Tweeting about testing: do low-income, parenting adolescents and young adults use new media technologies to communicate about sexual health?

COVID-19 Information Dissemination Using the WeChat Communication Index: Retrospective Analysis Study

Background

The COVID-19 outbreak has tremendously impacted the world. The number of confirmed cases has continued to increase, causing damage to society and the economy worldwide. The public pays close attention to information on the pandemic and learns about the disease through various media outlets. The dissemination of comprehensive and accurate COVID-19 information that the public needs helps to educate people so they can take preventive measures.

Objective

This study aimed to examine the dissemination of COVID-19 information by analyzing the information released by the official WeChat account of the People’s Daily during the pandemic. The most-read COVID-19 information in China was summarized, and the factors that influence information dissemination were studied to understand the characteristics that affect its dissemination. Moreover, this was conducted in order to identify how to effectively disseminate COVID-19 information and to provide suggestions on how to manage public opinion and information governance during a pandemic.

Methods

This was a retrospective study based on a WeChat official account. We collected all COVID-19–related information, starting with the first report about COVID-19 from the People’s Daily and ending with the last piece of information about lifting the first-level emergency response in 34 Chinese provinces. A descriptive analysis was then conducted on this information, as well as on Qingbo Big Data’s dissemination index. Multiple linear regression was utilized to study the factors that affected information dissemination based on various characteristics and the dissemination index.

Results

From January 19 to May 2, 2020, the People’s Daily released 1984 pieces of information; 1621 were related to COVID-19, which mainly included headline news items, items with emotional content, and issues related to the pandemic’s development. By analyzing the dissemination index, seven information dissemination peaks were discerned. Among the three dimensions of COVID-19 information—media salience, content, and format—eight factors affected the spread of COVID-19 information.

Conclusions

Different types of pandemic-related information have varying dissemination power. To effectively disseminate information and prevent the spread of COVID-19, we should identify the factors that affect this dissemination. We should then disseminate the types of information the public is most concerned about, use information to educate people to improve their health literacy, and improve public opinion and information governance.

Changes in sexual behavior among high-school students over a 40-year period

The aim of this study was to investigate sexual behavior, contraceptive use, risk factors as well as sources of sex information among first-year high-school students in Sweden. Secondly, to assess differences between genders and study programs as well as changes over a 40-year period. A repeated cross-sectional survey was conducted in two cities. A questionnaire comprising 77 items was used. The study population consisted of 415 students (63.4% females). The median age of sexual intercourse was 15 years. In total, 37% had had sexual intercourse, compared to 56.3% in 2009 and 45% in 1999 (p < 0.001), and the proportion of students who had their first sexual intercourse was not influenced by gender. More students in vocational programs (46.3%), compared to theoretical (33.3%), had experience of at least one sexual intercourse (p = 0.019). The same extend of contraception use at first and latest intercourse was reported, compared to previous studies. Forty-nine percent were mostly informed about sex from the internet, while in previous years, magazines, family and youth clinics were the main information sources. Comparing over time, students were in general less sexually experienced and less engaged in non-penetrative sex and physical intimacy. These findings call for a new approach, when designing sex and relationship education and health-care counseling in adolescents.

Mobile sex-tech apps: How use differs across global areas of high and low gender equality

Digital technologies are increasingly intertwined into people's sexual lives, with growing scholarly interest in the intersection of sex and technology (sex-tech). However, much of the literature is limited by its over emphasis on negative outcomes and the predominance of work by and about North Americans, creating the impression that sex-tech is largely a Western phenomenon. Based on responses from 130,885 women in 191 countries, we assessed how women around the world interact with mobile technology for sex-related purposes, and whether in areas of greater gender inequality, technological accessibility may be empowering women with knowledge about sexuality. We investigated women's use of technology to find sexual partners, learn about sex and improve their sexual relationships, and track their own sexual health. About one-fifth reported using mobile apps to find sexual partners. This use varied by region: about one-third in Oceania, one-fourth in Europe and the Americas, and one-fifth in Asia and Africa. Staying connected when apart was the most commonly selected reason for app use with a sexual partner. About one-third had used an app to track their own sexual activity. Very few reported that the app they used to improve their sexual relationships was detrimental (0.2%) or not useful (0.6%). Women in countries with greater gender inequality were less likely to have used mobile apps to find a sexual partner, but nearly four times more likely to have engaged in sending and receiving sexts. To our knowledge, this study provides the most comprehensive global data on sex-tech use thus far, demonstrates significant regional variations in sex-tech use, and is the first to examine women's engagement in sex-related mobile technology in locations with greater gender disparities. These findings may inform large-scale targeted studies, interventions, and sex education to improve the lives of women around the world.

