Journal of Sexual Aggression An international, interdisciplinary forum for research, theory and practice

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Sexual offenders contacting children online: an examination of transcripts of sexual grooming

Georgia M. Winters, Leah E. Kaylor & Elizabeth L. Jeglic

To cite this article: Georgia M. Winters, Leah E. Kaylor & Elizabeth L. Jeglic (2017) Sexual offenders contacting children online: an examination of transcripts of sexual grooming, Journal of Sexual Aggression, 23:1, 62-76, DOI: 10.1080/13552600.2016.1271146 To link to this article: https://doi.org/10.1080/13552600.2016.1271146

Published online: 16 Jan 2017.

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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=tjsa20 JOURNAL OF SEXUAL AGGRESSION, 2017 VOL. 23, NO. 1, 62–76 http://dx.doi.org/10.1080/13552600.2016.1271146

Sexual offenders contacting children online: an examination of transcripts of sexual grooming Georgia M. Wintersa,b, Leah E. Kaylorb,c and Elizabeth L. Jeglicb aThe Graduate Center, City University of New York, New York, NY, USA; bPsychology Department, John Jay College of Criminal Justice, New York, NY, USA; cDepartment of Psychology, Saint Louis University, Saint Louis, MO, USA

ABSTRACT ARTICLE HISTORY The present study investigated transcripts of adults sexually grooming Received 25 January 2016 decoy victims on the Internet. One hundred transcripts were coded for Revised 3 December 2016 offender characteristics, victim characteristics, and dynamics of the Accepted 6 December 2016 conversation. The results revealed that all of the offenders were male, KEYWORDS most of whom believed they were communicating with an adolescent ; internet sex female. The sexual intentions of the offenders were made clear, with the crimes; sexual grooming; majority introducing sexual content early on into the conversation. The online grooming; child sexual length of the contact ranged from one day to nearly one year, abuse suggesting that the duration of the online grooming process may vary significantly. The majority of offenders also communicated with the decoy victim over the telephone and attempted to arrange an in-person meeting, many within short periods of time. Implications for prevention and future research are discussed.

Originally airing in 2004, the television program To Catch a Predator captured the public’s attention by broadcasting encounters between sexual predators and law enforcement officers who were posing as children online. Such media coverage has heightened public attention to the dangers of sexual predators targeting children on the Internet (Hansen, 2006). Sexual solicitation of minors online involves an adult requesting a minor to engage in sexual conversations or activities via the Internet (Mitchell, Finkelhor, & Wolak, 2001). Adults who sexually solicit minors online may engage in sexual grooming behaviours, whereby an offender prepares a child for sexual abuse (Craven, Brown, & Gilchrist, 2006). Sexual grooming online involves an individual attempting to contact a minor with the goal of some form of sexually inappropriate behaviour (eg cybersexual activity, child , arranging an in-person meeting for the purpose of sexual contact; Staks- rud 2013). Although the perpetrator has reached out to the potential victim, the minor may not respond to the initiation of conversation. The use of the Internet to identify and target victims is a relatively new phenomenon, but one that has a wide reach. Currently almost all young people (97%) in the United States between the ages of 12 and 18 use the Internet (Ybarra, Leaf, & Diener-West, 2004). A national telephone survey found that as many as 12% of males and 27% of females between the ages of 10 and 17 reported being sexually solicited online (Ybarra et al., 2004), suggesting that children are increasingly receiving sexual solicitations on the Internet (Child Exploitation and Online Protection Centre, 2010). Over the past two decades, there has been an increase in awareness for professionals and the public alike about the use of the Internet to facilitate child sexual abuse (Beech, Elliott, Birgden, & Findlater, 2008). However, there is still much to be understood in terms of the characteristics of the offenders and their conversations with poten- tial victims.

CONTACT Georgia M. Winters [email protected], [email protected] © 2017 National Organisation for the Treatment of Abusers JOURNAL OF SEXUAL AGGRESSION 63

Offenders of online sexual grooming Sexual grooming typically describes the process whereby an offender manipulates a minor into a situ- ation where sexual abuse can be more readily committed, while also preventing future disclosure (van Dam, 2001; Wyre, 2000). Importantly, there has yet to be a universal definition of the term given difficulties determining where the process begins and ends, as well as the variety of behaviours that could be involved depending on the offender, the victim, and the context (Gillespie, 2002). While sexual grooming is not a new concept, the Internet has given potential offenders new opportunities to sexually exploit children (Gillespie, 2002), by providing the offender with anonymity and easy access to victims (Cooper, 1998). Offenders use the Internet to manipulate potential victims by intro- ducing sex talk, exposing the child to pornography, or asking victims to view or perform sexual activi- ties (Lanning, 2005). Further, offenders may have the goal of arranging a meeting with the child to engage in in-person sexual acts. One way these Internet offenders locate children and initiate con- versations with potential victims is through online chat rooms (Malesky, 2007). These online offenders may use sexual grooming behaviours to sexually solicit minors on these Internet platforms. Of the 2391 public reports of inappropriate online sexual behaviours in the UK between 2009 and 2010, 64% involved sexual solicitation of minors (Child Exploitation and Online Protection Centre [CEOP], 2010). It should be noted that groups, such as CEOP, have raised awareness of these issues and facili- tate reporting of these crimes, which may help explain why online solicitation has been deemed a significant social problem in recent years. Overall, it appears that sexual solicitation of children is one of the most frequently reported sexually inappropriate behaviours on the Internet. While researchers have long been investigating contact sexual offenders, online sexual offenders have been considered a relatively new phenomenon (Craven, Brown, & Gilchrist, 2007). Carr (2004) argued that individuals who groom children via the Internet are qualitatively different than those who engage in in-person grooming. Babchishin, Hanson, and Hermann (2011) conducted a meta- analysis comparing online (eg , luring children through the Internet) and offline sexual offenders. The meta-analysis revealed that online offenders were more likely to be Caucasian and younger than in-person offenders. In terms of psychological variables, online offenders showed greater empathy for victims, higher sexual deviancy, and lower impression management. A content analysis of online grooming transcripts also revealed that while online sexual offenders use similar tactics for in-person grooming, the overall process may differ in order and timing (Black, Wollis, Woodworth, & Hancock, 2015). Wolak and Finkelhor (2013) investigated whether Internet-related offenses differed from in-person crimes by conducting in-depth phone interviews with a national sample of law enforcement investigators regarding their cases. Contrary to other research, these authors concluded there is little evidence to suggest that offenders who communicate with victims online were different or more dangerous than those committing offenses in-person and both groups used similar tactics in their offense process. Researchers have been interested in how offenders locate and target their online victims in order to better understand the offense process. Child molesters who engage in in-person grooming tend to select victims based on physical attractiveness, ease of access, and perceived vulnerabilities (Lanning, 2010; McAlinden, 2006; Olson, Daggs, Ellevold, & Rogers, 2007). Similarly, while it is unclear whether physical attractiveness plays a role in the selection process, research has shown that online perpetra- tors may select victims based on accessibility, opportunity, and the child’s perceived vulnerabilities (Malesky, 2007;O’Connell, 2003). Malesky (2007) examined the online activity of 31 convicted sexual offenders who had communicated with a minor via the Internet and found that the majority monitored and visited chat rooms geared toward minors and a half of this sample reviewed profiles to identify potential victims. These online offenders chose a victim based on the presence of sexual content in the minor’s profile, perceived neediness or submissiveness of the child, the child explicitly stating their age in their profile, and the use of young-sounding usernames. Once the victim is selected, the offender begins to engage the child in conversation. At that point, online offenders tend to immediately state their gender, age, and location (Marcum, 2007). 64 G.M.WINTERSETAL.

