The Risks Young People Face as Porn Consumers

Abstract

Adolescents are now significant users of internet pornography. Samples of voluntary consumption were identified from 14 countries. Considered collectively they demonstrate that boys are much more interested in viewing pornography than girls and that both genders watch more pornography as they get older. By age 18 most boys are consumers. From a risk management point of view, internet pornography has not been proven to be a safe product. It poses dangers similar to any activity that has a high potential for the development of problematic behaviors or addiction through sustained overconsumption. Until causality linking pornography consumption to harm is either disproven or demonstrated to be very low, there is a strong case for governments and policy makers to intervene in the unrestricted supply of internet pornography to all consumers, particularly adolescents. The precautionary principle should be invoked to minimize the likelihood that internet pornography consumption will become a global public health crisis. Prevention of harm is always preferable to treating it. Reducing risk from internet pornography by discouraging its consumption is relatively inexpensive and easy to do.

Full text

Received: May 20, 2016
Revision received: July 15, 2016
Accepted: September 18, 2016
OnlineFirst: December 10, 2016
Copyright © 2016  Turkish Green Crescent Society
ISSN 2148-7286  eISSN 2149-1305
http://addicta.com.tr/en/
DOI 10.15805/addicta.2016.3.0109  Winter 2016  3(3)  387‒400
Original Article
ADDICTA: THE TURKISH JOURNAL ON ADDICTIONS
Citation: Mead, D. (2016). The risks young people face as porn consumers. Addicta: The Turkish Journal on Addictions, 3,
387–400. http://dx.doi.org/10.15805/addicta.2016.3.0109
* ThepreparationofthispaperwassupportedinpartbyYeşilay,theTurkishGreenCrescentSociety.
The views expressed in the paper are those of the author.
Anearlierversionofthepaperwaspresentedatthe“3rdInternationalCongressofTechnologyAddiction,”heldinIstanbul,
Turkey, May 3–4, 2016.
1 Correspondence to: DarrylMead (PhD),The RewardFoundation, TheMelting Pot,5 RoseStreet, Edinburgh,EH2 2PR,
UnitedKingdom.Email:darryl@rewardfoundation.org
2 HonoraryResearchAssociate,DigitalHumanities,InformationStudies,UniversityCollegeLondon.
Abstract
Adolescents are now significant users of internet pornography. Samples of voluntary consumption were
identified from 14 countries. Considered collectively they demonstrate that boys are much more interested
in viewing pornography than girls and that both genders watch more pornography as they get older. By
age 18 most boys are consumers. From a risk management point of view, internet pornography has not
been proven to be a safe product. It poses dangers similar to any activity that has a high potential for the
development of problematic behaviors or addiction through sustained overconsumption. Until causality
linking pornography consumption to harm is either disproven or demonstrated to be very low, there
is a strong case for governments and policy makers to intervene in the unrestricted supply of internet
pornography to all consumers, particularly adolescents. The precautionary principle should be invoked
to minimize the likelihood that internet pornography consumption will become a global public health
crisis. Prevention of harm is always preferable to treating it. Reducing risk from internet pornography by
discouraging its consumption is relatively inexpensive and easy to do.
Keywords
Internet pornography • Adolescents • Risk management • Porn consumption • Precautionary principle
Darryl Mead1,2
The Reward Foundation
The Risks Young People Face as Porn Consumers*

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There is a paucity of research for understanding the potential harm of internet
pornography to children. In this context, children are considered young people under
the age of 18 years. It is evident that more research is needed to demonstrate if causal
relationshipsexistbetweenconsuming internetpornographyandspecic harmsto
children. With this in mind, the issue becomes how policy makers should proceed
until the uncertainty is resolved.
What We Know about the Number of Children Using Internet Pornography
The market for legal pornography intended for consumption by adults continues to
expand by at least 10% per annum. The world’s largest corporate supplier is Pornhub
Network with 100 million visits per day worldwide, or 87.8 billion video views a year
(Pornhub, 2016). The second largest supplier, Xvideos, claims that it adds 10,000
newvideosperday.Clearly,pornographyisbeingconsumedfromtheinternetona
vast and unprecedented scale.
Commercialinternetpornographysuppliersdonotpubliclyadmitthatconsumers
undertheageof18usetheircontent.Forexample,assuppliersof“adultentertainment”
Pornhub only provides statistics for its consumers over the age of 18 (Pornhub, 2016)
and never mentions younger consumers. A more accurate scale of use is suggested
by research from the U.K.’s DepartmentofCultureMediaandSport(2016), which
found that 1.4 million unique visitors to adult sites in Britain were under the age of
18 during the month of May 2015.
Areviewofrecentjournalliteratureidentied38datasetsforadolescents’voluntary
watchingofinternetpornography.Eachdatasetisrepresentedintheguresbythe
mean age of the viewing group. Figures 1 and 2 provide an international view of
onlinepornographyviewingforbothadolescentboysandgirls.Sourcesofthedata
arecitedinAppendix1forbothgures,alongwithinformationregardingthesizeof
the samples and date of collection.
Figure 1. Adolescent boys voluntarily viewing internet pornography.