Digital Health Technology to Enhance Adolescent and Young Adult Clinical Preventive Services: Affordances and Challenges

The lives of adolescents and young adults (AYAs) have become increasingly intertwined with technology. In this scoping review, studies about digital health tools are summarized in relation to five key affordances-social, cognitive, identity, emotional, and functional. Consideration of how a platform or tool exemplifies these affordances may help clinicians and researchers achieve the goal of using digital health technology to enhance clinical preventive services for AYAs. Across these five affordances, considerable research and development activity exists accompanied by signs of high promise, although the literature primarily reflects demonstration studies of acceptability or small sample experiments to discern impact. Digital health technology may afford an array of functions, yet its potential to enhance AYA clinical preventive services is met with three key challenges. The challenges discussed in this review are the disconnectedness between digital health tools and clinical care, threats to AYA privacy and security, and difficulty identifying high-value digital health products for AYA. The data presented are synthesized in calls to action for the use of digital health technology to enhance clinical preventive services and to ensure that the digital health ecosystem is relevant, effective, safe, and purposed for meeting the health needs of AYA.

Evaluating the Quality of Health-Related WeChat Public Accounts: Cross-Sectional Study

Background

As representatives of health information communication platforms accessed through mobile phones and mobile terminals, health-related WeChat public accounts (HWPAs) have a large consumer base in the Chinese-speaking world. However, there is still a lack of general understanding of the status quo of HWPAs and the quality of the articles they release.

Objective

The aims of this study were to assess the conformity of HWPAs to the Health on the Net Foundation Code of Conduct (HONcode) and to evaluate the suitability of articles disseminated by HWPAs.

Methods

The survey was conducted from April 23 to May 5, 2019. Based on the monthly (March 1-31, 2019) WeChat Index provided by Qingbo Big Data, the top 100 HWPAs were examined to evaluate their HONcode compliance. The first four articles published by each HWPA on the survey dates were selected as samples to evaluate their suitability. All materials were assessed by three raters. The materials were assessed using the HONcode checklist and the Suitability Assessment of Materials (SAM) score sheet. Data analysis was performed with SPSS version 17.0 (SPSS Inc, Chicago, IL, USA) and Excel version 2013 (Microsoft Inc, Washington DC, USA).

Results

A total of 93 HWPAs and 210 of their released articles were included in this study. For six of the eight principles, the 93 HWPAs nearly consistently did not meet the requirements of the HONcode. The HWPAs certified by Tencent Corporation (66/93, 71%) were generally slightly superior to those without such certification (27/93, 29%) in terms of compliance with HONcode principles. The mean SAM score for the 210 articles was 67.72 (SD 10.930), which indicated “adequate” suitability. There was no significant difference between the SAM scores of the articles published by certified and uncertified HWPAs (P=.07), except in the literacy requirements dimension (t_df=97=–2.418, P=.02).

Conclusions

The HWPAs had low HONcode conformity. Although the suitability of health information released by HWPAs was at a moderate level, there were still problems identified, such as difficulty in tracing information sources, excessive implicit advertisements, and irregular usage of charts. In addition, the low approval requirements of HWPAs were not conducive to improvement of their service quality.

Indicators of adolescents' preference to receive oral health information using social media

OBJECTIVES

To assess (1) adolescents' preference to use social media (SM) to receive oral health information (OHI) and (2) factors associated with this preference.

MATERIALS AND METHODS

A cross-sectional survey was conducted in 2016, Eastern Province, Saudi Arabia including male middle school students. A questionnaire assessed explanatory variables including background, previous OHI seeking practices, internet use purposes, convenience of using SM for OHI and perceived usefulness of obtained OHI. The outcome variable was respondents' preference to use SM to receive OHI. Simple and multiple logistic regression models were used for statistical analysis.

