of the issue. The
pornography issue spans the continuum
between individuals’ rights on one
extreme and complete restriction of such
material for society’s good on the other
extreme (see Figure 1). Whereas the larger
majority sees pornography as a threat to
community standards and moral norms
(12), some defend pornography based on
the arguments that ‘pornography is free
speech and should not be regulated’ (13,
p. 661), that pornography is relatively
harmless, and that laws regulating porno-
graphy involve the imposition of the
moral norms of one group on the rest of
society. It is correct that under the First
Amendment, the Government cannot con-
stitutionally restrict a form of expression
simply because it promotes ideas or val-
ues that the Government or the majority
12
© 2008 International Union for Health Promotion and Education. All rights reserved. Not for commercial use or unauthorized distribution.
toward holding external social causes or
Pornography as influences accountable. It is clear that
Social Issue many aspects of pornography meet this
definition of social issue, and warrant
public health advocacy efforts.
• Social harm is done Adverse effects of pornography
• Leaders responsible to protect society Pornography can currently be found in
• Expression affects innocent all types of media. Several studies con-
• Pornography is addictive, manipulative clude that pornography has the capacity
and harmful to users and non-users to alter the user’s mental, emotional, and
social attributes (10). A rigorous and
relatively recent meta-analysis verifies
these and other adverse effects. The
researchers found that exposure to
of the citizens believe to be ‘wrong’ or pornography puts consumers at risk for:
‘improper’. Nevertheless, material that is (1) developing sexually deviant tenden-
ruled obscene in accordance with the cies; (2) committing sexual offenses; (3)
three tests as set forth in the 1973 experiencing difficulties in one’s intimate
Supreme Court case of Miller v. California relationships; and (4) accepting rape
is not constitutionally protected under myths (e.g. ‘she deserves it because of
the First Amendment (14). On the other how she dances or is dressed’) (16).
side of the continuum are those who want These recent findings corroborate similar
to completely restrict pornography for findings from 20 years ago in the final
the professed good of society. They point report of the Surgeon General’s workshop
to studies that document the social harm on pornography and public health.
associated with pornography use. In Several consensus statements about the
order to define pornography as a public effects of pornography on public health
health issue and create helpful public pol- were produced and include the following:
icy, professionals, including health educa- 1. children and adolescents who partici-
tors, must use perspectives that are pate in the production of pornography
oriented toward pornography being a experience adverse, enduring effects; 2.
social issue. prolonged use of pornography increases
Social issues from the public health beliefs that less common sexual practices
perspective involve problems that affect are more common; 3. pornography that
individuals or groups beyond their portrays aggression as pleasurable for the
capacity to correct (15). Social issues victim increases the acceptance of the use
are detectable when responsibility is of coercion in sexual relations; 4. accept-
shifted from individuals being able to ance of coercive sexuality is related to
adequately make changes themselves, sexual aggression; and 5. in laboratory
Pornography has potential adverse effects on more than just the user. Examples of
potential adverse effects of pornography use on the user and others include the
following:
User
• Sexual addiction
• Sexually acting out
• Deviant sexual behavior
• Predisposes or intensifies the predisposition to rape women
Women
• Higher likelihood to be described in sexualized terms
• Forced to participate in violent sexual acts such as rape
• More likely to be categorized in traditional gender roles
• More likely to experience sex without emotional involvement
• Broken marriages
Children
• Become objects of sexual interest
• Victims of sexual maltreatment and fantasies
• Accessibility increases use of pornography as source of sex education, which
creates future unrealistic and harmful attitudes toward sex and relationships
Figure 2. Potential adverse effects of pornography
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studies measuring short-term effects,
exposure to violent pornography increases
punitive behavior toward women (2).
Figure 2 summarizes the potential adverse
effects of pornography as described
below.
Pornography poses specific risks for
users
Studies conducted since the 1986
report of the Surgeon General have shown
that consistent exposure to pornography
can lead to addiction (2, 14). Pornography
treatment specialists have identified four
stages in the development of porno-
graphic addiction (14). In the first stage,
addiction, the consumer is hooked on
pornographic materials and keeps coming
back for more. It becomes a sexual stimu-
lant recalled during masturbation and sex-
ual intercourse. In the second stage,
escalation, the materials needed to
achieve similar levels of stimulation often
portray aggressive or more violent behav-
iors: ‘It is reminiscent of individuals
afflicted with dependence and drug addic-
tions. Over time there is nearly always an
increasing need for more of the stimulant
to get the same initial effect’ (14). In the
third stage, desensitization, materials that
were once viewed as shocking become
more acceptable and perceived as com-
mon practice. In the last stage, acting
out sexually, the consumer engages in sex-
ual behaviors similar to those viewed
in the pornographic materials, which
may include ‘promiscuity, exhibitionism,
group sex, voyeurism, … having sex with
minor children, rape, and inflicting pain
on themselves or a partner during sex’
(14). Though clinical research aimed at
identifying the effects of pornography on
the brain is not currently available, a clin-
ical research study is underway using
brain mapping to determine if a causal
relationship between the viewing of
pornography and eventual anti-social
behavior exists (17). Jeffrey Satinover (18)
wrote the following as part of his testi-
mony before the Senate Subcommittee on
Science, Technology, and Space during a
hearing on pornography addiction:
Like cigarettes, that particular form of
expression we call pornography,
unlike all other forms of expression, is
a delivery system that has a distinct
and powerful effect upon the human
brain and nervous system. Exactly
like cigarettes, and unlike any other
form of expression, this effect is to
cause a powerful addiction (p. 6).
