Objective: To examine the prevalence of sexting behaviors as well as their relation to dating, sex, and risky sexual behaviors using a large school-based sample of adolescents.

Design: Data are from time 2 of a 3-year longitudinal study. Participants self-reported their history of dating, sexual behaviors, and sexting (sent, asked, been asked, and/or bothered by being asked to send nude photographs of themselves).

Setting: Seven public high schools in southeast Texas.

Participants: A total of 948 public high school students (55.9% female) participated. The sample consisted of African American (26.6%), white (30.3%), Hispanic (31.7%), Asian (3.4%), and mixed/other (8.0%) teens.

Main outcome measure: Having ever engaged in sexting behaviors.

Results: Twenty-eight percent of the sample reported having sent a naked picture of themselves through text or e-mail (sext), and 31% reported having asked someone for a sext. More than half (57%) had been asked to send a sext, with most being bothered by having been asked. Adolescents who engaged in sexting behaviors were more likely to have begun dating and to have had sex than those who did not sext (all P < .001). For girls, sexting was also associated with risky sexual behaviors.

Conclusions: The results suggest that teen sexting is prevalent and potentially indicative of teens' sexual behaviors. Teen-focused health care providers should consider screening for sexting behaviors to provide age-specific education about the potential consequences of sexting and as a mechanism for discussing sexual behaviors.