The Association between the Quantity and Severity of Pornography Use: A Meta-analysis

Figures & data

Figure 1. Flow diagram of the article selection process.

Table 1. Characteristics of the 61 studies included in the present meta-analysis.

Studies	PPU scales	QPU	Sample size (Male/Female)	Age (in years) M(SD); Range	Country	Sexual attitudes of countries based on the World Values Survey dataset	Sexual orientation (ratio of heterosexual participants)	Quality evaluation ^a (range 0–7)	Effect size (r)
Antons et al. (2019)	s-IAT-sex	frequency	1498/0	31.76 (11.26); 18–83	Germany	Permissive	1.00	6.5	0.219
		usage time							0.286
Ballester-Arnal et al. (2017)	ISST-Compulsivity	usage time	554/1003	20.37 (1.98); 18–25	Spain	Permissive	0.94	4.5	0.494
Baranowski et al. (2019)	s-IAT-sex	usage time	0/482	25.79 (7.27); 18–77	Germany	Permissive	-	6.5	0.430
Blais-Lecours et al. (2016)	CPUI-9	usage time	235/597	25.20 (7.99); 18–78	Canada	Permissive	-	6	0.343
	SCS								0.300
Borgogna, Isacco et al. (2020)	CPUI-9	frequency	244/0	19.63 (6.22); -	USA	Permissive	1.00	6	0.120
Borgogna et al. (2018)	PPUS	frequency	0/949	22.80 (8.50); 18-	USA	Permissive	0.82	5.5	0.453
Borgogna, McDermott et al. (2020)	PPUS	frequency	520/0	25.46 (11.99); 18–80	USA	Permissive	0.83	6.5	0.410
Bőthe, Lonza et al. (2020)	PPCS-6	frequency	509/0	34.13 (9.65); 18–76	Hungary	Conservative	-	7	0.383
	PPCS-6	frequency	3684/0	38.92 (12.61); 18–76	Hungary	Conservative	-	7	0.444
Bőthe, Tóth-Király, Bella et al. (2021)	PPCS	frequency	545/537	24.3 (5.4); 18–64	Hungary	Conservative	0.82	7	0.220
Bőthe, Tóth-Király, Demetrovics et al. (2021)	PPCS	frequency	258/8	37.2 (12.3); 18–76	Hungary	Conservative	0.69	6.5	0.270
		usage time							0.230
	PPCS	frequency	10,581/4470	33.2 (11.0); 18–76	Hungary	Conservative	0.83	6.5	0.510
		usage time							0.300
	PPCS	frequency	712/48	39.6 (9.7); 19–75	Hungary	Conservative	0.79	6.5	0.300
		usage time							0.250
Bőthe, Tóth-Király et al.(2020)	PPCS	frequency	231/252	27.7 (9.3); 18–73	Hungary	Conservative	0.90	7	0.460
Bőthe, Tóth-Király et al. (2018)	PPCS	frequency	382/390	22.58 (4.89); 18–54	Hungary	Conservative	0.80	7	0.290
		usage time							0.140
Bradley et al. (2016)	CPUI-9	usage time	370/338(5 not mentioned)	30.20 (9.90); -	USA	Permissive	-	6.5	0.180
Brahim et al. (2019)	CIUS-adapted sexually explicit material	frequency	150/156	32.63 (10.83); 18–69	Switzerland	Permissive	0.84	6.5	0.160
Brand et al. (2011)	IAT-sex	frequency	89/0	23.98 (4.09); -	Germany	Permissive	1.00	5.5	0.365
		usage time							0.203
Brand et al. (2016)	s-IAT-sex	frequency	19/0	25.05 (1.43); -	Germany	Permissive	1.00	5	0.290
		usage time							0.400
Chelsen (2011)	CPUI-9	usage time	530/0	undergraduate students	USA	Permissive	-	5	0.620
Chen, Ding et al. (2018)	s-IAT-sex	frequency	622/448	20.19 (1.18); 18-	China	Conservative	-	6.5	0.350
		usage time							0.280
Chen and Jiang (2020)	PPCS	frequency	192/125	24.64 (7.39); 18–48	China	Conservative	0.92	7	0.670
		usage time							0.280
	PPUS	frequency	201/131	24.47 (7.27); 18–45	China	Conservative	0.92	7	0.560