RESULTS

The response rate was 91.2% (456/500). Of those, 57.5% preferred using SM to receive OHI. The odds for this were significantly associated with being Saudi (OR = 3.12, 95%CI = 1.36, 7.18), previously using Twitter (OR = 4.59, 95%CI = 1.77, 11.89) and Instagram for OHI (OR = 2.60, 95%CI = 1.51, 4.45), frequent use of the internet to obtain OHI (OR = 1.25, 95%CI = 1.02, 1.54) and ease of obtaining OHI using the Internet (OR = 2.69, 95%CI = 1.5, 4.39).

CONCLUSION

Most adolescents preferred using SM to receive OHI. This was associated with previous OHI seeking practices and convenience of using SM. These findings have implications for designing SM-based health education campaigns targeting adolescents.

Consumption of Health-Related Content on Social Media Among Adolescent Girls: Mixed-Methods Pilot Study

Background

Consumption of health- and fitness-related social media content is a predominant behavior among teenage girls, which puts them at risk for consuming unreliable health-related information.

Objective

This mixed-methods study (qualitative and quantitative) assessed health behavior attitudes and practices as well as social media use among adolescent girls. Additionally, similar practices and behaviors of adults who regularly interact with this population were studied.

Methods

Girls aged 12-18 years were recruited to complete a 28-item survey and participate in a 45- to 60-minute focus group. Adults who regularly interact with adolescent girls, including parents, teachers, and healthcare professionals, were recruited from the local community and given a link to provide online consent and complete a survey.

Results

A total of 27 adolescent girls participated in one of nine focus groups. Participants included 18 high school (age: mean 16.1 years; SD 1.3 years) and 9 middle school (age: mean 12.4 years; SD 0.7 years) girls. Eleven adults completed the online survey. Adolescents used social media to communicate and connect with friends, rather than as a source of health information. Although adolescents may see health-related content, most do not follow health-related pages or share such pages themselves, and fewer are actively searching for this information. Adolescents tend to trust information from familiar sources, and the participants reported that they do not follow official news accounts. Adults considered modeling and discussing healthy behaviors important and reportedly expected adolescents to see some level of health-related, especially fitness-related, content on social media.

Conclusions

Education interventions are warranted for both adolescents and adults with whom adolescent girls regularly interact, in the areas of sedentary behavior to guide them to access reliable online health-related information and be judicious consumers of online health information.

Adolescent and emerging adults' evaluation of a Facebook site providing sexual health education

OBJECTIVE

To explore participants' evaluation of an online sexual health intervention posted on Facebook and identify appealing and effective ways to present sexual health content to adolescents and emerging adults (AEAs).

DESIGN AND MEASURES

A qualitative approach using peer moderated focus groups was used to elicit reflections on the Facebook site's content, appeal, and ease of navigation. Focus group discussions were transcribed, coded, and analyzed for themes using conventional content analysis. Demographic data were analyzed with SPSS.

SAMPLE

Participants (n = 63) were recruited from a Midwestern university and both an urban and rural high school. Eight focus groups were conducted.

RESULTS

Participants reported significant concerns with the stigma associated with having sexual health conversations with parents, peers or providers. Participants thought the Facebook site provided reliable sexual health information, was not condescending, and was more visually appealing than other sites frequented by technology-proficient AEA. AEAs suggested developing an independent sexual health education website.

CONCLUSION

Findings demonstrate the importance for having accurate and reliable sexual health information available on the internet. The use of visually appealing social media to communicate sexual health content that is interactive, informative, and user-friendly and meets the educational needs of AEA in the Midwest is recommended.