A meta-analysis of studies examining online sexual offenders found that the average age of a perpe- trator was 38.6 years (Babchishin et al., 2011). Furthermore, Williams, Elliott, and Beech (2013) suggested that offenders can be categorised as either a true-representation (ie discloses age) or deceptive-representation (ie poses as a minor) persona in regard to the age they report to a potential victim. Interestingly, studies have shown that the majority offenders do not represent themselves as other children online (Briggs, Simon, & Simonsen, 2011; Kloess et al., 2015; Marcum, 2007;O’Connell, 2003). One study suggested that there may be as few as 5% of offenders who represent themselves as younger than their actual age (Wolak, Finkelhor, Mitchell, & Ybarra, 2010), while other studies suggest that up to one-third of online convicted sexual offenders posed as children (Malesky, 2007). In many instances the topic of sex is introduced early in the online conversation, possibly followed by the exchange of sexually explicit photographs or videos. Kloess et al. (2015) conducted a qualitat- ive analysis of five cases of online sexual solicitation of minors. The results suggested that the online communication was highly sexual, which often involved compliments and flattery used to facilitate online sexual activity. Briggs et al. (2011) found that offenders initiated conversation, acknowledged the child’s age, and then had sexually explicit conversations. Further, many of the online offenders took part in sexual behaviours, such as sending and receiving photographs, engaging in or teaching the child masturbation, or engaging in cybersex. An examination of online conversations of under- cover investigations found that the content of the conversations was generally sexual in nature, and that this sexual content was commonly discussed in the first conversation (Mitchell, Finkelhor, & Wolak, 2005). Marcum (2007) concluded that the sexual interests of the online offenders were made explicit during their conversations with the victims. The length of communication between the victim and offender differs depending on whether the goal of the offender was to meet the child in person or engage only in online sexual activity (Marcum, 2007). Briggs et al. (2011) proposed that offenders who develop online sexual relationships with minors are motivated by one of two goals. The first is fantasy-driven, which involves the use of the Internet to engage in cybersex with children without the explicit intent to meet in-person. Second, offenders may be contact-driven, meaning they ultimately have the goal of arranging an in-person meeting with the victim to engage in sexual activity. Of those who visited chat rooms to meet children, Malesky (2007) found that 14 of the 25 perpetrators in the sample attempted an in- person meeting with the minor. It has been proposed that most online offenders are patient enough to develop relationships with victims, which can potentially move from an online relationship to an in-person meeting (Wolak, Finkelhor, & Mitchell, 2004).

Stages of online grooming Similar to the in-person sexual grooming literature, there appears to be stages to the online grooming process. Staksrud (2013) proposed a general model for the online grooming process. During the first stage, the offender observes chat rooms while refraining from participating in communication. Next, a potential victim is identified and a conversation is initiated. The offender then attempts to have per- sonal conversations with the minor, preferably private conversations. The second stage is comprised of the core grooming strategies which involves strategic communication with the potential victim. The final goal may be to engage in sexually explicit conversations, share sexual photographs or videos, or meet the child in person. O’Connell (2003) provided a more in-depth description of the “core grooming strategies” as suggested in the second stage of Staksrud’s model, comprised of five stages. The first two stages, friendship-forming and relationship-forming, describe the offender’s attempts to gather information about the child, assess vulnerability, and use this information to relate to the potential victim. Next, the offender engages in a risk-assessment stage, during this time they survey the risk for being detected and assess the secretiveness of the conversations. Once the offender feels safe to proceed, they begin the exclusivity stage, during which they attempt to create a feeling of exclusive- ness between them and the child. Lastly, during the sexual stage, the individual will introduce sexual JOURNAL OF SEXUAL AGGRESSION 65 content into the conversations. Introduction of sexual content typically involves three strategies: gently pressing boundaries, lowering inhibitions by use of sexually explicit material, and engaging in fantasy re-enactments. Black et al. (2015) conducted an analysis of transcripts from 44 convicted online sexual offenses to examine the applicability of O’Connell’s model of grooming. The authors concluded there was some evidence that offenders use the strategies proposed in O’Connell’s model; however, the timing and linear progression of the stages may differ. The results showed that many of the core grooming tech- niques were employed during the first 20% of the transcripts.

Victims of online sexual grooming Researchers have also turned their attention to the victims of online grooming in an effort to better understand who offenders are targeting. The vast majority of the reported victims are aged 13 or above (Staksrud, 2013). Wolak et al. (2010) found that 99% of victims of Internet sex crimes in their study were between the ages of 13 and 17 years. The majority of child victims were aware they were communicating with an adult (Wolak et al., 2004). Further, most of the victims who agreed to meet with the individual in person indicated they expected sexual contact to occur. Of those who engaged in sexual contact, 73% reported the sexual contact occurred more than once with the individual. According to Staksrud (2013), “the Internet does not make children more vulner- able, but might make already vulnerable children more accessible” (p. 163). Researchers have also examined victim’s perspectives of the online grooming process. A study conducting a qualitative analysis of interviews with eight victims of online grooming found that manipulation occurred through: frequent contact and conversations, deceitfulness and secrecy, sexualisation of the relation- ship, flattery and kindness, erratic or nasty temperament, and grooming of individuals in the victim’s life (Whittle, Hamilton-Giachritsis, & Beech, 2014). The researchers concluded that the grooming process that online victims experience may be very similar to in-person grooming.