Establishing that pornography is
addictive provides great support for
anti-pornography advocates, similar to
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© 2008 International Union for Health Promotion and Education. All rights reserved. Not for commercial use or unauthorized distribution.
the power that anti-tobacco advocates
gained after it was proven that ciga-
rettes are addictive.
Although the characteristics of
pornography users are highly varied,
consumers are still most likely to be
males, both young and old. Approxi-
mately 67% of self-reported visitors to
pornographic sites are males. However,
women are more likely to act out the
behaviors they see, such as having multi-
ple partners, casual sex, or affairs (8).
Among male users, pornography has seri-
ous adverse effects on beliefs about sexu-
ality in general and on attitudes toward
women in particular (19-22). Pornography
can lead to a heightened consciousness
of a woman’s physical features (23), and
may stimulate the development of unreal-
istic and harmful attitudes toward sex
and relationships among children who
view pornography on television (24). One
study found that over half of pornogra-
phy users felt that pornography had
impacted their sexual behavior and 10%
admitted being addicted to Internet
pornography (8, 25). Frequent pornogra-
phy use has also been associated with
sexually aggressive behaviors (25–29)
and an unrealistic view of sexuality –
viewers of pornography give far higher
estimates of the incidence of oral sex, and
anal sex (30). And, viewers have
increased tendencies toward group sex,
sadomasochism, and bestiality than non-
viewers (30).
Pornography may intensify a pre-
disposition to rape women, and under-
mine some men’s internal and social inhi-
bitions against acting out their rape
desires (20, 31). The Federal Bureau of
Investigation states that it has found
pornography at 80% of the scenes of vio-
lent sex crimes, or in the homes of the per-
petrators (7). There are many other
studies that link pornography to rape or
sexual force (32–36), as well as battery
(37), especially in combination with alco-
hol (38). It can even be linked to “rape fan-
tasies” among women, and attitudes
supportive of sexual violence against
women (39). Although findings of some
studies have linked pornography with
rape and other violent crimes, the strength
of that link is still uncertain. Other studies
downplay the role of pornography in sex
crimes (40). Therefore, more research is
warranted to better understand if a causal-
effect relationship exists for this issue.
Pornography poses specific risks for
a user’s partner
Pornography use may also affect the
user’s partner. Studies have demon-
strated that pornography can diminish
Original article
a person’s sexual happiness and satis-
faction with a partner (22, 34), and can
lead users to put more importance on
sex without emotional involvement (41).
Partners of men involved in pornogra-
phy may experience adverse emotional
affects, such as a lowered self-esteem
(22, 42). The National Council on Sexual
Addiction and Compulsivity (NCSAC)
states that, though the Internet does not
cause sexual addiction, it does provide
a method of sexual ‘acting out’ that may
progress to addictive behavior (43). The
NCSAC also reports that 70–75% of sex
addicts have considered suicide, 40%
suffer serious relationship/marital prob-
lems, 60% have financial problems, 58%
have taken part in illegal activities, and
83% also struggle with alcoholism,
drugs, compulsive gambling, or eating
disorders. Partners and children of sex
addicts may then be at risk of develop-
ing similar behaviours (43). The above
behaviors may be a significant contri-
bution to the findings from the 2003
meeting of the American Academy of
Matrimonial Lawyers, where two-thirds
of the 350 divorce lawyers in atten-
dance said the Internet played a signif-
icant role in divorces in the past year,
with excessive interest in online porn
contributing to more than half of such
cases (11).
Pornography poses specific risks for
children
Pornography may also have an influ-
ence on child sexual maltreatment (45, 44).
Child molesters indicated significantly
more exposure to pornography than
rapists in adulthood and were significantly
more likely both to use such materials
prior to and during the offenses (46).
Extensive interviews with sex offenders
(rapists, incest offenders, and child moles-
ters) have uncovered a sizable percentage
of offenders who use pornography to
arouse themselves prior to and during
their assaults (41, 47, 48). Finally, not all
children and adolescents escape unin-
jured from viewing pornography; many are
either traumatized or precipitated into a
strict perversion (49). The average age of
first Internet exposure to pornography is
11, and the largest consumer group of
Internet pornography is 12- to 17-year-
olds. Ninety percent of children between
the ages of 8 and 16 who reported viewing
porn online did so while doing their home-
work. Approximately 90% of sexual solici-
tations to youth occurred in chat rooms
(8). In addition, 4% of Internet-using youth
reported having been solicited to send a
sexual picture of themselves during the
previous year (50).
13
Original article
Pornography and the Internet
The Internet has added a new dimen-
sion to the social debate on pornogra-
phy (51). As of June 30, 2007 an
estimated 1.17 billion across the world
have access to the Internet (52). Only
232.7 million of those total users are
from the USA and Canada. In fact, Asia
(436.8 million) and Europe (321.8 mil-
lion) have the most Internet users
around the world (52). Individuals who
would never have considered entering
an adult store or renting explicit videos
are now able to download pornography
with the click of a button. Easy access,
perceived anonymity, and affordability
have contributed to an increase in the
estimated number of pornographic web-
sites from 28,000 to 4.2 million between
1998 and 2007, which represents 12% of
total websites (8, 53).