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Consideredcollectively,adolescentmalesshowgrowinginterestinviewinginternet
pornography with increasing age. Consumption levels for those aged 15 years in
different countries cluster between 20% and 60%. By the time they approach 18 years,
over 80% of the boys in nearly all samples were active consumers. The heaviest users
wereidentiedasbeingfromSweden,Germany,theNetherlands,andItaly.
Figure 2. Adolescent girls voluntarily viewing internet pornography.
By comparison, 15-year-old girls showed little enthusiasm for becoming internet
pornographyconsumers,clusteringbelow10%.ExceptionswereinAustraliaat39%
(smallsample)andtheCzechRepublicwith52%(largesample).Similartotheboys,
the heavier consumers among the older girls were from northwestern Europeans
countries,specically,GermanyandSweden.Overall,fewergirlsineverynational
sample were voluntary consumers compared with their male counterparts.
The samples cited comprised 14,313 boys from 13 countries and 15,031 girls
from 14 countries. The data is comprehensive enough to demonstrate that internet
pornography use generally rises with age within a wide range of countries, and that
boys show a greater level of interest than girls.
Adolescents and Potential Harms from Internet Pornography
There is a considerable amount of academic literature concerning the use of
pornography by adolescents; although those with an exclusive focus on internet
pornography is much more limited. The cumulative potential for harm to adolescents
is likely to remain a contested space for the next few years. Nevertheless, social,
health, and learning issues have been discussed in various reviews, such as those
led by Owens,Behun,Manning,andReid(2012), Peter and Valkenburg (2016), and
Lim,Carrotte,andHellard(2016).
Adolescent consumers are subject to many areas of inuence through internet
pornography. Importantly, it has become the default source of sex education or a
manual for sex. In this way, it can reduce inhibitions and barriers for more risky
behavior. Pornographic videos depicting all genres and interests are instantly available
to every consumer in a few clicks.

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A long list of harms is currently under investigation, including social isolation,
depression, lethargy, erectile dysfunction, and a declining interest in real partners.
Earlyinternetpornographyusecorrelateswithearlysexualdebutandawiderange
of anti-social markers (Svedin,Åkerman,&Priebe,2011).
In modeling sex, the activities depicted generally ignore health risks, displaying
condom-free performances with multiple partners. The performers are often
physically enhanced and they usually behave in an exaggerated way. There is
evidence correlating the increased levels of hetero-anal sex in real-life with its very
frequent depiction in popular pornography (Braun-Courville&Rojas,2009;Mattebo
etal.,2016;Rogala&Tydén,2003;Tydén&Rogala,2004). This view is also held by
front-linesexualhealthprofessionalssuchasthoseatEdinburgh’sChalmersSexual
HealthCentre(Hardman,S.2016,personalcommunication,16June)andattheGold
CoastCentreAgainstSexualViolence(Macleod, D. 2016, personal communication,
11 November).
Free access to internet pornography means that virgin consumers often view this
material for years before they engage in partnered sex. For some, it can become a
substitute for partnered sex. Through unconscious sexual conditioning, it can also
encourage the development of tendencies for voyeurism and to escalation to different
genres, potentially including illegal child sexual exploitation material (CSEM).
Escalationmaybedriveninpartbytheneedtofeelsexuallyarousedwhenaffected
by pornography-induced erectile dysfunction (Wilson & Jack, 2014). This side-
effectisaresultofdesensitization,acharacteristicofaddiction.Heavyconsumption
can also lead to confusion over sexual orientation, as bored users escalate to genres
of pornography at odds with their natural orientation. For example, heterosexual
individuals may begin to view homosexual pornography and vice versa to create
sexual arousal (Downing et al., 2016).
Therst-evereffort to producea meta-analysis (ananalysis of multiplestudies
toobtainalargersamplesize)concerningtheimpactofpornographyasadriverfor
sexualaggressionappearedattheendof2015.However,theanalysisonlyexplored
theimpacton thegeneralpopulation,anddidnotaddresschildrenspecically.No
equivalent research for those under 18 years has been published. Nevertheless, the
meta-analysisdetailedanumberofinterestingndings:
ConsumptionwasassociatedwithsexualaggressionintheUnitedStatesandinternationally,
among males and females, and in cross-sectional and longitudinal studies. Associations
werestronger forverbalthanphysicalsexual aggression,althoughbothweresignicant.
The general pattern of results suggested that violent content may be an exacerbating factor
(Wright,Tokunaga,&Kraus,2015).