Proactive investigations Proactive investigations of online sexual offending involve law enforcement posing as children on the Internet. Unsuspecting individuals may engage in communication with a person who they believe to be a child, possibly attempting to set up a meeting or engage in other sexual acts. Should the suspect engage in such behaviours, they can be subsequently charged with applicable criminal offences. Mitchell, Wolak, and Finkelhor (2005) found that one quarter of arrests for Internet sex crimes against children were a result of proactive investigations. Krone (2005) conducted interviews with officers who conducted proactive investigations posing as female minors. The results suggested that the investigations were largely successful in arresting online offenders, with the length between identification of a suspect and arrest averaging 14 months. The study also revealed that the offenders were quick to develop sexual relationships and most offenders were interested in meeting for in-person sexual contact in addition to cybersexual activities. Another study of proactive investigations included interviews with 10 police officers who posed as male children online (Grosskopf, 2010). Similar to the results of Krone (2005), the offenders in these investigations engaged in highly sexualised conversations early on and many wanted to meet offline for sexual contact. Interestingly, the study suggested that proactive investigation with officers posing as male minors may be different compared to females, as the relationship may take longer to develop before it becomes highly sexual in nature. Mitchell, Wolak, et al., (2005) argued there are three main reasons why online undercover investi- gations are safeguarding the public. First, 13% of offenders arrested during proactive investigations were found to be committing similar indiscretions against in-person victims. Second, the investigations assist in identifying other misconducts, in that 41% of offenders were also in possession of child porno- graphy. Finally, a portion of offenders contacting children online (43%) appeared to have the intention 66 G.M.WINTERSETAL. of meeting the child in person to engage in sexual acts, as determined by the offender bringing sex- related items to the arranged meeting. Mitchell, Wolak, et al., (2005) concluded that law enforcement and other agencies should continue to conduct proactive investigations, as they may be a means to prevent sexual abuse, the online presence could deter potential offenders, and it allows police to gather solid evidence. Further, Mitchell, Wolak, et al., (2005) reported that these investigations have been largely successful in the court of law, with high rates of guilty pleas and low rates of dropped cases. It is clear that undercover investigations for offenders attempting to groom children online are an important step towards preventing future sexual abuse.

The current study The vast majority of minors in the United States utilise the Internet, with many of these children experiencing sexual solicitation online (Ybarra et al., 2004). The Internet provides potential offenders with a means for targeting and sexually grooming children with the aim of engaging in online and/or offline sexual contact. While various studies have sought to gain a better understanding of these online sexual offenders, to our knowledge there has yet to be a comprehensive study investigating numerous features of these types of offenses (eg offender and victim characteristics, analysis of the online conversation). The present study seeks to fill this gap in the literature by examining transcripts of proactive investigations in order to garner valuable information about online sexual offending. As such, our study sought to provide more comprehensive information regarding three important com- ponents of online sexual offenses: offender characteristics, victim characteristics, and dynamics of the conversation. In order to do so, we analysed data for a large sample of transcripts of proactive inves- tigations from the public domain Perverted Justice, which posts conversations of adults contacting decoy children online for sexual purposes.

Method Materials Transcripts analysed in this study were obtained from the Perverted Justice website (http://www. perverted-justice.com/). Perverted Justice is an American, not-for-profit website that provides a data- base of transcripts of individuals contacting decoy children online for sexual purposes. Adult volun- teers, who are affiliated with and trained by Perverted Justice, enter chat rooms posing as decoy children. If an adult attempts to contact the Perverted Justice volunteer online via chat rooms, the decoy victim converses with the adult in their role as a minor. Through these online communications, the volunteer obtains sufficient information to provide to law enforcement in an effort to convict the adult who has attempted to engage a minor in sexual behaviour online. Henceforth, the Perverted Justice adult volunteer will be referred to as the decoy victim. Perverted Justice posts the verbatim transcripts of these online sexual encounters between an adult and decoy minors for public knowledge and awareness. Taken from the Perverted Justice mission statement, the goal of this organisation is “to root out and bring to light those who would use the internet as a way to sexually abuse children, to brighten the darkened corner of the internet from which they wish to prey upon small children”. As of January 2016, the work of Perverted Justice volunteers and law enforcement has resulted in 593 criminal convictions since June 2004. Further- more, Perverted Justice, in conjunction with National Broadcast Company (NBC), created the popular television program To Catch a Predator, which apprehends online sex offenders in sting oper- ations (Hansen, 2007). Transcripts from Perverted Justice have been used in several peer-reviewed publications (eg Marcum, 2007; Williams et al., 2013). One hundred transcripts were randomly selected from 593 avail- able transcripts (16.9%) in the database for the present study. Transcript length ranged from 4 to 220 pages, single-spaced. JOURNAL OF SEXUAL AGGRESSION 67

Participants All 100 offenders were male and the average age of an offender was 35.33 years (range 19–64). The decoy victims were portrayed to be primarily female (95%; n = 95) and between the ages of 12 and 15 years.

Data coding Transcripts were examined using a coding scheme developed by the primary researchers using both an inductive (ie review of information provided on the Perverted Justice website) and deductive (ie review of relevant literature on online offenders and victims) approach. Three main categories of information were coded: offender characteristics, decoy victim characteristics, and conversation characteristics.

Offender characteristics Offender demographic information was gathered, including gender, actual age, online age (the age they reported online) and location (ie city, state). Additionally, the offender’s online username was coded for sexual content. A username was considered sexual if the name was “of, relating to, or associated with sex or the sexes” as defined by the Merriam-Webster’s Dictionary online dictionary (n.d.).

Decoy victim characteristics Information about the decoy victim’s portrayed gender, age, location, and whether they stated that they resided in the same state as the offender was coded.