According to figures from Top Ten
Reviews, 40 million US adults regularly
visit Internet pornography websites; 72%
of visitors to pornography sites are male
and 28% are female. Furthermore, there
are 4.2 million pornographic websites
(12% of total websites). Ninety percent of
8- to 16-year-olds have viewed pornogra-
phy online (8).
Internet pornography is a lucrative
business: estimates indicate that world-
wide there are 72 million visitors to
pornographic websites each month. It is
also estimated that 25% of total search
engine requests every day are for porno-
graphic material (8). In fact, some sites
have received up to 2.8 million hits per
day (54). Industry followers projected
that this ‘e-porn’ accounts for 10% of all
e-commerce (54). In the USA, the num-
ber of individual visitors to Internet porn
sites jumped from 22 million to 28 mil-
lion (30%) from December 1999 to
February 2001 (55).
Children: a vulnerable group
As a result of the demographics of
Internet users, there is concern over
the easy accessibility to and the sheer
volume of sexually explicit material,
especially for children. A high propor-
tion of youth are being thrust into an
increasingly sexualized cyberspace (an
estimated 77 million under the age of 16
will be on the Internet by 2005) (55).
Many pornographic websites are set up
free of charge and serve as ‘bait’ or
‘teasers’ meant to lure people into com-
mercial websites (55). Although more
children and adolescents use comput-
ers at school (81%) than at home (65%),
home is the most common location for
Internet access, followed by school
(56). The predominant uses of home
14
© 2008 International Union for Health Promotion and Education. All rights reserved. Not for commercial use or unauthorized distribution.
computers among 5- through 17-year-
olds are to play games (59%), to con-
nect to the Internet (46%), and to
complete school assignments (44%)
(56). With respect to gender, overall
computer and Internet use rates for
boys and girls are now about the same,
in contrast to the 1990s when boys used
the Internet more than girls.
In a 2001 poll by the Kaiser Family
Foundation, 70% of 15- to 17-year-olds
said they had accidentally come across
pornography online (11). The use of fil-
tering and blocking software was associ-
ated with only a modest reduction in
unwanted exposure, suggesting that
such software may help but is far from
foolproof (57). Thus, although home set-
tings are the ideal place for children and
teen access to pornography, home and
worksite settings are the prime access
points for adults.
Workplace setting
The Internet is becoming a much
greater entertainment and personal tool
for employees at the workplace than ever
before. Yet the prevalence of e-porn in the
workplace is among the most serious and
costly concern for business administra-
tors (54). Approximately 70% of all Internet
porn traffic occurs during the 9-to-5 work-
day, with high-earning employees most
likely to access. More men than women
exclusively use work computers to access
pornography (58). A study among Fortune
500 companies showed that more than
60% of the respondents had disciplined or
fired employees based on an Internet
access issue, whereas another survey by
PC World found that one in five companies
had disciplined employees for improper
Net activities (8).
According to business administrators
and human resource departments, the
Internet is distracting employee atten-
tion from work-related activities and, in
some cases, is also creating a potentially
more serious corporate problem – a hos-
tile work environment (58, 59, 60).
Employers are especially concerned
with productivity, addiction, and legal
issues arising from employees accessing
web sites that promote pornography
(59, 60). Furthermore, when these sites
are unwittingly viewed by a co-worker,
an increasing number of lawsuits are
brought upon companies of all sizes by
employees affected by pornography at
the workplace. As a result, companies
are learning their legal rights to know
how the Internet is used by their
employees during work time (61). To
protect themselves and their employees,
‘companies must perform due diligence
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to avoid lawsuits resulting from the inap-
propriate use of the Internet by their
workers’ (59, p. 55).
Non-work Internet activity on-the-job is
usually high all day in the US workplace.
According to Nielsen-Net Ratings, work-
place Internet activity for non-work pur-
poses is largely due to: (a) easy access to
fast broadband Internet connections; and
(b) the relative privacy available to
employees during their workday. As a
result, Internet users can browse more
pages more privately when they are at
work compared to home usage. Many
companies are taking pornography seri-
ously by imposing stiff penalties for work-
time violations and installing software
tracking services that alert administrators
to persons in violation of problems. And,
among employed health promotion spe-
cialists at worksites, in conjunction with
human resource departments, many com-
panies are proactively protecting their
work environment and seeking to promote
productivity (59).
Policy solutions: a public health
response to pornography
When a public health problem is a
social issue, it becomes imperative that
social leaders and public health advo-
cates become involved to help create a
protective environment. In such cases,
decision-makers, administrators, and
public health professionals seek to
establish policies, rules or regulations
that will provide important protective
and preventive solutions to a problem
that is beyond the capacity of certain
individuals to change for themselves.
Pornography is a social issue and
requires concerted health education
attention because: (a) society gains more
benefits by collective rules/policies than
by relying on individual choice or indus-
try self-regulation; (b) there is usually
limited control and responsibility among
persons closely associated with users;
(c) persons’ abilities to avoid the conse-
quences of pornography are not enough
to change the problem or sustain change
over time; (d) the pornography industry
has little or no accountability for the
social ills its products exert on both
users and non-users; and finally, (e) the
addictive and seductive nature of
pornography makes breaking the habit
very difficult and often prompts a cycle
of needing an increasingly intense dose
to produce an intended affect among its
users. Thus, pornography is an impor-
tant public health issue, and due to its
effects on society, it is a social issue that
requires the consideration of rules, regu-
lations, or policies to protect society and
VOL. XV, NO. 1 2008

promote public health. Fortunately, there
is much that health educators can do. We
will turn attention to a brief history of
pornography legislation.