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The newest area of concern is the potential for internet pornography addiction to
affect heavy users (Wilson&Jack,2014). According to a 2015 review into internet
addictionsledbyLove(Love,Laier,Brand,Hatch,&Hajela,2015), compulsive use
ofinternetpornographytsthedenitionofanaddictivebehaviorestablishedbythe
AmericanSociety ofAddiction Medicine. Recent research from the University of
Cambridge(Voon et al., 2014) indicates that compulsive use of internet pornography
causes the same brain changes as those seen in cocaine addicts and alcoholics.
The default situation, which has evolved throughout most parts the world, is to accept
unlteredinternet access, allowingeveryone unlimited accessto all pornography.
Theexceptionisillegaldepictionsofchildrenin CSEM, which isbannedthrough
aninternational agreement underpinned by theUnited NationsConvention onthe
RightsoftheChild(United Nations, 1989).
Internet Pornography and Risk Management
The cornerstone of risk management is the precautionary principle. Where there is
an unproven risk, the activity must be assumed to be harmful until proven otherwise.
Allowing adolescents to consume internet pornography falls into this category. Thus,
precautions should be taken to avoid the possible risk until when, or if, internet
pornography is proven either harmless or low-risk. According to the European
Commission, “the precautionary principle may be invoked when a phenomenon,
productorprocessmayhaveadangerouseffect,identiedbyascienticandobjective
evaluation,ifthisevaluationdoesnotallowtherisktobedeterminedwithsufcient
certainty.”(EUR-Lex,n.d.).
This paper will now explore the options available to governments if they choose
to use the precautionary principle to minimize access for adolescents to internet
pornographywhilethedebateoverharmsisresolvedorclaried.
Harm Minimization - Reducing Access to Legal Pornography
Making legal pornography illegal will not prevent consumption unless its supply
canbeefcientlyblockedbeforeitreachesconsumers.Atpresent,thisisonlyfeasible
forcountriesinvestingheavilyininternetcensorship,suchasIranandChina.
From a risk management point of view, internet pornography poses dangers similar
to any activity that has a high potential for the development of problematic behaviors
or addiction through sustained overconsumption. In fact, internet pornography has
not been demonstrated to be a safe product, and therefore, it could be mandated under
product liability law as a defective product when consumed in excess.
Itisimportanttorecognizetheroleofsearchenginesinprovidingchildrenwiththe
abilitytondpornography.Typing“porn”intoGooglegenerates345,000,000results

