In 2016, Utah Governor Gary R. Herbert signed a resolution declaring pornography a public health crisis.

The resolution sparked debate at the time, but for most public health experts, the idea that pornography has some relevance to our health as a society isn’t too controversial.

This topic is in my wheelhouse. I am a public health researcher and teacher, and have conducted several studies on adolescent pornography use. Personally, I do think pornography is a public health issue; it has implications for sexual and reproductive health promotion, and violence prevention.

In addition to my research on pornography, I instruct a graduate-level course on pornography as a public health issue at the Boston University School of Public Health. My students will be called upon to deliberate about whether and how to protect the public’s health – and what counts as overstepping their bounds.

So I teach them to think critically about the issue, to look past rhetoric, and to become critical consumers of research evidence. I teach them that it’s OK if they find themselves conflicted at times, because determining what’s dangerous or healthful for the public is not always simple.

Why I started researching pornography

My own research on pornography and adolescent health was sparked by an unanticipated finding in a dating violence study. In 2011, I was analyzing data from a sample of more than 300 Boston-area 14-20-year-old girls, nearly half of whom had experienced physical or sexual abuse by a dating partner. Although the study wasn’t about pornography, 34 percent of the young people surveyed had seen pornography in the past month, and almost 11 percent reported having been forced or coerced to participate in a sexual behavior that the perpetrator saw in pornography. It seemed possible that pornography was a contributing factor to adolescent dating and sexual violence.

From there I undertook a qualitative research study. I interviewed 23 teenagers (16-18 years old) who had all seen pornography at least once in the past year. They told my research team what they watched, with whom, why, when, for what reasons and how they felt about it. A few themes emerged, and these underscored why pornography could be viewed as a public health issue.

First, they had seen a wide variety of pornography: for example, straight porn, three-ways, bondage, racially specific porn, humiliation porn, incest porn and what they called “rape porn.”

Second, most watched it because they were curious. They wanted to know how sex worked – what to do. More than one reported wanting to know what sounds to make with her boyfriend. One boy wanted to know how to please his girlfriend, and one came away with the understanding that lots of women have orgasms from anal sex.

Third, there were several who had experienced some painful and uncomfortable sex because their partners wanted to imitate pornography.

And finally, their parents didn’t know how to talk to them about pornography.

Interviewing this small group of teenagers was only a starting point. I next undertook a quantitative study. A sample of 72 male and female teenagers, 15-17 years old, completed a survey about their pornography viewing.

Pornography was the number one source of information about sex for the teens in this sample. Moreover, more than half (51 percent) had been asked to watch pornography together by a dating or sexual partner, and 44 percent had been asked to do something sexual that a partner saw in pornography.

We also found that adolescent dating abuse victimization was associated with more frequent pornography use, viewing pornography in the company of others and being asked to perform a sexual act that a partner saw in pornography. Approximately 50 percent of dating abuse victims and 32 percent of nonvictims reported that they had been asked to engage in a sexual act that their partner saw in pornography, and 58 percent of all youth who were asked did not feel happy to have been asked.

The results of the study are not generalizeable, and we can’t make causal inferences. Nevertheless, the findings help shape future research questions about the possible connection between adolescent pornography use and experiences of abuse. The research convinced me that it is worthwhile for public health practitioners and scholars to continue to ask how pornography may be related to adolescent health.

What I teach my students about pornography

A few students heard about my research and volunteered to assist me with it. They were interested in more formal training on how to think about pornography using their public health perspective, so I developed a class. To my knowledge, it was the first course on pornography at a school of public health.

My course on pornography and public health covers a wide variety of topics. We study sexually explicit material and obscenity throughout history, such as the “porn wars” of the 1980s, or how, historically, anti-porn efforts have been used to persecute gay and lesbian people. We also examine legislation designed to limit children’s access to Internet pornography, the evidence base on pornography and violent aggression, the link between sex trafficking and pornography and the occupational health and labor conditions of paid pornography performers.

Throughout the course, I encourage students to analyze the rigor of pornography research, to identify gaps in the knowledge base and to propose innovative policy and programmatic solutions that might mitigate some of the harms we suspect are affecting the public. For example, a few students pointed out there is insufficient evidence to conclude that pornography is “biologically addictive” (though the Utah resolution references this possibility). And some students began developing a “pornography literacy curriculum” for teenagers with me that will be pilot tested this summer.

Interestingly, the Utah resolution suggests that the citizenry needs education about pornography, but the state forbids public schools to educate youth about the intricacies of sex, or advocate contraception, homosexuality or sex outside of marriage. Instead, Utah uses what is called “abstinence only” sex education, which isn’t the kind promoted by public health experts.

While there is a lot of debate about pornography and its potential impact on youth and adults, even people on opposite sides of the issue seem to agree that adolescents deserve education about sex – and that pornography isn’t the right way for them to learn. This is one of the reasons it makes sense to think about the public health implications of pornography.

We need to keep studying pornography and public health

Questions also remain about how adults are affected by sexually explicit media. Some research suggests it may cause both men and women to become dissatisfied with their own bodies and with their sexual relationships. The ideas that the availability of Internet pornography is having a significant impact on individuals’ interest in having sex in person, or that most people who watch pornography will inevitably seek out more and more shocking material, remain questions, though.

Engaging researchers trained in psychology, sociology, sexology, medicine, neuroscience, economics and public health in rigorous pornography scholarship will help generate evidence to guide future public policy decisions.