Dec 04, 2019
By Janet Zacharias , Lynn Scruby

Addressing pornography, Part 2: Implications for nursing practice

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Take away messages:

  • Nurses can play an important role in addressing the issue of pornography from a public health perspective.
  • Nurses need to recognize the importance of spreading awareness about the health and social impact of pornography.
  • Nurses can make a difference by engaging in political action and knowing what steps they can take to advocate for change.

In part 1, we reviewed the harms of pornography on the health and well-being of individuals, families, and society. These findings include ease of access, early exposure to a large variety of pornographic content, its addictive nature, erectile dysfunction, increased high-risk behaviours among adolescents, negative impact on relationships, attitudinal and behavioural changes in adolescents, as well as gender issues such as violence and exploitation of women and the strong link to human trafficking, all of which have been documented in the literature.

The topic of pornography creates moral tension; however, it fits the criteria for a public health issue, making it a health issue first, with secondary moral implications. A gap exists in addressing this issue from a health care perspective. The CNA Code of Ethics for Registered Nurses was built on values such as striving to be informed of social issues that affect health and well-being and advocating for change. Specifically, promoting health and well-being and promoting justice are two of the seven core values of the Canadian Nurses Association (CNA, 2017).

Based on the research we reviewed, we offer four main recommendations for nurses and other health care professionals to address the issue of pornography from a public health perspective.

  1. Create professional awareness
    • Promote, support, and conduct more Canadian research about the health impacts of pornography on individuals, including youth, families, and society.
    • Urge the CNA to develop a position statement on pornography.
    • Develop information sessions and publish articles in health care journals to inform and equip health care professionals with newly emerging health concerns.
    • Integrate the topic of pornography as a public health issue into health care school curricula to equip new health care professionals.

  2. Create public awareness
    • Promote media advocacy by advertising via various media to create public awareness of the harms of pornography on health and behaviour.
    • Equip teachers and integrate the topic of pornography into school sexual education curricula. Additionally, children and adolescents need to be taught the difference between healthy sexual relationships and the fantasy of pornography; the concept of mutual respect and dignity needs to be emphasized (Lim et al., 2016; Mattebo et al., 2013).
    • Equip parents. Develop workshops and resources for parents to inform them about pornography and equip them with the skills to have ongoing conversations with their children and adolescents.
    • Promote the use of personal filtering software for families and individuals to facilitate parental and personal control settings for electronic devices in the home, as no regulations currently exist in Canada.
    • Partner with organizations that have developed tools and programs intended to educate and equip parents and educators.

  3. Lobby for policy changes
    • Urge Health Canada to continue to study the negative health impacts of pornography and to consider regulation. The recent study by the Standing Committee on Health (Government of Canada, 2017) was a first step in addressing this issue nationally, and no national regulatory framework exists to block or filter Internet content.
    • Use various advocacy tools to call for action, including contacting health officials and creating publicity through social media, newspaper articles, letters, and petitions. Public health professionals and educators have repeatedly been identified as key leaders in advocating for policy changes regarding pornography (Mattebo et al., 2013; Owens et al., 2012).
    • Lobby for age verification in Canada to limit access for minors. In the United Kingdom (UK), online age verification regulations are to be implemented in 2019, making it mandatory for major pornography websites to ask for a credit card or other forms of identification for age verification (Government of UK, 2019).
    • Lobby for restrictive online and television access to pornography. This action restricts access for minors and those who do not want access in their home without infringing on freedoms. Since 2013, the UK has worked with Internet service providers (ISPs) to implement default filtering that blocks pornography, with an opt-in choice available upon request by an adult (Robinson & Thomas, 2015). After this change, Sky, one of the four major ISPs in the UK, reported that 70% of its customers chose to block pornography, compared with only 5% prior to implementation.
    • Partner with other organizations to lobby for policy changes. Some Canadian organizations have lobbied for policy changes such as age verification and restrictive access for minors (e.g., Defend Dignity, Stewardship International). Strategies can also be derived and adapted from those implemented in other countries (e.g., UK).

  4. Treatment strategies
    • Equip health care professionals, including nurses, to recognize concerns. Careful and proper assessment is required to identify addictions so that appropriate referrals can be made.
    • Give proper referrals. Resources for individuals and families affected by problematic sexual behaviour, such as addiction to pornography, are important, and although awareness among clinicians has grown over the past few decades, treatment options still vary and are not well known (Riemersma & Sytsma, 2013). Referrals are often made to trained counsellors, certified sexual addiction therapists, and treatment centres, as well as resources and support groups (for partners and family as well). Treatment options may differ for children and adolescents, and may need to include social and relational skills training, as these aspects may be underdeveloped owing to the impacts of addiction at this development stage (Riemersma & Sytsma, 2013).
    • Engage in research to evaluate the effectiveness of current treatment programs and develop future programs. Because pornography or sexual addiction has yet to be included in the DSM-5 (American Psychiatric Association, 2013), most treatment centres that address pornography/sexual addiction currently are private. Health Canada and its corresponding organizations need to work in collaboration with treatment centres to develop guidelines and effective, evidence-based treatment strategies and programs to provide the public with more available and accessible resources and treatment options.

Final thoughts

Pornography is a complex issue with numerous health concerns. An upstream approach is necessary to counter the impacts it has created. Health care professionals, including nurses, stand in a position to take the lead in creating awareness, develop and implement prevention strategies, and lobby for policy changes. As with other public health issues such as drugs, alcohol, and smoking/vaping, regulations are necessary to limit exposure in children and adolescents.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Canadian Nurses Association (2017). Code of ethics for registered nurses.

Government of Canada, Minister of Health. (2017). Response from minister of health.

Government of UK, Department for Digital, Culture, Media & Sport, & Margot, J. (2019). Age-verification for online pornography to begin in July. [Press Release].

Lim, M. S. C., Carrote, E. R., & Hellard, M. E. (2016). The impact of pornography on gender-based violence, sexual health and well-being: What do we know? Journal of Epidemiology and Community Health, 70(1), 3–5. doi:10.1136/jech-2015-205453
Mattebo, M., Larsson, M., Tydén, T., & Häggström-Nordin, E. (2013). Professionals’ perceptions of the effect of pornography on Swedish adolescents. Public Health Nursing, 31(3), 196–205. doi:10.1111/phn.12058

Owens, E. W., Behun, R. J., Manning, J. C., & Reid, R. C. (2012). The impact of Internet pornography on adolescents: A review of the research. Sexual Addiction & Compulsivity, 19(1–2), 99–122. doi:10.1080/10720162.2012.660431

Riemersma, J., & Sytsma, M. (2013). A new generation of sexual addiction. Sexual Addiction & Compulsivity, 20(4), 306–322. doi:10.1080/10720162.2013.843067

Robinson, D., & Thomas, D. (2015, July 16). Cameron opens new front in war on porn.  Financial Times.

Janet Zacharias, RN, BN is a Clinical Instructor at Red River College in Winnipeg, Manitoba. Email: jzacharias50@rrc.ca

Lynn Scruby, RN, PhD is an Assistant Professor at the College of Nursing, Rady Faculty of Health Sciences, University of Manitoba.
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