Conversation characteristics Conversations were coded for duration, sexual content, exchange of photographs, and whether an in- person meeting was arranged. Data on the length of contact between the decoy victim and offender were coded and included data related to the dates of communication, total number of days con- tacted, total number of days between first and last conversation, and the total number of conversa- tions. The total coded length of each conversation and the length of total contact were calculated in hours. A new “conversation” was coded if contact between offender and decoy victim ceased for more than one hour, at which point a new “conversation” began when either party attempted contact again. A conversation was coded as “unanswered” if a party attempted to initiate contact, and the other party did not respond within one hour. Conversations were also coded for the number of times the offender and decoy victim initiated conversations (both answered and unan- swered attempts). Additionally, transcripts were coded to determine the number of minutes or days into the relationship that sexual content was first broached. The definition of “sexual” content was described above using the Merriam-Webster’s Dictionary online dictionary (n.d.). Further, transcripts were coded to determine if photographs were sent from either party and the number of minutes or days before pictures were exchanged. Transcripts were also coded to deter- mine whether the offender tried to contact the decoy victim via telephone or text message. Finally, transcripts were coded to ascertain whether an in-person meeting was arranged, the number of days the parties were conversing before a meeting was suggested, and whether the decoy victim or offender brought up the idea of the meeting.

Procedure The two primary researchers separately coded several transcripts (not included in the final sample) based on the coding scheme described above in order to ensure the feasibility and reliability of the scheme. The per cent agreement between the primary researchers’ coding was 82.1%. Any 68 G.M.WINTERSETAL.

discrepancies between the two researchers were discussed; inconsistencies in coding were mainly due to one missed date of conversation by one coder that impacted several codes. The coding scheme was further adapted when necessary and finalised. Then, the primary researchers trained a group of Master’s-level research assistants on the coding scheme. Each research assistant individu- ally coded one sample transcript (not included in the final sample) to ensure a thorough understand- ing of the coding scheme. The primary researchers provided corrective feedback if necessary (eg addressing miscalculations; typing mistakes). The inter-rater reliability was examined for codes that required subjective decision-making (eg whether a username or content was sexual in nature). The determination of sexual usernames and content was coded independently by the primary researchers and there was perfect inter-rater agreement (100%). The primary researchers also reviewed the coding databases of the research assistants to review for miscalculations or inconsisten- cies (eg the total number of days contacted; number of days before a meeting was suggested). Ana- lyses of the data were conducted using a combination of Microsoft Excel and SPSS software.

Results Offender characteristics Offenders in all of the transcripts that were examined were male (100%; n = 100) with an average actual age of 35.33 years (range 19–64) and the average online age of 32.35 years old (range 19– 61). Approximately one-third of offenders lied about their age to the decoy victim (33%; n = 33) and all but one (97%; 32/33) presented themselves as younger than their actual age (mean age differ- ence from actual to portrayed was 9.03 years). We found that the actual age of the offender was 50 or above in 16% of the cases (n = 16). None of the offenders stated they were minors under the age of 18. Relatively few of the offenders (16%; n = 16) had usernames that were sexual in nature.

Victim characteristics The portrayed gender of the decoy victims in the sample was 95% female (n = 95) and 5% male (n = 5). The mean portrayed age of the decoy victims was 13.21 years old (range 12–15). The majority of the decoy victims (88%; n = 88) lived in the same state as the offender, with 10% (n = 10) residing in the same city. None of the decoy victims had online usernames that were sexual in nature, though it should be noted that in 15% (n = 15) of the transcripts the decoy victim’s username name was not provided.

Conversation characteristics The average number of days of contact between the offender and decoy victim was 9.52 (range 1–74). Three transcripts were not analysed due to the first date (or more) of contact not being provided. The mean total number of days between the first and last contact was 24.77 days (range 1–335). Again, six transcripts were not included due to missing dates. The total number of con- versations, not including unanswered attempts to start a conversation, was on average 10.97 days (range 1–68). The average total number of hours contacted was 15.48 (range 0.82–148.60), though two transcripts were unknown due to lack of time stamps. The offenders initiated the conversation on average 7.35 times (range 1–44), while the mean number of conversations initiated by the decoy victim was 3.68 (range 0–24). Thus, the majority of contact was initiated by the offender in 76% (n = 76) of the cases, by the decoy victim in 19% of the cases (n = 19), and was equal in 5% (n = 5) cases. The results indicated that 89% (n = 89) of offenders introduced sexual content in the first conver- sation with the decoy victim (range 1–10). All but two (98%; 98/100) offenders introduced sexual content by the second day of conversation with the decoy victim. The mean number of minutes before sexual content was introduced into the conversation was 33.94 minutes (although two JOURNAL OF SEXUAL AGGRESSION 69

transcripts were unknown due to lack of time stamps provided), with a range from 1 to 285 minutes. In more than two-thirds of the cases (69%; n = 69), sexual content was introduced in under 30 minutes from the start of the conversation with the decoy victim. Some examples of sexual content include: “young girls make me horny”, “we could cuddle when we watch a movie”, “do you talk about sex and things like that?”, “do you have a cute butt”, “when did you loose your virgi- nity?”, “hi sexy”, “I bet I am too old for you and like it says I am bored and naked”, “are you a virgin”, and “whats the most u have done with a guy”. It was found that 85% (n = 85) of the offenders sent a photograph to the decoy victim or had a picture posted on their profile. On average, the picture was sent or viewed 2.69 days into conversa- tion (range 1–119 days). Of those 85 individuals, 77 (90.6%) sent the photograph on the first day. In 95% (n = 95) of the transcripts, the decoy victim sent the offender a photograph or had one posted on their profile. The photographs were sent to the offender on average 1.55 days into conversation (range 1–20), with 89 of the 95 (93.7%) being sent on the first day of conversing. Some examples of conversations regarding photographs include “can you take pics and send to me”, “got any bikini pics?”, “yea, so do u have a pic or a cam?”, and “everyday I look at your pic and imagine myself kissing your soft lips”. In 83% (n = 83) of the transcripts, the offender and decoy victim contacted one another through calling or texting, in addition to Internet communication. Conversations surrounding telephone contact included comments such as, “we need to talk on the phone and get serious”, “u think i could maybe call u?”, “that way i can picture ur voice when we chat?”, “hopefully we can talk on phone soon and i see u fri”, and “ hurry up and get a cell phone”. The results revealed that in 96% (n = 96) of the cases, the offender and decoy victim arranged an in-person meeting. Of the four cases when a meeting was not arranged, in three instances a meeting was mentioned though it never came to fruition. The majority of the time (89%; n = 89), the offender brought up the idea of a meeting, with only six instances being initiated by the decoy victim and five being unknown because the discussion took place over the telephone. Examples of offenders comments discussing in-person meetings include: “i will gi[v]e u a big kiss on ur lips and one on ur neck when we meet and r alone”, “i can come and pick u up baby”, “so what r my chances that we hang out?”, “you ever wanna hook up sometime?”, and “u wanna hang out do some cool stuff”. The mean number of days before the idea of a meeting in-person was introduced up was 3.4 (range 1–56 days).