Development of a Mobile App on Contraceptive Options for Young African American and Latina Women

Young African American and Latina women aged 15 to 24 are more likely to adopt short-acting forms of contraception over long-acting reversible contraception. Mobile applications and other forms of digital media may be useful for providing adolescents with information about sexual and reproductive health both inside and outside of the health care setting. The miPlan app was designed in accordance with principles of user experience design, and its content was informed by the theory of planned behavior and the transtheoretical model of behavior change. A university-based design team engaged young African American and Latina women to inform app development and provide input on app design, conducting multiple rounds of usability testing. Researchers then evaluated the acceptability of the miPlan app in family planning clinics among African American and Latina women aged 15 to 24. Participants rated the app highly acceptable, finding it both easy to use and highly informative. We demonstrate that mobile applications designed in conjunction with user populations may be effective at providing health information due to users' ability to identify with them and their accessibility.

Social Media Use and Sexual Risk Reduction Behavior Among Minority Youth: Seeking Safe Sex Information

BACKGROUND

Sexual health is an important area of study-particularly for minority youth and youth living in disadvantaged neighborhoods.

OBJECTIVES

The purpose of the research was to examine the sources of sexual health information associated with youth adopting sexual risk reduction behaviors.

METHODS

Data collection took place in a small city in the Northeastern United States using cross-sectional behavioral surveys and modified venue-based sampling. Participants included 249 African American and Latino youth aged 13-24. Participants reported their sources of information about contraception and human immunodeficiency virus/sexually transmitted disease, such as TV/movies, parents, social media; their intentions to have sex; and condom and contraception use during their last sexual activity. Social media use, past pregnancy experience, past sexual history, age, and gender were also measured. Standard tests of bivariate association (chi-square and F tests) were used to examine initial associations between sexual risk reduction behavior and exposure to sexual risk reduction information on social media. Logistic regression models were used to test multivariate relationships between information sources and sexual risk reduction behavior.

RESULTS

Youth who were exposed to sexual health messages on social media were 2.69 times (p < .05) and 2.49 times (p < .08) more likely to have used contraception or a condom at last intercourse, respectively. Parents, schools, or traditional media as information sources were not significantly associated with contractive use or condom use at last intercourse.

DISCUSSION

Youth sexual behavior is increasingly informed by social media messages. Health practitioners should utilize social media as an important health promotion tool.

Nurses on the Front Lines: Improving Adolescent Sexual and Reproductive Health Across Health Care Settings

: Nurses care for adolescents in a variety of settings, including communities, schools, and public health and acute care clinics, which affords them many opportunities to improve adolescents' sexual and reproductive health and reduce the rates of unplanned pregnancy and sexually transmitted infections. To ensure that adolescents have access to sexual and reproductive health care (which includes both preventive counseling and treatment) in all nursing practice sites, nurses need to gain the knowledge and hone the skills required to deliver evidence-based counseling and services to adolescents and parents. Collectively, nurses can use their unique combination of knowledge and skills to make a positive impact on adolescent sexual and reproductive outcomes. Nurses have the capacity and opportunity to disseminate information about sexual and reproductive health to adolescents and their parents in communities, schools, public health clinics, and acute care settings. This article discusses the Society for Adolescent Health and Medicine's goals and recommendations, which address adolescent sexual and reproductive health as both a health care and a human rights issue.

Social Media and HIV: A Systematic Review of Uses of Social Media in HIV Communication

Background

Social media, including mobile technologies and social networking sites, are being used increasingly as part of human immunodeficiency virus (HIV) prevention and treatment efforts. As an important avenue for communication about HIV, social media use may continue to increase and become more widespread.

Objective

The objective of this paper is to present a comprehensive systematic review of the current published literature on the design, users, benefits, and limitations of using social media to communicate about HIV prevention and treatment.

Methods

This review paper used a systematic approach to survey all literature published before February 2014 using 7 electronic databases and a manual search. The inclusion criteria were (1) primary focus on communication/interaction about HIV/acquired immunodeficiency syndrome (AIDS), (2) discusses the use of social media to facilitate communication, (3) communication on the social media platform is between individuals or a group of individuals rather than the use of preset, automated responses from a platform, (4) published before February 19, 2014, and (5) all study designs.