		usage time							0.170
	s-IAT-sex	frequency	167/156	25.31 (6.93); 18–45	China	Conservative	0.95	7	0.460
		usage time							0.220
Chen et al. (2020)	PPUS	frequency	782/0	21.32 (4.61); 18–48	China	Conservative	0.92	5	0.360
	PPUS	frequency	528/0	22.19 (5.17); 18–48	China	Conservative	0.95	6	0.470
Chen, Jiang et al. (2021)	PPCS	frequency	8845/0	25.82 (7.83); 18–65	China	Conservative	0.91	6.5	0.445
		usage time							0.305
	BPS	frequency							0.349
		usage time							0.227
	SCS	frequency							0.319
		usage time							0.218
Chen, Luo et al. (2021)	PPCS	frequency	4651/0	22.17 (4.33); 18–48	China	Conservative	0.93	6	0.390
	PPCS	frequency	695/0	25.39 (7.18); 18–48	China	Conservative	0.94	6	0.560
Chen, Wang et al. (2018)	PPUS	frequency	594/432	18.79 (0.93); 17–21	China	Conservative	-	5.5	0.570
Chen, Yang et al. (2018)	PPUS	frequency	466/342	18.54 (0.75); 17–22	China	Conservative	-	5.5	0.600
Degomez (2011)	ISST-Compulsivity	frequency	215/514	25; 18–66	USA	Permissive	-	5.5	0.199
Downing et al. (2014)	CIUS-adapted sexually explicit material	usage time	265/0	32.90 (12.50); 18-	USA	Permissive	0.19	6	0.380
Engel et al. (2019)	s-IAT-sex	usage time	630/564	42.64 (19.40); 18-	Germany	Permissive	0.83	5.5	0.454
Fernandez et al. (2017)	CPUI-9	frequency	76/0	22.27 (3.45); 18-	Malaysia	Conservative	0.90	6	0.320
Grubbs, Exline et al. (2015)	CPUI-9	usage time	228/103	19.50 (1.90); undergraduates	USA	Permissive	0.88	6	0.300
	CPUI-9	usage time	49/48	19.50 (1.30); undergraduates	USA	Permissive	0.89	6	0.320
	CPUI-9	usage time	136/72	31.80 (10.60); 18-	USA	Permissive	0.79	6.5	0.190
Grubbs et al. (2017)	CPUI-9	usage time	1021/498	19.30 (1.30); undergraduates	USA	Permissive	-	6	0.220
	CPUI-9	usage time	370/338 (5 not mentioned)	30.2 (9.9); 18-	USA	Permissive	-	6.5	0.180
Grubbs and Gola (2019)	CPUI-9 (compulsivity)	usage time	147/0	19.80 (3.70); undergraduates	USA	Permissive	-	5	0.320
	CPUI-9 (compulsivity)	frequency	297/0	46.50 (15.30); 18-	USA	Permissive	-	5.5	0.210
		usage time							0.190
	CPUI-9 (compulsivity)	usage time	433/0	33.5 (9.7); 18-	USA	Permissive	-	5.5	0.430
Grubbs, Kraus et al. (2019)	CPUI-9 (3 items)	frequency	862/599	44.80 (16.70); 18-	USA	Permissive	-	6.5	0.263
		usage time							0.144
Grubbs, Kraus et al. (2020)	CPUI-9 (compulsivity)	usage time	445/405	33.98 (9.87); -	USA	Permissive	-	6.5	0.441
Grubbs, Lee et al. (2020)	CPUI-9 (compulsivity)	frequency	946/478	43.92 (16.74); 18-	USA	Permissive	-	6.5	0.402
	BPS								0.335
Grubbs, Wilt, Exline, & Pargament et al. (2018)	CPUI-9	usage time	915/437	undergraduates;	USA	Permissive	0.90	5.5	0.180
	CPUI-9	usage time	387/406	18-	USA	Permissive	0.84	6.5	0.230
Harper and Hodgins (2016)	CPUI-9 (compulsivity)	frequency	86/105	21.05 (2.96); 17–38	Canada	Permissive	0.85	5.5	0.528
		usage time							0.302
	IP-CRIT	frequency							0.536
		usage time							0.389
Hatch et al. (2020)	PPUS	frequency	172/141 (4 not mentioned)	36.32 (10.20); -	USA	Permissive	-	6	0.460
		usage time							0.440
Klein et al. (2020)	s-IAT-sex	usage time	72/0	25.56 (4.45); 18– 40	Germany	Permissive	-	6	0.516