Discussion This exploratory study examined publically available transcripts of sexual offenders who contacted minors on the Internet with the aim of better understanding the phenomenon of online grooming. Thus, the present study included an analysis of characteristics of the offender and victim, as well as the dynamics of the conversations. Overall, we found the offenders in the sample were males, most of whom were contacting minors who they believed to be females between the ages of 12 and 15. The offenders’ sexual intentions were typically made clear immediately, with sexual content being intro- duced on average 34 minutes into the conversation and some even having sexual online usernames. The duration of contact between the offender and decoy victim greatly varied, although on average the communication lasted approximately 25 days between the first and last date of contact. Impor- tantly, almost all of the offenders attempted to arrange an in-person meeting. These findings shed light on various aspects of the online grooming process and offenders who commit such crimes.

Offender characteristics All of the offenders in this study were male, which is consistent with prior research showing that sex offenders overwhelmingly are men (Greenfeld & Snell, 1999). The average age of the online offenders was 35 years old, which is similar to the findings from a meta-analysis comparing online and in- person offenders which found a mean age of 38.6 years for those who committed sexual offenses 70 G.M.WINTERSETAL. online (Babchishin et al., 2011). In this study, offenders’ ages ranged between 19 and 64 years. Hanson (2002) found that extra-familial child molesters showed relatively little reduction in recidivism risk until after the age of 50. Therefore, it appears that this group of offenders may continue to be at risk of reoffending into late adulthood. Given that our findings depicted 16% of the sample was age 50 or above, it may be that online offenders continue to be at high risk into late adulthood as well. The guise of the Internet may allow offenders of all ages to contact potential victims online. It would be beneficial for future studies to explore online predation in relation to age to gain a better understanding of the risk level of these online offenders. Approximately one-third of the offenders in our sample lied about their age, with all but one por- traying themselves as younger than their true age. Interestingly, none of the offenders represented themselves as children (under the age of 18) over the Internet. This finding is inconsistent with prior studies that have estimated between 5% and 33% of online sexual offenders pose as minors on the Internet (Malesky, 2007; Wolak et al., 2004). Overall, our sample consisted of solely true-representation offenders and none who posed as children (ie deceptive-representation). However, it must be stressed that the sample utilised in the present study was comprised of adult volunteers contacting people online with the intent to find adult offenders. Therefore, it is unlikely that the Perverted Justice volunteers would have engaged in conversations with other minors. We found that a small number (16%) of the offenders had usernames that were sexual in nature. The use of sexual usernames may make the offender’s sexual goals explicit before the conversation even begins. Prior researchers have suggested the intent of online sexual offenders is often made clear early on during conversation (Kloess et al., 2015; Marcum, 2007; Mitchell, Finkelhor, et al., 2005). Our study further supports this notion by showing that some perpetrators’ goals are overtly sexual even prior to the conversation commencing. Agencies that monitor chat rooms for inappropri- ate behaviours should be aware that some online sexual offenders who engage in conversations with minors may display their intentions in the content of their usernames.

Victim characteristics Similar to previous research which found that targeted children tend to be between the ages of 13 and 17 (Wolak et al., 2010), the decoy victims in our study portrayed themselves as minors between the ages of 12 and 15 years. None of the decoy victims in this study had a username that was sexual in nature. Therefore, it does not appear as if the offenders were contacting these potential victims based on overt sexual material, but rather selecting victims at random to begin a discussion in hopes of unveiling sexual interest. The information gathered from the study does shed light on one aspect of victim selection, in that offenders appear to target victims within close geographical proximity. We found that the large majority of the victims resided in the same state as offenders (88%). Given that a person’s state of residence is typically posted in the chat room profile, these findings suggest offenders may be making a conscious decision to sexually groom those who live nearby in the event that they can persuade the victim into an in-person meeting. As Malesky (2007) found, many offenders view profiles of potential victims during the victim selection process, which is likely the occurrence with many of the offenders in our sample. Other studies have found that online offenders inquire about the potential victim’s location early on, likely with the goal of deter- mining if access to the child would be too difficult and a new target should be sought (Black et al., 2015). This highlights the importance of educating children to not give out personal information and their location on their profile or in conversations with strangers.