Results

The search identified 35 original research studies. Thirty studies had low or unclear risk of at least one of the bias items in the methodological quality assessment. Among the 8 social media platform types described, short message service text messaging was most commonly used. Platforms served multiple purposes including disseminating health information, conducting health promotion, sharing experiences, providing social support, and promoting medication adherence. Social media users were diverse in geographic location and race/ethnicity; studies commonly reported users aged 18-40 years and users with lower income. Although most studies did not specify whether use was anonymous, studies reported the importance of anonymity in social media use to communicate about HIV largely due to the stigma associated with HIV. The ability to share and receive information about HIV was the most commonly reported benefit of social media use and the most common challenges were related to technology. Measures of frequency of use, satisfaction, and effects of use varied across studies.

Conclusions

Using social media to bridge communication among a diverse range of users, in various geographic and social contexts, may be leveraged through pre-existing platforms and with attention to the roles of anonymity and confidentiality in communication about HIV prevention and treatment. More robust research is needed to determine the effects of social media use on various health and social outcomes related to HIV.

The use of social media among adolescents in Dar es Salaam and Mtwara, Tanzania

Social media form part of the rapid worldwide digital development that is re-shaping the life of many young people. While the use of social media by youths is increasingly researched in the North, studies about youth in the South are missing. It therefore remains unclear how social media can be included in interventions that aim at informing young people in many countries of the global South about sexual and reproductive health. This paper presents findings of a mixed-methods study of young people's user behaviour on the internet and specifically of social media as a platform for sexual health promotion in Tanzania. The study used questionnaires with 60 adolescents and in-depth interviews with eight students aged 15 to 19 years in Dar es Salaam, and in Mtwara, Southern Tanzania. Findings show that youth in Dar es Salaam and Mtwara access the internet mainly through mobile phones. Facebook is by far the most popular internet site. Adolescents highlighted their interest in reproductive and sexual health messages and updates being delivered through humorous posts, links and clips, as well as by youth role models like music stars and actors that are entertaining and reflect up-to-date trends of modern youth culture.

Exploring Social Networking Technologies as Tools for HIV Prevention for Men Who Have Sex With Men

Social networking technologies are influential among men who have sex with men (MSM) and may be an important strategy for HIV prevention. We conducted focus groups with HIV positive and negative participants. Almost all participants used social networking sites to meet new friends and sexual partners. The main obstacle to effective HIV prevention campaigns in social networking platforms was stigmatization based on homosexuality as well as HIV status. Persistent stigma associated with HIV status and disclosure was cited as a top reason for avoiding HIV-related conversations while meeting new partners using social technologies. Further, social networking sites have different social etiquettes and rules that may increase HIV risk by discouraging HIV status disclosure. Overall, successful interventions for MSM using social networking technologies must consider aspects of privacy, stigma, and social norms in order to enact HIV reduction among MSM.

"Friending" teens: systematic review of social media in adolescent and young adult health care

Background

Social media has emerged as a potentially powerful medium for communication with adolescents and young adults around their health choices.

Objective

The goal of this systematic review is to identify research on the use of social media for interacting with adolescents and young adults in order to achieve positive health outcomes.

Methods

A MEDLINE/PubMed electronic database search was performed between January 1, 2002 and October 1, 2013, using terms to identify peer-reviewed research in which social media and other Web 2.0 technologies were an important feature. We used a systematic approach to retrieve papers and extract relevant data.

Results

We identified 288 studies involving social media, of which 87 met criteria for inclusion; 75 studies were purely observational and 12 were interventional. The ways in which social media was leveraged by these studies included (1) observing adolescent and young adult behavior (n=77), (2) providing health information (n=13), (3) engaging the adolescent and young adult community (n=17), and (4) recruiting research participants (n=23). Common health topics addressed included high-risk sexual behaviors (n=23), alcohol, tobacco, and other drug use (n=19), Internet safety (n=8), mental health issues (n=18), medical conditions (n=11), or other specified issues (n=12). Several studies used more than one social media platform and addressed more than one health-related topic.

Conclusions

Social media technologies offer an exciting new means for engaging and communicating with adolescents and young adults; it has been successfully used to engage this age group, identify behaviors, and provide appropriate intervention and education. Nevertheless, the majority of studies to date have been preliminary and limited in their methodologies, and mostly center around evaluating how adolescents and young adults use social media and the resulting implications on their health. Although these explorations are essential, further exploration and development of these strategies into building effective interventions is necessary.

