1. New Uses of Technology for Teen Sexual Health Education Ellen Selkie, MD University of Wisconsin School of Medicine and Public Health Public Health Symposium May 8, 2009

2. Acknowledgements Capstone Committee Members: Megan Moreno Meghan Benson Rich Brown Planned Parenthood of Wisconsin MASH, GSAFE, First Unitarian Society, Goodman Community Center Barb Duerst and Pat Remington My husband and family Fellow MD & MPH students Elizabeth Cox

3. Overview Background Project Methods Findings Discussion Conclusion

4. Background: Teens and Sex Youth Risk Behavior Survey, 2007 48% of high school students ever had sex 35% sexually active in last 3 months 62% used condom, 16% used OCP 15% had had at least 4 partners Since 1991: 16% decrease in sexual intercourse, 25% increase in condom use, all others unchanged

5. Public Health Concerns 42.5 live births per 1000 in girls age 15-19 (in 2007) – 7% increase since 2005 after 14 years of decline Age group 15-24 accounts for half of all new annual STI cases (9.1 million) despite only making up ¼ of population In 2006, an estimated 5,259 young people aged 13-24 in the 33 states reporting to CDC were diagnosed with HIV/AIDS, representing about 14% of the persons diagnosed that year.

6. Teen births per 1,000 Source: National Vital Statistics Report

7. Chlamydia Infections 2007 Source: CDC STD Surveillance

8. Healthy People 2010 Reduce pregnancies among adolescent females. Increase the proportion of adolescents who have never engaged in sexual intercourse. Reduce HIV infections in adolescent and young adult females aged 13 to 24 years that are associated with heterosexual contact. Reduce the proportion of adolescents and young adults with Chlamydia trachomatis infections. Increase the proportion of adolescents who abstain from sexual intercourse or use condoms if currently sexually active.

9. Social Networking Sites etc...

10. Facebook

12. Teens’ use of social networking sites (SNS) Estimated 15.3 million teens use SNS Approx 12% of Facebook users and 33% of MySpace users are under age 18 In a sample of 500 teen MySpace profiles, ~24% referenced sex and 3.6% referenced teen’s own sexual activity

13. What is out there? Support groups for health issues: Asthma Diabetes Epilepsy STIs Abortion Pregnancy Health facts/resources on these pages are scant Teens continue to be misinformed about important puberty and sexuality topics

14. Project Methods Approved by Social/Behavioral IRB Recruited 29 participants aged 14-19 at 4 different sites Participants were consented; signed confidentiality agreement and completed demographic survey 5 focus groups, each lasting 30-45 minutes 2 facilitators per group Each group transcribed and analyzed for common themes

15. Main Focus Group Questions How and when do you use sites like Facebook, MySpace, or MyYearbook? What websites do you use for health information? If you had questions or problems that have to do with sex or puberty, where would you go to get answers? If there were information about sex or puberty on the websites we talked about, what questions would you like answered? How would you like to read this information on the sites? We are thinking of looking at text message programs where people could text in to get answers to questions about sex and puberty. What do you think of this program? What questions would you like answered by text?

16. Findings/Common Themes Types of information teens are looking for: Relationships Pregnancy prevention STIs Where they are getting it: Google Often results are difficult to interpret “…usually if I type it in I have to search, like click on five different ones to find the answer I’m looking for.” Searching can take too long, may give wrong answers “…if you just type in ‘the pill,’ it’s not gonna show a birth control pill, it’s gonna show a whole bunch of pills. You just have to type the right thing.”

17. Common Themes cont. Technology has the advantage of being anonymous and nonjudgmental “Whenever you go to your doctor you always get a lecture.” “Maybe they don’t want to talk to their friends. Maybe their friends don’t know nothing about it.” “I know I don’t tell my mom some stuff because I’m afraid of what she’ll do.” Suggestions from teens for programs: Facebook/MySpace chat with health workers, other teens Commonly asked questions page Video series on sexuality topics Automated text message program

18. Discussion Findings reveal that teens are aware of ways that technology could be used for education Barriers to finding sexual health information are similar to those we have seen in other aspects of adolescent care and communication (access, trust, privacy) Future directions: Creation and monitoring of SNS pages and text program for Planned Parenthood Research questions: Analysis of search engine results, use of technology in other health areas

19. Conclusions Teen pregnancy remains a major public health problem in the US Social networking sites are widely used by teens to connect with friends and other people like them Teens are interested in using digital resources to get sexual health information However, digital resources for teens must be: Credible Confidential Trustworthy Accessible

20. Planned Parenthood of Wisconsin 31 health centers, 3 with abortion services Services: Contraception Pregnancy testing and counseling STI testing and treatment Well woman exams Midlife (menopausal) care Abortion care Care is given on a sliding fee scale Community education programming 1-800-230-PLAN; http://www.ppwi.org

21. Resources The National Campaign to Prevent Teen and Unwanted Pregnancy Youth Risk Behavior Survey National Center for Health Statistics Teenwire.com CDC Guttmacher Institute

22. Questions? Contact me: Ellen Selkie selkie@wisc.edu

23. Thank you!!!