Conversation characteristics Through examination of the conversations, we found that, on average, offenders had conversations with the victim on approximately nine different days; however, the range of days the conversation lasted varied widely. Similarly, we found wide ranges for the days between the first and last JOURNAL OF SEXUAL AGGRESSION 71 contact, total number of conversations, and total number of hours the communication lasted. These numbers suggest that while some offenders take time to develop a relationship with the victim, others move quickly into arranging in-person meetings. We found that, overall, offenders attempted to arrange an in-person meeting after only a short period of time, with an average of only about 3 days. Traditionally, sexual grooming has been thought to be a long and strategic process (van Dam, 2001; McAlinden, 2006) and online offenders may slowly develop a relationship prior to pursu- ing an in-person meeting (Wolak et al., 2004). However, our results suggest that the grooming process may occur fairly quickly for online sexual offenders. Similarly, Black et al. (2015) found that many core online grooming techniques were employed during the first 20% of transcripts of Internet offenders. It may be the case that the Internet has the ability to speed the grooming process along, whereas building trust and manipulating a victim in person may be more time-consuming. One possible explanation for the increased speed of online grooming may be the secretiveness of private online conversations, in that an offender can likely retreat from the situation should they assess the risk become too high. Furthermore, offenders may attempt to converse with multiple potential victims at one time in order to locate children they can more quickly and easily access. The Internet may also provide the opportunity for offenders to communicate with children more easily without parental involvement, whereas in-person grooming may be more visible to the child’s caregivers and community members. We also found that sexual content was introduced into the conversation within the first day of conversation in 98% of the cases. Even more shocking, the majority of the offenders (69%) broached sexual content in the first 30 minutes of conversing with the victim. This coincides with prior research that sexual interests and intentions are made explicit at the commencement of contact with the victim (Marcum, 2007), often introducing sexual material in the first conversation (Mitchell et al., 2005). It is plausible that this is done to determine whether the minor would be interested in enga- ging in a sexual relationship. It may be that the offender aims to learn early on whether conversing with the targeted child has the potential to become more sexual, or whether the minor is uninter- ested so that they can begin searching for another potential victim. As proposed by Black et al. (2015), online offenders may assess risk at an earlier stage than in-person child molesters to quickly determine whether the child is worth pursuing. Furthermore, in our sample, the goal of the decoy victim is to assist law enforcement in gathering evidence against the offender, so it may be that sexual content is initiated or welcomed in order to obtain proof of the offenders’ deviant intentions. The majority of offenders and victims exchanged pictures, often within the first day. The willing- ness to share photographs may be a way to build trust between the offender and victim. This exchange of photographs may be used as a technique to familiarise the child with the adult with whom they are conversing. Further, it is unclear in this particular study whether the photographs were sexual in nature, though prior research has suggested photograph exchange may be used for sexual purposes (Briggs et al., 2011). It may be that sending sexual content desensitises the victim to this type of material, which could allow the offender to more easily escalate to increased sexualised behaviours. Future studies should seek to examine if, and when, these photograph exchanges between online offenders and their victims contain sexual content. Nevertheless, these results stress the importance of parents and children alike being educated on the potential dangers of exchanging such personal information via the Internet, as this exchange could be made with a person with inappropriate sexual intentions. Almost all of the offenders in this study initiated and arranged a meeting with the victim. This suggests that the motivation behind the online contact is to reach the ultimate goal of a contact offense with the victim. The sample in the present study appears to represent online offenders who converse with children with the aim of committing an in-person offense (ie contact-driven), rather than those who engage in conversation with the goal of cybersex (ie fantasy-driven). Thus, the intentions of online offenders may in fact frequently be to commit in-person offenses. It is impor- tant to note that this may not be fully representative of online offenders given that the transcripts 72 G.M.WINTERSETAL. involved adults posing as children who are not likely to be able to engage in extensive cybersex- related activities, which could differ if the offender were speaking to a real child victim who may be manipulated into engaging in online sexual behaviours. However, the results do provide support that these types of proactive investigations may be a crucial part in preventing contact- driven offenders from luring real child victims with the goal of committing a contact offense. The increased use of proactive investigations has raised the question as to whether offenders in such sting operations are victims of entrapment, which can be used as a viable defence in the US court of law (Seto, 2002; Yamagami, 2001). Entrapment defences argue that the offender was coerced into committing a crime they would not otherwise have engaged (Tawil, 2000). We exam- ined the question of entrapment by investigating which party was initiating conversation and who proposed the idea of the in-person meeting. It could be argued that if the adult posing as a child is contacting the offender frequently and introducing the idea of a meeting, then the offender is being unduly persuaded into these acts. Our results revealed the majority of conversations with the decoy victim were initiated by the offender and the offenders most often introduced the idea of a meeting with the decoy victim. Therefore, it appears that these offenders are not being forced into communicating with these adults posing as children and they themselves are suggesting the sexual activity be moved to an in-person setting. It remains unclear to what extent the adults posing as children in proactive investigations would continue a sexually driven conversation compared to a real child victim, who may retreat when this form of content is introduced. Future research should investigate the extent to which decoy victims in proactive investigations lure sexual content out or encourage sexual conversations as compared to real child victims’ communication. Additionally, it would be beneficial to determine whether decoy victims brought up the idea of an in-person meeting more frequently compared to real child victims. Although the offender and victim met in an online chat room, the conversations were not exclu- sive to the Internet, with 83% of the offenders and decoy victims being in contact via telephone or text message. We consider this an especially important finding, because the use of other means of communication has largely been overlooked in the past literature regarding online sexual offenders. Tener, Wolak, and Finkelhor (2015) examined the use of the “Internet” to contact minors (which included the use of cell phones) and referenced qualitative data that refer to cell phone use by offen- ders. However, more examination into the use of cell phones to contact minors may be warranted given the offenders in the present study were able to gain access to the decoy child both over the Internet and through the use of the victim’s phone. This raises the alarm that children’s parents and other community members (eg school employees, extended family) should monitor tel- ephone usage closely in addition to children’s access to the Internet. Overall, the findings of this study align well with Staksrud’s(2013) and O’Connell’s(2003) models of online grooming. As Staksrud proposed, it appears that our offenders first entered chat rooms and identified a potential child to converse with, possibly through examination of geographical locations on their online profiles. This conversation was conducted in a private chat room, with the offender’s likely intent being to have a more personal exchange with the potential victim. At this point, it is pro- posed that offenders engage in core grooming strategies, which were detailed by O’Connell. Our data also lend support for the sexual stage as described by O’Connell, whereby the offender introduces sexual content into the conversations. Importantly, our results showed that this stage was typically initiated very early on, as seen by the majority offenders in our sample discussing sexual content within 30 minutes of conversing with the child. It may be that some offenders may move quickly into the sexual stage, or skip the stages of friendship-forming, relationship-forming, and risk- assessment all together. This finding aligns with prior research that has found that online offenders may engage in key grooming strategies early on in conversations, which is especially evident by the early introduction of sexual content (Black et al., 2015). The final stage in Staksrud’s model involves the offender’s final goal, which in most of our sample was to meet the child for an in-person meeting. While there are some similarities with our sample and prior models of online sexual grooming, future JOURNAL OF SEXUAL AGGRESSION 73 research should seek to examine the prevalence of the various stages and extent the models are applicable to the majority of online offenders.

Limitations There were some limitations to the current study that should be noted. We must first recognise the ethical issues and challenges surrounding the undertaking of the Perverted Justice website. The website is part of a non-profit foundation that trains adult citizens as volunteers to enter chat rooms as minors. Importantly, however, the website works with law enforcement if a volunteer posing as a minor is solicited for sex by an adult, in order to facilitate the prosecution and conviction of these individuals. Despite this collaboration with police, the data garnered from this public domain for research purposes should be taken with some caution given the website’s morally driven aims and lack of stringent monitoring. While the Perverted Justice website allowed us to investigate a large number of transcripts of sexual groomers, these transcripts consisted of communication involving adults posing as child victims. As noted by Williams et al. (2013), a decoy victim will likely continue to engage in conversa- tions with the offender even though the content may be unsettling; however, a true victim may decide to stop contact with the offender once they become uncomfortable. It is also possible the decoy victim may even steer the conversation in an effort to encourage the sexual offender to broach specific topics of conversation. Furthermore, it is important to note that none of the adult offenders in this study were posing as children in the online chat rooms. It is unclear as to whether Perverted Justice volunteers would have engaged in conversation with those who rep- resented themselves as a minor. Although there is merit to using transcripts of adults posing as chil- dren to track and examine online sexual offender grooming strategies, it may not be representative of true online grooming. As it is difficult to garner such data, few studies have been able to utilise cases of online grooming (eg Kloess et al., 2015). In the future, it would be beneficial for more research to examine transcripts from real victims as opposed to transcripts generated from adults posing as children.