Kohut and Stulhofer (2018)	CPCS	frequency	314/0	second year of secondary school	Croatia	Conservative	-	5.5	0.400
	CPCS	frequency	197/0	second year of secondary school	Croatia	Conservative	-	5.5	0.240
Kor et al. (2014)	PPUS	frequency	834/886	39.52 (14.18); 18–70	Israel	Permissive	-	6	0.560
	PPUS	frequency	180/120	43.85 (14.34); 18–69	Israel	Permissive	-	6	0.610
Kraus et al. (2018)	SCS	frequency	265/0	21.56 (3.63); university students	USA	Permissive	0.82	6.5	0.300
Kraus et al. (2020)	BPS	frequency	698/360	32.94 (7.45); 18–55	USA	Permissive	0.82	6.5	0.391
		usage time							0.230
	BPS	frequency	338/132	44.90 (15.90); 18-	USA	Permissive	0.88	6.5	0.470
		usage time							0.330
	BPS	usage time	0/512	26.04 (6.07); 18–54	Poland	Conservative	-	6	0.070
	BPS	usage time	191/0	26.04 (6.07); 18–54	Poland	Conservative	-	6	0.170
Laier et al. (2014)	s-IAT-sex	usage time	0/51	21.83 (2.48); 18–29	Germany	Permissive	1.00	5.5	0.540
Laier et al. (2015)	s-IAT-sex	usage time	71/0	29.15 (6.22); 20–48	Germany	Permissive	0.00	6.5	0.185
Leonhardt et al. (2021)	CPUI-9 (compulsivity)	frequency	649/0	34.12 (10.46); 18–83	USA	Permissive	0.98	6.5	0.360
	CPUI-9 (compulsivity)	frequency	0/772	34.12 (10.46); 18–83	USA	Permissive	0.98	6.5	0.420
Leonhardt et al. (2018)	SCS	frequency	350/336	28.64 (7.85); 18–59	USA	Permissive	-	7	0.177
Levin et al. (2019)	CPUI-9	usage time	91/0	21.31 (3.99); 18–45	USA	Permissive	0.95	6.5	0.400
Lewczuk et al. (2020)	CPUI-9	frequency	485/395	43.69 (14.06); 18–69	Poland	Conservative	-	7	0.530
	BPS								0.440
Mennig et al. (2020)	OPDQ	usage time	537/156(7 not mentioned)	32.9 (12.6); 18-	Germany	Permissive	-	6.5	0.220
Pawlikowski et al. (2014)	s-IAT-sex	usage time	106/28	26.31 (8.31); -	Australia	Permissive	-	6	0.231
Rimington (2008)	SCS	usage time	134/123(5 not mentioned)	graduates and undergraduates; 18-	USA	Permissive	0.90	4.5	0.290
Rousseau et al. (2021)	CPCS	frequency	337/0	15.9 (0.52); high school sophomores	Croatia	Conservative	-	6	0.310
Sevcikova et al. (2021)	s-IAT-sex	frequency	129/20	55.44 (5.44); 50–77	Czech	Permissive	0.63	7	0.210
Shirk et al. (2021)	PPUS	frequency	172/0	33.9 (8.53); -	USA	Permissive	-	6.5	0.390
Snagowski and Brand (2015)	s-IAT-sex-craving	frequency	123/0	23.79 (5.10); 18-	Germany	Permissive	1.00	5.5	0.227
		usage time							0.198
Stark et al. (2017)	s-IAT-sex	usage time	48/0	25.96 (4.96); 18–44	Germany	Permissive	1.00	6	0.330
	s-IAT-sex	usage time	0/47	24.94 (5.09); 18–42	Germany	Permissive	1.00	6	0.330
Volk et al. (2019)	CPUI-9	frequency	90/0	32.1 (7.79); 18–49	USA	Permissive	-	7	0.242
	CPUI-9	frequency	0/89	32.1 (7.79); 18–49	USA	Permissive	-	7	0.026
Volk et al. (2016)	CPUI-9	usage time	187/171	34.13 (10.61); 18–66	USA	Permissive	0.88	7	0.200
Wéry et al. (2016)	s-IAT-sex	frequency	388/0	28.74 (8.80); 18–72	Belgium	Permissive	0.89	6.5	0.235
Wetterneck et al. (2012)	SCS	usage time	152/342	29.50 (9.00); 18–66	USA	Permissive	0.90	5.5	0.380
Wilt et al. (2016)	CPUI-9	usage time	732/338	19.33 (2.53); undergraduates	USA	Permissive	-	6	0.220