History of legislation regarding
pornography
The first important Supreme Court
decision applying to pornography was
Roth v. United States (1957), stating that
obscenity was not protected by the First
Amendment. Later, Miller v. California
(1973) attempted to clarify the previous
law by discarding the national standard in
favor of a local community standard. This
was in response to the concern that defen-
dants might be judged by the standards of
the least tolerant of the nation’s commu-
nities. As the various federal courts have
explored the pornography issue, one defin-
ing question has been who determines
whether a given material is obscene and
therefore will not have First Amendment
protection.
In recent years, Congress has
attempted to be more aggressive in its
measures, with many legislators pro-
claiming pornography as a public health
issue. The Communications Decency Act
(CDA) and the Child Online Protection
Act (COPA) attempted to criminalize the
transmission of pornography to minors
(55). The CDA was passed, but was ulti-
mately struck down by the Supreme
Court because it was deemed too broad
because it was feared that it would create
an unacceptable effect upon the speech
of adults using the Internet (who would
not know what speech would be immune
to prosecution and when), thus constitut-
ing a breach of freedom of speech. The
Court also stated that any attempts to
verify a completely adult audience on the
Internet would not be feasible, and that
the institution of either an adult-verifica-
tion-number system or a credit-card-veri-
fication system would harm many of the
noncommercial publishers of informa-
tion. COPA was an attempt to address the
weaknesses of the CDA but it too failed
because of similar concerns (55).
Health educators and policies
pertaining to pornography
For the above reasons, an outright
ban on pornography seems an unrealis-
tic goal. However, that does not mean
that pornographers should be allowed
free reign as they have been thus far. An
article discussing the debate around
COPA stated, ‘online sex advice colum-
nists and adult Web site operators, argue
that they should not be required to
install expensive and sometime unreli-
able software needed to block children’s
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© 2008 International Union for Health Promotion and Education. All rights reserved. Not for commercial use or unauthorized distribution.
access’ (62, p. A:3). Yet, this is exactly
what is being required of individuals
who want to protect their homes,
schools, and public libraries from
pornography: they are required to buy
filters that are often expensive, and
sometimes unreliable or inefficiently
managed.
A more appropriate approach is to
expect the pornography industry to face
regulation or tax liabilities by policies
being implemented through government
and community leaders’ response to this
social issue. Regulation of some sort is
inevitable, yet given this public health
issue, it must be an effective type of reg-
ulatory supervision. It is clear that self-
regulation is far from a realistic solution.
Considering the pornography industry’s
practices, that would be as wise as hav-
ing a fox guarding the hen house. Aside
from the benefits of regulation and taxa-
tion, other policy-based approaches –
especially local considerations – must
also be considered in order to have a
comprehensive approach for addressing
pornography.
Activism at the local level
A think-globally and act-locally
approach is appropriate for pornography.
Actions that address the pornography
issue at a local level are necessary to
counter the widely held belief that com-
munity inaction indicates community
approval of pornography. Many people
assume pornography is legal when it is
available in a community (63). Local gov-
ernment and organizational leaders also
have limited resources to dedicate to this
social issue. Therefore, citizens within
communities have an important role to
take the initiative to mobilize grassroots
efforts that can improve and preserve the
quality and character of their communi-
ties. Local citizens may not be able to
change the world, but they can make an
impact where they live. This is especially
true when public health professionals,
especially health educators, invite exist-
ing or new community groups they work
with to become active in affecting local
change. Although many professionals
share responsibility and unique skills for
dealing with pornography as a public
health issue, health educators should
take the lead in such grassroots efforts.
Together, community members and
health educators can influence local poli-
cies involving Internet pornography by: 1.
encouraging public places, where the
Internet is available, to adopt acceptable
use policies; 2. encouraging adult supervi-
sion and involvement in youth Internet
usage; and 3. coordinating Internet safety
Original article
education campaigns, including informa-
tion and media literacy (3).
Examples of local advocacy
Recently in Lincoln, Nebraska, a
group called Concerned Citizens Against
Pornography (CCAP) has been success-
ful in removing pornographic magazines
from the shelves of gas stations. They
accomplished this by simply producing
a one-page flier that listed all the gas sta-
tions in Lincoln, and whether or not they
featured pornographic magazines. CCAP
then distributed the information they
compiled. This led to a community-led
boycott of gas stations that distributed
these magazines. As a result many gas
stations changed their policy concern-
ing pornographic magazines, because of
the pressure to self-regulate and change
their policies in pornographic magazine
distribution, in order to stay in business
(64).
A citizens’ group in Bountiful, Utah,
received national attention by asking city
officials to pass a resolution encouraging
business owners to voluntarily cover or
remove certain offensive magazines from
the sight of children. The resolution was
non-binding, but expressed the feeling of
the community that such materials were
not appropriate (65).
Lastly, in Towson, Maryland, students
from a local preparatory school protested
at a Royal Farms store that openly
displayed hardcore pornographic maga-
zines. The students decided to stand out-
side the store and protest after learning
about the materials in one of their classes.