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and“sex”returns2,010,000,000results.Nearlyallresultsintherstfewpagesare
for pornography sites. Any effort to reduce access will require technical collaboration
withthesearchenginecompaniesaswellastheInternetServiceProviders(ISPs).
Fewer young people are likely to be able to access internet pornography easily
iftheISPsroutinelyblockaccesstoadultsites.Historically,thishasalreadybeen
enacted in the U.K. based on an automatic opt-out. When a person leases an internet
connection,itcomesunlteredandthereisanoptionfortheconsumertohaveadult-
content ltering turned on, blocking most common pornography sites. Uptake of
theseltershasbeenpoor,meaningthatmostU.K.consumershaveunlteredaccess.
More recently in the U.K., several major ISPs have moved toward setting up
newaccounts withadult lters turned on by default. However,thebill-payer still
hastheoption to opt-out.Overtime, themarketwill move towardlteringas the
defaultconditionintheU.K.Thissortoflteringiscurrentlyabluntinstrument,as
it does not block non-commercial pornography sites or sexting and sometimes blocks
legitimate content.
The majority of young people access pornography on mobile devices (Pornhub,
2016). Specically, internet-enabled gaming machines continue to increase in
popularity as sources of pornography. For pay-as-you-go mobile services, some
providershaveadefaultover-18ltering,whichcanonlyberemovedbyregistering
acreditcard.Oncethisisdone,adultcontentispermanentlyenabled.
Althoughlteringhastheabilitytoreduceoverallconsumption,itcanbeovercome
by a range of easy hacks within the capacity of many teens. Moreover, if one family
blocks pornography, a child can always watch it at their friends’ homes where it is
notblocked.Theprotectivebenetsoflteringarelikelytobegreatestforyounger
children who have fewer options to circumvent blocking.
ThereviewbytheUnitedKingdomGovernmentofthepotentialtoinstituteanage
vericationsystem to minimize the access to internetpornography ended its public
consultation phase on April 12, 2016 and is expected to result in the passage of the
DigitalEconomyBill(DepartmentofCultureMediaandSport,2016). This study is
investigatingoptionstobothestablishspecicmethodsofacceptableageverication
and to develop a range of control measures, which have the potential to encourage
internet pornography suppliers to conform to U.K. law. However, it is recognized
that no major pornography supplier is based in the U.K., and few are even within the
EuropeanUnion.Inessence,themeasureswouldencouragepornographysuppliersto
incorporatetheagevericationsoftwareforconsumerswithIPaddressesintheU.K.
Inthefuture,itislikelythatArticialIntelligence(AI)technologieswilldevelop
to the point where machines can identify pornography with a high degree of

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reliability.Havingrecentlyvisitedlabswheresomeoftheworld’sleadingcomputer
scientistsarebuildingimageidenticationalgorithms,itisapparentthatitwillbeat
least several years before it will be possible to block pornography purely based on
thecontentofimages.AIlteringcouldbedoneatboththeconsumerandsupplier
levels, making it a powerful technology once it is perfected.
Harm Minimization - Reducing Demand for Legal Pornography
If adults have less desire to consume legal pornography, they are less likely to
expose young people in their care to this material or to create opportunities where
young people can gain access while the adults are not present. There is also a body of
research indicating that pornography consumption by one adult in a relationship can
signicantlynegativelyaffectthefutureoftherelationship(Stewart&Szymanski,
2012;Szymanski,Feltman,&Dunn,2015). Therefore, active education to highlight
the harmful aspects of an overconsumption of internet pornography would be valuable
amongtheadultpopulationinanycountry.Excessiveconsumptionofpornographyis
already a global public health issue (Dines, 2010, 2016).
The single factor that tends to motivate people to reduce or eliminate pornography
consumption is the recent massive rise in erectile dysfunction, especially among
youngermen.Historically,levelsofimpotenceamongyoungmenhavebeen2%to
5% (Park et al., 2016).Arangeofrecentstudiesarendingthat27%to33%ofyoung
menage18–40yearsarehavingerectiledifcultiesandlowlibidorateswithareal
partner (Bronner & Ben-Zion, 2014; Klucken, Wehrum-Osinsky, Schweckendiek,
Kruse,&Stark,2016;Khn&Gallinat,2014;Mialon,Berchtold,Michaud,Gmel,
&Suris,2012;Pizzol,Bertoldo,&Foresta,2015;Sutton,Stratton,Pytyck,Kolla,&
Cantor,2015), though not with internet pornography (Landripet&Štulhofer,2015).
Essentially,theyhaveconditionedtheirbrainstorespondtoimagesonascreenand
not to real partners. For most young men, this problem can be treated by discontinuing
their use of pornography (Pacha, 2016; Park et al., 2016; Porto 2016).
A range of proven approaches to support people who wish to end their use of
pornography are available on the internet. For example, the site www.yourbrainonporn.
comprovidesmanyresourcestoexplaininternetpornographyaddiction.Onlinehelp
is readily available from recovery websites, such as NoFap.com and Reboot Nation
(www.rebootnation.org). Additionally, The Reward Foundation offers a three-step
approach to quitting (www.rewardfoundation.org).
Harm Minimization - Reducing Demand for Illegal Pornography
Creatingillegal pornography tosupply the needsof adultusers means children
are being harmed through the production process. It is likely that reducing demand