Improving sexually transmitted infection results notification via mobile phone technology

PURPOSE

To improve adolescent notification of positive sexually transmitted infection (STI) tests using mobile phone technology and STI information cards.

METHODS

A randomized intervention among 14- to 21-year olds in a pediatric emergency department (PED). A 2 × 3 factorial design with replication was used to evaluate the effectiveness of six combinations of two factors on the proportion of STI-positive adolescents notified within 7 days of testing. Independent factors included method of notification (call, text message, or call + text message) and provision of an STI information card with or without a phone number to obtain results. Covariates for logistic regression included age, empiric STI treatment, days until first attempted notification, and documentation of confidential phone number.

RESULTS

Approximately half of the 383 females and 201 males enrolled were ≥18 years of age. Texting only or type of card was not significantly associated with patient notification rates, and there was no significant interaction between card and notification method. For females, successful notification was significantly greater for call + text message (odds ratio, 3.2; 95% confidence interval, 1.4-6.9), and documenting a confidential phone number was independently associated with successful notification (odds ratio, 3.6; 95% confidence interval, 1.7-7.5). We found no significant predictors of successful notification for males. Of patients with a documented confidential phone number who received a call + text message, 94% of females and 83% of males were successfully notified.

CONCLUSIONS

Obtaining a confidential phone number and using call + text message improved STI notification rates among female but not male adolescents in a pediatric emergency department.

Health promotion in the digital era: a critical commentary

A range of digitized health promotion practices have emerged in the digital era. Some of these practices are voluntarily undertaken by people who are interested in improving their health and fitness, but many others are employed in the interests of organizations and agencies. This article provides a critical commentary on digitized health promotion. I begin with an overview of the types of digital technologies that are used for health promotion, and follow this with a discussion of the socio-political implications of such use. It is contended that many digitized health promotion strategies focus on individual responsibility for health and fail to recognize the social, cultural and political dimensions of digital technology use. The increasing blurring between voluntary health promotion practices, professional health promotion, government and corporate strategies requires acknowledgement, as does the increasing power wielded by digital media corporations over digital technologies and the data they generate. These issues provoke questions for health promotion as a practice and field of research that hitherto have been little addressed.

Quantified sex: a critical analysis of sexual and reproductive self-tracking using apps

Digital health technologies are playing an increasingly important role in healthcare, health education and voluntary self-surveillance, self-quantification and self-care practices. This paper presents a critical analysis of one digital health device: computer apps used to self-track features of users' sexual and reproductive activities and functions. After a review of the content of such apps available in the Apple App Store and Google Play™ store, some of their sociocultural, ethical and political implications are discussed. These include the role played by these apps in participatory surveillance, their configuration of sexuality and reproduction, the valorising of the quantification of the body in the context of neoliberalism and self-responsibility, and issues concerning privacy, data security and the use of the data collected by these apps. It is suggested that such apps represent sexuality and reproduction in certain defined and limited ways that work to perpetuate normative stereotypes and assumptions about women and men as sexual and reproductive subjects. Furthermore there are significant ethical and privacy implications emerging from the use of these apps and the data they produce. The paper ends with suggestions concerning the 'queering' of such technologies in response to these issues.

Reaching Youth With Sexually Transmitted Disease Testing: Building on Successes, Challenges, and Lessons Learned From Local Get Yourself Tested Campaigns

Nine programs were funded across eight states in the United States to customize, implement, and evaluate local campaigns in support of the national Get Yourself Tested (GYT) campaign. Each program promoted chlamydia screening and treatment/referral to sexually active young women (aged 15-25 years) and their partners through accessible, free, or low-cost services. This article documents the strategies and outcomes of these local GYT campaigns, highlighting the diversity in which a national sexual health campaign is implemented at the local level and identifying challenges and successes. Nearly all (n = 7) programs involved target audience members in campaign development/implementation. Youth were linked to free or low-cost sexually transmitted disease testing through community centers, high schools and colleges, community and clinic events; online or text-based ordering of test kits; and community pickup locations. Sites used a combination of traditional and new media, on-the-ground activities, promotional products, and educational and social events to promote testing. With the exception of one site, all sites reported increases in the number of persons tested for chlamydia during campaign implementation, compared to baseline. Increases ranged from 0.5% to 128%. Successes included development of local partnerships, infrastructure, and capacity; use of peer leaders and involvement; and opportunities to explore new innovations. Challenges included use of social media/new technologies, timing constraints, limited organizational and evaluation capacity, and unforeseen delays/setbacks. Each of these issues is explored, along with lessons learned, with intent to inform future sexual health promotion efforts.