Future directions While the present study provided important quantitative information regarding online sexual offen- ders, there is still a need to deepen our understanding of sexual grooming techniques by investi- gating the rapport-building skills the offenders employ to build trust with their potential victims. For example, Williams et al. (2013) identified three potential themes in conversation: rapport-building, sexual content, and assessment. Research should continue to examine the specific themes in conver- sation that commonly occur to better understand this online sexual grooming process. Furthermore, investigating the models of online predation suggested by Staksrud (2013) and O’Connell (2003) could greatly increase our knowledge of how these offenders operate in order to better prevent online child sexual abuse. It should also be noted that all offenders in the current study were male and most of the victims were female, as such it would be vital to examine transcripts between different genders of victims and offenders. For instance, the content of the conversation and style of grooming techniques may change drastically if the conversation were between a female offender and a male victim as opposed to a male offender and a female victim. Understanding different grooming techniques used between different genders of offenders and victims may serve to increase the detection of chil- dren being sexually groomed over the Internet. The Perverted Justice website also did not provide demographic information of the offenders (eg race/ethnicity, socio-economic status, education level, occupation), which could be valuable information to better understand who these online sexual offenders are. Similarly, future studies need to further investigate the characteristics of online offenders such as their personality traits, sexual interests, and interpersonal functioning. 74 G.M.WINTERSETAL.

This information can further shed light on how online sexual offenders are different, or similar, to offenders who commit offenses in person.

Implications While the literature available on the behaviours and tactics of Internet sexual offenders continues to grow, there is still much to learn about online sexual offenders. This study sought to provide valuable information regarding online sexual grooming. Specifically, we investigated the offender and victim characteristics, and dynamics of the conversation using transcripts of adults contacting minors online for sexual purposes. This information could potentially increase the public’s knowledge of these types of offenders and offenses, with the aim of aiding in protecting youth from becoming a victim of online sexual abuse. The results of this study could serve to educate parents, school staff, prac- titioners, policy makers, and potential victims about the characteristics of, and tactics used by, offen- ders who contact children online. By better understanding online predation, caregivers and community members alike can monitor children’s Internet activity with increased vigilance. It is likely that vulnerable children are more frequently targeted by online offenders, seeing as these chil- dren are often aware they are conversing with adults online (Wolak et al., 2004). As Staksrud (2013) suggested, the Internet makes vulnerable children more accessible to online offenders, making it especially important for parents and school staff to be particularly vigilant towards children who may be more susceptible to this type of predation. Furthermore, individuals involved in overseeing children’s online activity should also seek to educate children on safe Internet use in age-appropriate language. In addition, this study can inform members of the criminal justice system in the pursuit of both preventing and prosecuting sexual exploitation of minors over the Internet. With increased efforts from organisations such as Perverted Justice and law enforcement, we can make the Internet a safer place by better protecting children from online sexual offenders.

Acknowledgements Special thanks to Emily A. Greene-Colozzi, Krystyn L. Margeotes, Sean J. McKinley, Gina Moreno, and Brielle M. Nuzzo for assisting in the coding of the transcripts.

Disclosure statement No potential conflict of interest was reported by the authors.

References Babchishin, K. M., Hanson, R. K., & Hermann, C. A. (2011). The characteristics of online sex offenders: A meta-analysis. Sexual Abuse: Journal of Research and Treatment, 23(1), 92–123. doi:10.1177/1079063210370708 Beech, A. R., Elliott, I. A., Birgden, A., & Findlater, D. (2008). The internet and child sexual offending: A criminological review. Aggression and Violent Behavior, 13(3), 216–228. doi:10.1016/j.avb.2008.03.007 Black, P. J., Wollis, M., Woodworth, M., & Hancock, J. T. (2015). A linguistic analysis of grooming strategies of online child sex offenders: Implications for our understanding of predatory sexual behavior in an increasingly computer-mediated world. Child Abuse & Neglect, 44, 140–149. doi:10.1016/j.chiabu.2014.12.004 Briggs, P., Simon, W. T., & Simonsen, S. (2011). An exploratory study of internet-initiated sexual offenses and the chat room sex offender: Has the internet enabled a new typology of sex offender? Sexual Abuse: Journal of Research and Treatment, 23(1), 72–91. doi:10.1177/1079063210384275 Carr, J. (2004). Child abuse, child pornography and the Internet. The National Children’s Homes. Retrieved from http:// uploadi.safe.si/editor/1149589931pornographyreport.pdf Child Exploitation and Online Protection Centre. (2010). Annual Review 2009-2010. Retrieved from http://ceop.police.uk/ Publications/ Cooper, A. (1998). Sexuality and the internet: Surfing into the new millennium. Cyberpsychology & Behavior, 1(2), 187–193. doi:10.1089/cpb.1998.1.187 JOURNAL OF SEXUAL AGGRESSION 75