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forCSEMwillreducethenumberofchildrenbeingharmed,eitherwithinthelocal
community or elsewhere in the world.
If an individual becomes addicted to internet pornography, the need to progressively
increase the impact provided by imagery is similar to that experienced by substance
abusers. With substances, an addict needs more of the same, and with pornography,
an addict needs different and new images to experience a high. Many internet
pornography addicts achieve this by escalating to different genres of pornography.
Over time, they may move from heterosexual hardcore pornography to viewing
group sex, gay porn, transgender porn, or a multitude of sub-genres that do not match
their original taste, and can lead to sexual conditioning and fetishes (Downing et
al.,2016;Wéry&Billieux,2016). Unfortunately, some addicts inevitably move to
consumingCSEM.
Thus, the internet has generated a new type of child abuser. Internet pornography
addictscanescalatetoCSEMwithoutthemselveshavinganyinterestincommitting
contact offenses against children. The legal authorities in many countries treat
those in possession of images of child abuse as much of a potential risk as contact
offenders. For pornography addicts with no history of abuse, but who have escalated
topossessionofCSEM,quittingpornographyusemaybeeffectiveinitselftoreduce
the risk of further offending.
Separately,theworkofSeigfried-Spellarand Rogers (2013) suggests that:
…child pornography users were more likely to consume both adult and animal pornography,
rather than just solely consuming child pornography. Results suggested deviant pornography
usefollowedaGuttman-likeprogressioninthatindividualswithayounger“ageofonset”for
adult pornography use were more likely to engage in deviant pornography (bestiality or child)
comparedtothosewithalater“ageofonset.”
Heretheimplicationisthatavoidingearlypornographyconsumptioncouldalso
helpreducedemandforCSEM.
Harm Minimization - Reducing Access to Illegal Pornography
The supply of illegal pornography is very much like the supply of illegal
recreational drugs. Draconian laws, banning substances, and very heavy investment
inenforcementcangreatlyreducethesupply,drivingdemandunderground.However,
it can never be 100% effective and it generates serious unintended consequences.
Organizedcrimetendstouseawidemixofsimpleandsophisticatedtechniquesto
get its pharmaceutical products to market. Illegal pornography is similar. It can be
made by anyone with a smartphone, which is the majority of the population. It can be
distributed by any communication channel. Moreover, pornography gains monetary
or economic value as well as social status when it is banned or scarce. For example,

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CSEMdemandsahighpricebecauseitisillegal.Thiseconomicvalueencourages
organizedcrimetoproduceevermoreCSEM,compromisingthesafetyofchildren
around the world, especially in poorer countries.
Recently,alarminggrowthisbeingreportedinon-demandproductionofCSEM
for individual live-streaming. Organized crime experts have located users who
pay money to impoverished families in poor countries and force young children to
performlivesexactsviawebcamforthesexualgraticationofclientsabroad.
Technologyproviders,suchas NetClean in Sweden,provideblocking,analytic,
and forensic software for corporate networks to block child sexual abuse content.
NetCleanalso supplysoftware forISPs toblock thiscontent.Arelatedcompany,
Griffeye, supplies technology that allows law enforcement agencies to gather
intelligence and visual evidence from large data platforms handling images and video.
Thesetechnologiesrelyondigitalngerprintingofknownabuseimages,whichcan
then spot additional occurrences of the same material, allowing illegal images to be
tracked as they are shared across child abuse networks. This technology is used by
the Metropolitan Police in the U.K.
CSEM is generally found on the dark web. Much of this is shared using The
Onion Ring (Tor) anonymity network.This provides privacy, though leaks from
EdwardSnowdenshowthatintheUnitedStates,theNationalSecurityAgencyhas
developedtechniquestoidentifyandinltrateTornetworks,especiallywhentheyare
beinginstalled.OneofthelargestU.K.successesagainstchildsexexploitationwas
courtesy of a hack by Anonymous who gave material to the police that enabled 700
CSEMconsumerstobeidentiedandcharged.
Conclusion
In little more than a decade, internet pornography has moved from being a niche
product to something consumed routinely by most adolescent boys in advanced
economies. Fewer girls consume pornography, but they may be affected by the way
it can change the behavior of boys.
From a risk management perspective, until causality linking pornography
consumption to harm is either disproven or demonstrated to be very low, there is a
strong case for governments and policy makers to intervene in the unrestricted supply
of internet pornography to all consumers, particularly adolescents.
The precautionary principle should be invoked to minimize the likelihood that
internet pornography consumption will become a global public health crisis.
Prevention of harm is always preferable. Reducing the risk from internet pornography
by discouraging its consumption is relatively inexpensive and easy to do. This requires