They protested for two weeks until the
store’s manage-ment responded to their
concerns (66).
In these cases, health educators and
other community advocates are ideally
qualified to implement and/or support
the local legislative process. As commu-
nity cosponsors of legislation they can
play a critical role through their support
of the ordinances at hearings and meet-
ings. When a local government unit fails
to respond favorably to revised licensing
initiatives, several options are available.
First, successful licenses implemented in
surrounding government units, such as
the county or neighboring cities, may be
used to influence communities that are
slow to act. Second, in a growing number
of states and local jurisdictions, the initia-
tive process allows citizens to place pro-
posed licensure ordinances on the ballot
through signature-gathering activities.
The initiative approach is often used to
bypass the usual municipal/county ordi-
nance adoption process. Third, advocacy
methods may be used to generate a com-
15
Original article
munity outcry in favor of licensing ordi-
nances. The cosponsors and their repre-
sentative organizations can become
partners in an alliance focused on creat-
ing city-level or county-level support.
Advocacy tools such as contact with offi-
cials (calls, emails, visits), publicity
(press conferences, meetings), and media
information (opinion editorials, media
advocacy, press releases, articles, letters)
may all be utilized to focus attention on
the need to change. Fourth, advocacy
methods may be used to create economic
pressure against offending businesses.
The following section will focus on
describing examples of public health pol-
icy positions to regulate pornography
that health educators may take.
Undesirable access to Internet
pornography
The Internet is presently unregulated
since it is not technically ‘broadcasting’ as
defined in the Federal Communications
Act. Thus, the Internet is able to show
pornographic images and movies with vir-
tual freedom. Although pornographers
should be responsible for making sure
their material does not reach those who
do not want it, they are not financially
motivated to make changes as evidenced
by the profitability and surge in Internet
use and purchasing e-porn. Thornburgh
and Lin (3) suggest a few ways by which
minors can be protected from viewing
Internet pornography; these include: 1.
age verification; 2. labeling material that is
offensive to minors; 3. regulating porno-
graphic or offensive spam, and ‘mouse-
trapping’; and 4. self-regulation. These
strategies may be expanded to protect
adults who do not wish to face accidental
exposure to pornographic material on the
Internet.
Internet: age verification
Age verification would require individu-
als to ensure that they are of a legal age
before pornographic material may be
viewed. This has been proposed in several
past legislative bills, but met with opposi-
tion because it was felt that it imposes bur-
dens on Web administrators and infringes
on the freedoms of adult viewers.
Internet: offensive label warning
Pornographic material would need to
be labeled as such in a machine-readable
format. An R-rated movie is required to
market itself as such. Pornographers
should be under the same restrictions.
Research needs to be undertaken to
ascertain how ratings could be attached
to a website. Once a rating is in place, an
age verification system based on ratings
16
© 2008 International Union for Health Promotion and Education. All rights reserved. Not for commercial use or unauthorized distribution.
could then be built in to the web browser
so that individuals can have control over
what material may be viewed on their
computer.
Internet: regulate ‘spam’ and
‘mousetrapping’
‘Spam’ and ‘mousetrapping’ are two
techniques that pornographers have used
to get people to use – whether willingly or
not – their products. ‘Mousetrapping’ is a
technique that forces a user to remain on
a specific website until the computer is
rebooted. Because there is no consensus
on what constitutes speech protected by
the First Amendment, some have pro-
posed policies that prohibit the sending of
commercial spam that has material that is
offensive to minors without appropriate
labeling (i.e. a warning in the subject mes-
sage), without prior age verification, or
after the recipient has formerly objected
to receiving such material (3). The prac-
tice of mousetrapping, or forcing the
browser to a pornographic page that was
not expressly navigated to, can be made
punishable by law without prior age
verification.
Internet: self-regulation
Self-regulation techniques can be insti-
gated both by the Internet Service
Providers (ISPs), and by the sources of
adult-oriented web sites. A technique
that has been successful in various coun-
tries in Europe involves an ISP hotline
that Internet users can call to report
potential postings of child pornography.
The ISPs can then respond to the tip. ISPs
can be stricter in enforcing terms of serv-
ice (i.e. the posting of inappropriate
material or harassment) to which users
must agree. Commercial sources of adult-
oriented material provide much of the
material that is used by ‘smaller’ affili-
ates. By contractually requiring the affili-
ates to post a label or to ensure the age of
users, larger providers can help regulate
pornography (3).
Internet: workplace solutions
Health educators can also work with
employers to devise workplace solu-
tions to the pornography problem.
Solutions such as creating and enforcing
‘acceptable use’ policies through Web fil-
tering software, and access reporting
software that can identify how much
time is being spent on accessing inap-
propriate web sites are common produc-
tivity and health promoting actions to be
taken (54, p. 6). Companies are begin-
ning to create acceptable use policies for
Internet usage and outline in very clear
terms what kind of Internet usage is
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permitted, what kind is not, and the con-
sequences for violating the rules. These
policies often include (54, pp. 5–6):
• ‘a disclaimer that warns against the
dangers of the Internet and prevent-
ing the company from being liable for
any material viewed or downloaded’;
• ‘a summary of network use limita-
tions’ that outlines inappropriate
uses of the computer network
resources (i.e. downloading porno-
graphic material);
• ‘an agreement not to waste or damage
computer resources’ that includes
avoiding frivolous use, among which
is the downloading of pornography;
• ‘a “no expectation of privacy” state-
ment’ that would allow the company
to monitor and/or log Internet usage,
and permit the company to block
sites with inappropriate content.