Craven, S., Brown, S., & Gilchrist, E. (2006). Sexual grooming of children: Review of literature and theoretical consider- ations. Journal of Sexual Aggression, 12(3), 287–299. doi:10.1080/13552600601069414 Craven, S., Brown, S., & Gilchrist, E. (2007). Current responses to sexual grooming: Implication for prevention. The Howard Journal of Criminal Justice, 46(1), 60–71. doi:10.1111/j.1468-2311.2007.00454.x van Dam, C. (2001). Identifying child molesters: Preventing child sexual abuse by recognizing the patterns of offenders. Binghamton, NY: The Haworth Press. Gillespie, A. (2002). Child protection on the internet: Challenges for criminal law. Child and Family Law Quarterly, 14, 411–426. Greenfeld, L. A., & Snell, T. L. (1999). Women offenders. Bureau of Justice Statistics. Retrieved from http://www.bjs.gov/ content/pub/pdf/wo.pdf Grosskopf, A. (2010). Online interactions involving suspected paedophiles who engage male children. Trends and Issues in Crime and Criminal Justice, 403,1–6. Hansen, C. (2006). Prominent men caught in Petaluma sting. Retrieved from http://www.msnbc.msn.com/id/15130487/? page6 Hansen, C. (2007). To catch a predator: Protecting your kids from online enemies already in your home. New York, NY: Dutton, U.S. A. Penguin Group. Hanson, R. K. (2002). Recidivism and age: Follow-up data from 4,673 sexual offenders. Journal of Interpersonal Violence, 17 (10), 1046–1062. doi:10.1177/088626002236659 Kloess, J. A., Seymour-Smith, S., Hamilton-Giachritsis, C. E., Long, M. L., Shipley, D., & Beech, A. R. (2015). A qualitative analy- sis of offenders’ modus operandi in sexually exploitative interactions with children online. Sexual Abuse: A Journal of Research and Treatment, 1(29), 1–29. doi:1079063215612442 Krone, T. (2005). Queensland police stings in online chat rooms. Trends & Issues in Crime and Criminal Justice, 301,1–6. Lanning, K. V. (2005). Compliant child victims: Confronting an uncomfortable reality. APSAC Advisor, 14(2). Retrieved from http://www.abusewatch.net/Compliant20Child20Victims.pdf Lanning, K. V. (2010). Child molesters: A behavioral analysis for professional investigating the sexual exploitation of children (5th ed.). National Center for Missing and Exploited Children. Retrieved from http://www.missingkids.com/en_US/ publications/NC70.pdf Malesky, L. A. (2007). Predatory online behavior: Modus operandi of convicted sex offenders in identifying potential victims and contacting minors over the internet. Journal of Child Sexual Abuse, 16,23–32. doi:10.1300/J070v16n02_02 Marcum, C. D. (2007). Interpreting the intentions of internet predators: An examination of online predatory behavior. Journal of Child Sexual Abuse: Research, Treatment, & Program Innovations For Victims, Survivors, & Offenders, 16(4), 99–114. doi:10.1300/J070v16n04_06 McAlinden, A. (2006). “Setting ‘em up”: Personal, familial and institutional grooming in the sexual abuse of children. Social & Legal Studies, 15(3), 339–362. doi:10.1177/0964663906066613 Mitchell, K. J., Finkelhor, D., & Wolak, J. (2001). Risk factors for and impact of online sexual solicitation of youth. JAMA: Journal of the American Medical Association, 285(23), 3011–3014. Mitchell, K. J., Finkelhor, D., & Wolak, J. (2005). The internet and family and acquaintance sexual abuse. Child Maltreatment, 10(1), 49–60. doi:10.1177/1077559504271917 Mitchell, K. J., Wolak, J., & Finkelhor, D. (2005). Police posing as juveniles online to catch sex offenders: Is it working? Sexual Abuse: Journal of Research and Treatment, 17(3), 241–267. doi:10.1177/107906320501700302O O’Connell, R. (2003). A typology of child cybersexploitation and online grooming practices. Cyberspace Research Unit. Retrieved from http://netsafe.org.nz/Doc_Library/racheloconnell1.pdf Olson, L. N., Daggs, J. L., Ellevold, B. L., & Rogers, T. K. (2007). Entrapping the innocent: Toward a theory of child sexual predators’ luring communication. Communication Theory, 17(3), 231–251. doi:10.1111/j.1468-2885.2007.00294.x Seto, K. W. (2002). Note: How should legislation deal with children as the victims and perpetrators of cyberstalking? Cardozo Women’s Law Journal, 67,67–96. Sexual. (n.d.). In Merriam-Webster’s online dictionary. Retrieved from http://www.merriam-webster.com/ Staksrud, E. (2013). Online grooming legislation: Knee-jerk regulation? European Journal of Communication, 28(2), 152–167. Tawil, D. D. (2000). “Ready? Induct. Sting!”: Arguing for the government’s burden of proving readiness in entrapment cases. Michigan Law Review, 98(7), 2371–2394. Tener, D., Wolak, J., & Finkelhor, D. (2015). A typology of offenders who use online communications to commit sex crimes against minors. Journal of Aggression, Maltreatment & Trauma, 24(3), 319–337. doi:10.1080/10926771.2015.1009602 Whittle, H. C., Hamilton-Giachritsis, C. E., & Beech, A. R. (2014). Under his spell: Victims’ perspectives of being groomed online. Social Sciences, 3(3), 404–426. doi:10.3390/socsci3030404 Williams, R., Elliott, I. A., & Beech, A. R. (2013). Identifying sexual grooming themes used by internet sex offenders. Deviant Behavior, 34(2), 135–152. doi:10.1080/01639625.2012.707550 Wolak, J., & Finkelhor, D. (2013). Are crimes by online predators different from crimes by sex offenders who know youth in-person? Journal of Adolescent Health, 53(6), 736–741. doi:10.1016/j.jadohealth.2013.06.010 76 G.M.WINTERSETAL.

Wolak, J., Finkelhor, D., & Mitchell, K. J. (2004). Internet-initiated sex crimes against minors: Implications for prevention based on findings from a national study. Journal of Adolescent Health, 35, 424.e11–424.e20. doi:10.1016/j. jadohealth.2004.05.006 Wolak, J., Finkelhor, D., Mitchell, K. J., & Ybarra, M. L. (2010). Online “predators” and their victims: Myths, realities, and implications for prevention and treatment. Psychology of Violence, 1(S), 13–35. doi:10.1037/2152-0828.1.S.13 Wyre, R. (2000). Paedophile characteristics and patterns of behaviour. In C. Itzin (Ed.), Home truths about sexual abuse influ- encing policy and practice: A reader (pp. 49–69). London: Routledge. Yamagami, D. S. (2001). Comment: Prosecuting cyber-pedophiles: How can intent be shown in a virtual world in light of the fantasy defense? Santa Clara Law Review, 42(2), 547–579. Ybarra, M. L., Leaf, P., & Diener-West, M. (2004). Sex differences in youth-reported depressive symptomatology and unwanted internet sexual solicitation. Journal of Medical Internet Research, 6(1). doi:10.2196/jmir.6.1.e5