Note. ^a The higher the total score, the higher the quality of the research. PPU = Problematic Pornography Use; QPU = Quantity of Pornography Use; s-IAT-sex = Short Internet Addiction Test Adapted to Online Sexual Activities; ISST- Compulsivity = the compulsivity factor of Internet Sex Screening Test; IP-CRIT = adapted DSM-5 Internet pornography addiction criteria; BPS = Brief Pornography Screen; CIUS-adapted sexually explicit material = Compulsive Internet Use Scale adapted sexually explicit material; CPCS = Compulsive Pornography Consumption Scale; CPUI-9 = Cyber Pornography Use Inventory-9; PPCS = Problematic Pornography Consumption Scale; PPUS = Problematic Pornography Use Scale; SCS = Sexual Compulsivity Scales; OPDQ = Online Pornography Disorder Questionnaire.

Figure 2. The original funnel plot of the effect sizes (K = 82).

Figure 3. The adjusted funnel plot using the trim-and-fill method (K = 82).

Table 2. Summary of the results of the sub-group meta-analysis.

Moderator	Subgroup	k	Effect size (95% confidence) interval)			Q	I^2 (%)	p
			effect size(r)	lower	upper
Measurement of PPU	Developed based on the addiction framework	45	0.388	0.358	0.417	547.57	92.0	0.002
	Developed based on the obsessive-compulsive framework	22	0.323	0.285	0.361	144.17	85.4
	Developed based on the self-perceived PPU framework	20	0.280	0.214	0.344	284.47	93.3
Measurement of QPU	Frequency	51	0.381	0.347	0.415	967.9	94.8	< 0.001
	Use time	50	0.293	0.263	0.323	502.94	90.3
Measurement method	Single-item	78	0.312	0.280	0.344	1728.73	95.5	< 0.001
	Multi-item	23	0.426	0.379	0.470	320.42	93.1
Sexual orientation^a	Mostly sexual minority	2	0.309	0.116	0.479	2.45	59.1	0.718
	Mostly heterosexual	46	0.343	0.314	0.371	418.30	89.2
Sample type	Treatment-seeking	5	0.346	0.295	0.395	29.31	86.4	0.916
	Community	77	0.343	0.313	0.373	1126.88	93.3
Gender	Men	38	0.376	0.340	0.412	361.89	89.8	0.506
	Women	13	0.408	0.321	0.488	122.30	90.2
Sexual culture	Conservative	15	0.413	0.348	0.474	313.18	95.8	0.021
	Permissive	67	0.329	0.298	0.358	844.88	92.2
Sexual culture × Gender	Conservative × Men	13	0.426	0.355	0.493	-	-	0.246
	Conservative ×Women	7	0.425	0.324	0.517	-	-
	Permissive ×Men	25	0.342	0.284	0.398	-	-
	Permissive ×Women	6	0.383	0.262	0.493	-	-
Sexual culture × Measurement of PPU	Conservative × Addiction framework	11	0.444	0.380	0.504	-	-	< 0.001
	Conservative × Obsessive-compulsive framework	4	0.251	0.126	0.369	-	-
	Conservative × Self-perceived PPU framework	2	0.459	0.285	0.604	-	-
	Permissive × Addiction framework	34	0.364	0.322	0.405	-	-
	Permissive × Obsessive-compulsive framework	18	0.338	0.282	0.392	-	-
	Permissive × Self-perceived PPU framework	18	0.262	0.202	0.320	-	-

Note. ^a The ratio of heterosexual-sexual minority participants was reported in Table 1; if the ratio was greater than 0.5, it was considered as a mostly heterosexual sample. If not, it was considered as a mostly sexual minority sample.

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