Home and school settings for
children
Despite the illegalities, youth have
easy access to pornographic material,
and this can have traumatic, distorting,
abusive, and/or addictive effects.
As identified earlier in the paper, his-
torical efforts to legislate a safer
Internet have been fraught with court
entanglements and violations of free-
dom. However, an increasing amount of
support from legal analysts, and educa-
tion and social strategists are standing
behind a kids.us domain as a way to pro-
mote children’s safe Internet use (3, 67).
The kids.us domain represents a
new way of thinking about Internet
content and online safety for chil-
dren. Instead of reactive responses
to inappropriate content and bad
actors, the kids.us domain is a
proactive model. In essence, it is an
attempt to build an entirely new
webspace – set apart and dedi-
cated solely to content appropriate
for children. (67, p. 226)
Certainly no one solution has full efficacy
for the complex problem of access to
pornography, but the creation of a safe
haven for children on the Internet can be
a crucial first step (3, 67). The authors
conclude that advocacy and legislation
supporting a kids.us domain will ‘roast
the pig without burning down the house’,
as compared to previous legislation that
essentially ‘roasted the pig by burning
down the house’.
Limitations
Discussing the adverse effects to chil-
dren involved in the actual production of
VOL. XV, NO. 1 2008

pornography, and the associated policy
implications is beyond the scope of this
paper; however, we acknowledge these
effects add to the harm of pornography
on children and that child pornography
generates US$3 billion per year (Top Ten
Reviews, no date). Policies regarding
child pornography are discussed else-
where (Subrahmanyam et al., 2000;
Healy, 2004). Further, in an attempt to
present the positive impact of pornogra-
phy, no studies could be found regarding
a strengthening effect for self, relation-
ships with children, adolescents and
adults, or other social benefits. As stated
earlier, however, Barak and Fisher (9)
identified that the amount of sexuality
education material available and the
ease of access for relationship-finding
are enhanced through the use of the
Internet.
Finally, in keeping with the definition
of pornography as a social issue, we have
primarily targeted producers and dis-
seminators of pornography rather than
consumers, and we have focused discus-
sions primarily around local policies and
secondarily on national and international
policies. However, due to the pervasive
and interconnected points of distri-
bution found on the Internet, even local
or national policies have some impact for
international settings. Thus, an action
taken locally is expected to have an
impact on actions taken globally.
Conclusion
Pornography is a public health issue
because social harm is or can be done:
its expression affects the unsuspecting
and non-users, and it is also potentially
addictive to users. Current measures in
place to protect individuals from expo-
sure to pornography are inadequate,
and accidental exposure can easily
occur. For these reasons, regulations are
imperative. When advocating public
policy regarding pornography, it is
important to portray pornography for
what it is: a problem with ramifications
for the public’s health and safety.
Addressing the issue remains a serious
task. Public health in general has a
responsibility to advocate for regulation
because pornography is recognized as a
social issue for which policies and rules
are important solutions to protect the
health and safety of the public. In addi-
tion, the scale of these problems is
increasing due to the explosion of
Internet pornography around the globe,
and, thus, action must be taken immedi-
ately to minimize the long-term negative
social impacts of widespread pornogra-
phy use.
IUHPE – PROMOTION & EDUCATION VOL. XV, NO. 1 2008Downloaded from http://ped.sagepub.com by on May 3, 2008
© 2008 International Union for Health Promotion and Education. All rights reserved. Not for commercial use or unauthorized distribution.
Accessing pornography has become
too easy, and steps must be taken to
reverse the trend. However, an outright
ban on pornography is unrealistic, due to
First Amendment issues and to the bor-
derless nature of the Internet. Therefore,
the Government should act instead to
make producers of pornography more
accountable in allowing individuals to
decide for themselves whether or not to
use their products. Public health profes-
sionals, including health educators, may
play a key role in this process through
the promotion of such policies.
References
1. Koop CE. Report of the Surgeon General’s
workshop on pornography and public health.
Am Psychol. 1987;42:944–5.
2. McManus M. Final report of the Attorney
General’s Commission on Pornography.
Nashville, TN: Rutledge Hill Press; 1986.
3. Thornburgh D, Lin H. Youth, pornography, and
the Internet. Issues Sci Technol.
2004;20(2):43–9.
4. Cooper A, Delmonico DL, Burg R. Cybersex
users, abusers, and compulsives: new findings
and implications. Sexual Addictions &
Compulsivities. 2000;7: 5–29.
5. Tsang AB. Pornography as a cause or
pornographic experience as constituted? Hong
Kong Psychological Society.
1986;16–17:29–32.
6. Nemes I. The relationship between
pornography and sex crimes. J Psychiatry Law.
1992;20:450–81.
7. Baker D. Pornography isn’t free speech. Dallas
Morning News. 1989 17 Mar:Op. Ed.
8. Top Ten Reviews [Internet]. Internet
pornography statistics. [date unknown] [cited
2007 Sep 24]. Available from: http://internet-
filter-review.toptenreviews.com/internet-
pornography-statistics.html#anchor2
9. Barak A, Fisher W. Toward an Internet-driven,
theoretically-based, innovative approach to sex
education. J Sex Res. 2001;38(4):324–32.