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a comprehensive educational programme starting in primary school and going
throughout secondary school. Teaching children about the brain’s reward system
and its vulnerability to addiction can help young people take more responsibility
fortheir own actions.Teachingsexualeducation that emphasizesrespect, consent
and safe physical contact can replace, or at least, reduce the need for pornography
asasexmanual.Classesonmedialiteracytodeconstructthepornicationaspectof
advertising and the emotionally arousing messages that are being used to facilitate the
sale of merchandise can be useful in teaching young people critical thinking skills.
All of this can support a focus on reducing adolescent’s demand for pornography at a
local level while governments aim at a national level to reduce supply.
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Appendix 1
Boys Voluntarily Watching Internet Pornography (Sorted by percentage watching)
Countryandyearpublished Year data
collected
Sample
size
Boys mean
age
Boys
watching
HongKong2012(Shek&Cheung,2013) 2009–11 1,862 13.6 15%
Australia2011(Green,Brady,Olafsson,Hartley,&
Lumby,2011) 2010–11 100 10.5 16%
Cambodia2015(Lopez,Mukaire,&Mataya,2015) 2009 136 17.0 20%
HongKong2013(Ma&Shek,2013) 2011–12 2,185 14.6 23%
Netherlands2011(Peter&Valkenburg,2011) 2008 1,803 14.5 29%
Sweden2013(Skakoon-Sparling,Cramer,&Shuper,
2016) 2008? 142 12.9 30%
England2016(Stanleyetal.,2016) 2015 172 14.7 39%
Bulgaria2016(Stanleyetal.,2016) 2015 207 15.0 44%
Italy2016(Stanleyetal.,2016) 2015 273 15.3 44%
Australia2011(Shek&Cheung,2013) 2010–11 100 14.5 45%
Morocco2013(Kadri,Benjelloun,Kendili,Khoubila,&
Moussaoui, 2013) 2010–11 200 17.0 47%
Norway2016(Stanleyetal.,2016) 2015 218 15.0 50%
Cyprus2016(Stanleyetal.,2016) 2015 168 15.0 59%
CzechRepublic2014(Ševčíková&Daneback,2014) 2012 1,221 14.1 62%
Netherlands2013(Hald,Kuyper,Adam,&deWit,
2013) 2008–09 1,402 18.0 88%
Italy 2015 (Romito&Beltramini,2015) 2014? 319 18.2 89%
Sweden2015(Kastbom,Sydsjö,Bladh,Priebe,&
Svedin,2015)2009 1,219 18.0 90%
Sweden2011(Svedin,Åkerman,&Priebe,2011) 2009 1,902 18.2 90%
Germany2012(Weber,Quiring,&Daschmann,2012) 2007–08 209 17.3 93%
Sweden2014(Mattebo,2014) 2011 477 16.6 96%
Total 14,315

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Appendix 2
Girls Voluntarily Watching Internet Pornography (Sorted by percentage watching)
Countryandyearpublished
Year data
collected Samplesize Girlsmeanage
Girls
watching
Cambodia2015 2009 127 17.0 1.5%
England2016 2015 500 14.7 3.0%
Cyprus2016 2015 300 15.0 3.0%
HongKong2013 2011–12 1,885 14.6 4.6%
Italy 2016 2015 340 15.3 5.0%
HongKong2012 2009–11 1,716 13.6 6.0%
Norway 2016 2015 517 15.0 6.0%
Bulgaria 2016 2015 463 15.0 8.0%
Netherlands 2011 2011–12 1,885 14.5 10.0%
Australia 2011 2010–11 100 10.5 13.0%
Morocco 2013 2010–11 200 17.0 17.6%
Australia 2011 2010–11 100 14.5 39.0%
Italy 2015 2014? 383 18.2 39.2%
Netherlands 2013 2008–09 3,198 17.0 44.8%
CzechRepublic2014 2012 1,410 14.1 52.6%
Sweden2014 2011 400 16.6 54.0%
Germany2012 2007–08 143 17.3 61.0%
Sweden2015 2009 1,364 18.0 75.6%
Total 15,031
Note.ThesourcesfortheGirl’sdataarethesameasforthematchingBoy’ssetinAppendix1.