"It would be weird to have that on Facebook": young people's use of social media and the risk of sharing sexual health information

In today's media environment, information is not simply passed from producers to consumers, but is mediated by participants of new media cultures, including information on sexual health. In focus groups held in Sydney and regional Australia in 2011, we asked young people aged 16-22 about the potential for sexual health promotion via Facebook and other social media. Our findings point to the complex ways in which young people use social media, and the unlikelihood of traditional take-home sexual health messages having traction in social media spaces. Five key aspects which emerged were: the participatory culture of social network sites; the stigma of sexual health, especially sexually transmitted infections (STIs); young people's careful presentations of self; privacy concerns; and the importance of humour in sexual health messaging. Fears of bullying and gossip (or 'drama') were also likely to prevent the dissemination of sexual health messages in this environment. However, humorous online videos were noted by participants as a significant way to avoid stigma and enable the sharing of sexual health information. The young people in our study were interested in sexual health information, but did not want to access it at the cost of their own sense of comfort and belonging in their social networks. Any sexual health promotion within these sites must be understood as a site-specific intervention.

Using chat and text technologies to answer sexual and reproductive health questions: Planned Parenthood pilot study

Background

Teens and young adults in the United States are in need of sexual and reproductive health information, as evidenced by elevated rates of sexually transmitted infections (STIs), pregnancy, and births among this population. In-person sexuality education programs are helpful, but they are unlikely to rapidly accommodate teens and young adults in a moment of crisis. Evidence suggests that technologies such as instant messaging (IM) and text messaging may be effective ways to provide teens and young adults with sexual and reproductive health information. In September 2010, Planned Parenthood Federation of America launched a text and IM program designed to provide immediate answers to urgent sexual and reproductive health questions from a reliable and confidential source and to link young people to sexual and reproductive health services if needed.

Objective

To assess whether this program is successful in reaching the target population, whether user characteristics vary by mode (IM vs text), and whether mode is associated with reaching individuals with high levels of worry or reducing worry postchat.

Methods

Data were collected from prechat and postchat surveys for all IM and text message conversations between September 2010 and August 2011. A bivariate analysis was conducted using chi-square tests for differences in the main covariates by mode of conversation. In the multivariable analysis, logistic regression was used to identify factors that were independently associated with prechat levels of worry and changes in worry postchat.

Results

A total of 32,589 conversations occurred during the program’s first year. The odds of feeling very worried prechat were highest for IM users (adjusted odds ratio [AOR] 1.43, 95% CI 1.20-1.72), users 17 years and younger (AOR 1.62, 95% CI 1.50-1.74), Latino/Hispanic users (AOR 1.36, 95% CI 1.27-1.46), and black users (AOR 1.40, 95% CI 1.30-1.50). After controlling for the study covariates, there was no significant difference in the odds of feeling better (less worried) postchat between IM and text message users. Feeling better postchat was associated with being younger (≤17 years: AOR 1.42, 95% CI 1.17-1.72; 18-24 years: AOR 1.20, 95% CI 1.02-1.42), being Latino/Hispanic (AOR 1.31, 95% CI 1.10-1.55), reporting that the service was very helpful (AOR 3.47, 95% CI 3.24-4.32), and asking about emergency contraception (AOR 1.35, 95% CI 1.13-1.61). The odds of feeling better were lowest for users with questions about STIs (AOR 0.61, 95% CI 0.47-0.78).

Conclusions

The results from the process evaluation suggest that the program was able to provide informational support to vulnerable groups, such as teens and racial minorities, in moments of particular worry. Differences between the IM and text message users reveal that each mode appeals to a different population and that both are necessary to reach a diverse audience.