10. Cooper A, Griffen-Shelley E, Delmonico DL,
Mathy RM. Online sexual problems:
assessment and predictive variables. Sexual
Addiction & Compulsivities. 2001;8:267–85.
11. Paul P. The porn factor. Time.
2003;163(3):99,101.
12. Smith KB. Clean thoughts and dirty minds: the
politics of porn. Policy Stud J.
1999;27(4):723–34.
13. Meier E. Child pornography, the Internet, and
congressional activity. Pediatr Nurs.
1999;25(6):661.
14. Cline VB. Pornography’s effects on adults and
children [Internet]. 2001 [cited 2007 Sep 24].
Available from:
http://www.obscenitycrimes.org/clineart.cfm
15. Wallack L, Woodruff K, Dorfman L, Diaz I.
News for a change: an advocate’s guide to
working with the media. Los Angeles: SAGE;
1999.
16. Oddone-Paolucci E, Genios M, Violato C. A
meta-analysis of the publisher research on the
effects of pornography. The Changing Family
and Child Development. 2000;Jan:48–59.
17. Jarvik E. Group fighting pornography on a new
front. Deseret Morning News. 2004 May
5:A:11.
18. Hearing on the Brain Science Behind
Pornography Addiction and the Effects of
Original article
Addiction on Families and Communities.
Hearing before the Subcomm. on Science,
Technology, and Space of the Senate Comm.
on Commerce, Science, and Transportation.
2004 Nov 18.
19. Mulac A, Jansma LL, Linz DG. Men’s behavior
toward women after viewing sexually-explicit
films: degradation makes a difference.
Commun Monogr. 2002;69(4):311–28.
20. Cooper A, Galbreath N, Becker MA. Sex on
the Internet: furthering our understanding of
men with online sexual problems. Psychol of
Addict Behav. 2004;18(3):223–30.
21. Jensen R, Dines G. The content of mass-
marketed pornography. In: Dines G, Jensen R,
Russo, A, editors. Pornography: the production
and consumption of inequality. New York:
Routledge; 1998. p. 66–100.
22. Schneider JP. The impact of compulsive
cybersex behaviors on the family. Sexual and
Relationship Therapy. 2003;18(3):329–54.
23. McKenzie-Mohr D, Zanna M. Treating women
as sexual objects: look to the (gender
schematic) male who has viewed pornography.
Pers Soc Psychol Bull. 1990;16(2):296–308.
24. Benedek EP, Brown CF. No excuses: televised
pornography harms children. Harv Rev
Psychiatry. 1999;7(4):236–40.
25. Tyden T, Rogala C. Sexual behaviour among
young men in Sweden and the impact of
pornography. Int J STD AIDS.
2004;15(9):590–3.
26. Carr J, VanDeusen KM. Risk factors for male
sexual aggression on college campuses. J Fam
Violence. 2004;19(5):279–90.
27. Malamuth NM, Addison T, Koss M.
Pornography and sexual aggression: are there
reliable effects and can we understand them?
Annual Review of Sexuality Research.
2000;11:26–94.
28. Davies KA. Voluntary exposure to pornography
and men’s attitudes toward feminism and rape.
J Sex Res. 1997;34(2):131–7.
29. Fisher WA, Grenier G. Violent pornography,
antiwoman thoughts, and antiwoman acts: in search
of reliable effects. J Sex Res. 1994;31:23–8.
30. Zillman D. Effects of prolonged consumption of
pornography. Proceedings of the Surgeon
General’s workshop on pornography and
public health in Joint Select Committee Report;
1986 Jun 22–4; Arlington, VA; 1998. 15 p.
31. Russell DEH. Pornography and rape: a causal
model. Journal of Political Psychology.
1988;9(1):41–73.
32. Malamuth N. Rape fantasies as a function of
repeated exposure to sexual violence. Arch Sex
Behav. 1981;10:33–47.
33. Check J. The effects of violent and nonviolent
pornography. Ottawa, Canada: Department of
Justice; 1984.
34. Zillman D, Bryant J. Pornography, sexual
callousness, and the trivialization of rape. J
Commun. 1982;32:10–21.
35. Demare D, Briere J, Lips H. Violent
pornography and self-reported likelihood of
sexual aggression. J Res Pers.
1988;22:140–53.
36. Demare D, Lips HM, Briere J. Sexually violent
pornography, anti-women attitudes, and
sexual aggression: a structural equation
model. J Res Pers. 1993;27:285–300.
37. Sommers EK, Check JV. An empirical
investigation of the role of pornography in the
verbal and physical abuse of women. Violence
Vict. 1987;2:189–209.
38. Norris J, Kerr KL. Alcohol and violent
pornography: responses to permissive and
nonpermissive cues. J Stud Alcohol.
1993;Suppl 11:118–27.
17
 Original article
39. Corne S, Briere J, Esses L. Women’s attitudes
and fantasies about rape as a function of early
exposure to pornography. J Interpers Violence.
1992;7:454–61.
40. Langevin R, Curnoe S. The use of pornography
during the commission of sexual offenses. Int J
Offender Ther Comp Criminol. 2004;48(3):572–86.
41. Richards V. Pornography – safe or sexual?
[Internet]. 1996 [cited 2007 Sep 24]. Available
from: http://www.csun.edu/~vcpsy00h/
pornog.htm
42. Bridges AJ, Bergner RM, Hesson-McInnis M.
Romantic partners’ use of pornography: its
significance for women. J Sex Marital Ther.
2003;29(1):1–14.
43. National Council on Sexual Addiction and
Compulsivity (NCSAC) [Internet]. 2007
[cited 2007 Sep 24]. Available from:
http://www.ncsac.org/
44. Knudsen DD. Child sexual abuse and
pornography: is there a relationship? J Fam
Violence. 1988;3:253–67.
45. Testimony by John B. Rabun, Deputy Director,
National Center for Missing and Exploited
Children: hearing before the Subcomm. on
Juvenile Justice of the Senate Judiciary Comm.
1984 Sep 12.
46. Carter DL, Prentky RA, Knight RA, Vanderveer
PL, Boucher RJ. Use of pornography in the
criminal and developmental histories of sexual
offenders. J Interpers Violence.
1987;2(2):196–211.
47. Marshall W. Pornography and sex offenders. In:
Zillman D, Bryant J, editors. Pornography:
research advances and policy considerations.
New York: Academic Press; 1989.
48. Dobson J. Interview with Ted Bundy in Starke,
Florida [Internet]. 1989 Jan 23 [cited 2007
Sep 24]. Available from:
http://www.diskbooks.org/tb.html
49. Hayez JY. Confrontation of children and
adolescents with pornography. Arch Pediatr.
2002;9(11):1183–8.
18
© 2008 International Union for Health Promotion and Education. All rights reserved. Not for commercial use or unauthorized distribution.
View publication stats
50. Mitchell KJ, Finkelhor D, Wolak J. Online
requests for sexual pictures from youth: risk
factors and incident characteristics. J Adolesc
Health. 2007;41:196–203.
51. Durkin KF, Bryant CD. Log on to sex: some notes
on the carnal computer & erotic cyberspace as an
emerging research frontier. Deviant Behavior: An
Interdisciplinary Journal. 1995;16:179–200.
52. Internet World Stats [Internet]. World Internet
users and population stats report. 2007 [cited
2007 24 Sep]. Available from:
http://www.internetworldstats.com/
53. Egan T. Technology sent Wall Street into market
for pornography. New York Times. 2000 Oct 23.
54. Websense. Internet usage and the workplace:
it’s now an HR issue. San Diego, CA: White
Paper Series, Websense, Inc; 1999.
55. Alexander M. The first amendment and
problems of political viability: the case of
Internet pornography. Harv J Law Public Policy.
2002;25(3):977–1030.
56. DeBell M, Chapman C. Computer and Internet
use by children and adolescents in 2001.
Report no. NCES 2004–014. Washington,
DC: US Department of Education, National
Center for Education Statistics; 2003.
57. Mitchell KJ, Finkelhor D, Wolak J. The exposure
of youth to unwanted sexual material on the
Internet. Youth Soc. 2003;34(3):330.
58. eMarketer. Online activities of US adult Internet
users, by gender, 2006. 2007. White Paper available
with subscription from: www.emarketer.com
59. Rothke B. The big brother myth. eWeek.
2004;21(25):55.
60. Griffiths M. Excessive Internet use: implications
for sexual behavior. Cyberpsychol Behav.
2000;3(4):537–42.
61. Gorman J, Elm N. Monitoring employee Internet
usage. Business Ethics: A European Review.
1998;7(1):21–5.
62. Willing R. Supreme Court revisits Internet
pornography law, dispute focuses on minors’
access to sites. USA Today. 2004 Mar 3:A:3.
Downloaded from http://ped.sagepub.com by on May 3, 2008IUHPE – PROMOTION & EDUCATION
63. National Coalition for the Protection of
Children & Families. Library protection plan:
a guide to help concerned citizens persuade
public libraries to protect children from
Internet pornography [Internet]. 2004 [cited
2007 Sep 24]. Available from:
www.nationalcoalition.org/pdf/
library_protection.pdf
64. Family First. Independent citizens group unites
to fight pornography in local gas stations –
concerned citizens against pornography to
announce city-wide effort [Internet]. 2004
[cited 2004 May 18]. Available from:
http://www.familyfirst.org/news_releases/0716
02_independentcitizens.shtml
65. Associated Press. Group lobbies city officials
to press grocers into covering magazines
[Internet]. 2003 [cited 2004 May 18].
Available from: http://www.
family.org/cforum/fosi/
66. De Nike L. Students oppose store’s display
of pornography [Internet]. The Jeffersonian.
2003 Dec 11 [cited 2004 May 18].
Available from: http://www.
family.org/cforum/fosi/
67. McAfee AG. Creating kid-friendly webspace:
a playground model for Internet regulation.
Tex Law Rev. 2003;82(1):201–26.
68. Healy MA. Child pornography: an
international perspective. A working
document prepared for the World
Congress against Commercial Sexual
Exploitation of Children [Internet]. 2004
[cited 2007 Sep]. Available from:
http://www.crime-research.org/
articles/536/
69. Subrahmanyam K, Kraut RE, Greenfield
PM, Gross EF. The impact of home
computer use on children’s activities
and development. Children and
Computer Technology. 2000;
10(2):123–44.
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