Empowering Youth: Use of Technology in Advocacy to Affect Social Change



The purpose of this paper is to provide a conceptual framework for integrating technology with youth advocacy efforts to affect social change and influence social determinants of health, particularly in 1) recruiting people to join the cause, 2) organizing collective action, 3) raising awareness and shaping attitudes, 4) raising funds to support the cause, and 5) communicating with decision makers. Making strategic decisions to combine technology and youth advocacy will give youth a voice, arm them with advocacy skills, and increase their self-efficacy. These youth may become adults who are involved in larger policy-based decisions that will address the social determinants of health that affect the health status of people in their communities and throughout the world.


Social determinants, including socioeconomic, cultural, and environmental conditions, are the root cause of poor health and associated inequities between and among various racial, ethnic, or other demographic groups, and countries (Marmot, 2005). To effectively improve health status, we must modify or change social determinants. To do so will require a transformation of policies, rules, regulations, and legislation among various sectors, including, but not limited to public health, business, industry, and medicine. The change needed to affect social determinants is not the responsibility alone of policy makers and institutions. A shift in people's beliefs and how they think about issues, and subsequent individual advocacy efforts can support social change (Mankoff, Matthews, Fussell, & Johnson, 2007).

Advocacy is the use of resources and information to bring about systematic change. Health advocacy is “the processes by which the actions of individuals or groups attempt to bring about social and/or organizational change on behalf of a particular health goal, program, interest, or population” (2000 Joint Committee on Health Education and Promotion Terminology, 2002, p. 3). “Advocacy has the potential to shape or change policy in a way that can impact the health of thousands, if not millions, of people” (Galer-Unti, Tappe & Lachenmayr, 2004, p. 287).

History shows that public health advocacy works. The greatest advancements in improving public health in the 20th century are the result of change in policy or regulation (Centers for Disease Control and Prevention, 1999a). For example, water fluoridation has resulted in significant reductions in tooth decay and dental caries among both children and adults (CDC, 1999b). For a community to fluoridate water requires change to laws and policy (Roemer, 1965). Reductions in deaths due to motor-vehicle crashes are attributable to new regulations and standards for motor vehicles and road design as well as enactment and enforcement of laws that require drivers and passengers to wear safety belts (CDC, 1999c). The recognition that tobacco use is detrimental to a person's health was the basis for development and implementation several public health interventions that would limit a person's exposure to tobacco. Success in reducing access to tobacco products and limiting exposure to environmental tobacco smoke has required substantial advocacy efforts (Lantz et al, 2000; Schroeder, 2004). Some of the most well-known public health youth advocacy examples include youth involvement in tobacco prevention and control (Martin, Ribisl, Jefferson, & Houston, 2001) and substance use prevention (Tencati, Kole, Feighery, Winkleby, & Altman, 2002).

Advocacy, at its most basic level, is communication. It is one person or a group of people sending messages for the purpose of persuading or influencing others. While various tools aid with the communication process, technological advances, including software and associated devices, are expanding advocates' communication options. With these options comes the potential to make advocacy efforts more effective and efficient. The purpose of this paper is to provide a conceptual framework for integrating technology with youth advocacy efforts to affect social change. Table 1 provides a brief glossary of technology-related terms that will be used throughout the paper.

Table 1.  Glossary of terms
Type of TechnologyDescription
Social Networking SiteAn online community. People create personal profiles; organizations create pages. Allows users to maintain contact with friends, strengthen existing social networks, find new friends and expand networks.
ApplicationFeatures on social networking sites that allow people to customize their page and interact with each other. Examples are causes, photos, groups, events, gifts, videos, notes.
Wall or CommentsThe space on a SNS page where user's friends can post comments.
GroupA collection of people who share interest in a common issue. Groups share a common SNS page and share and discuss ideas on message or discussion boards. Groups can be private (membership must be approved by an administrator or moderator) or they can be public (anyone can join).
Mobile phonesA communication device that uses wireless technology to send information or communication across distances to other devices or people. Cell phones are the most common. Web-enabled mobile devices allow access to the Internet.
Multimedia Services (MMS)Audio, video, or picture images sent from one mobile phone to another.
Short Message Service (SMS)Text message (less than 160 characters) sent from one mobile phone to another
Other Internet-Based Technologies 
RSS Real Simple SyndicationA RSS is a web feed or reader that automatically notifies subscribers of new content available on websites or pages. It is like one-stop shopping for updates, rather than having to check individual sites or pages.
TwitterA social networking service that allows people to share brief (140 characters or less) updates on their location, activities, thoughts, and so forth, with followers. Messages can be sent or received using a mobile phone or the Internet. It is also referred to as microblogging.
BlogA type of webpage where a person makes (or posts) regular entries (e.g., text, photos, videos) similar to an online journal. Individual blogs can include personal information, thoughts and feelings, and read like a journal. Organization or topic-based blogs (e.g. breastfeeding or sexually transmitted infections) tend to be content specific. Readers can comment on posts.
PodcastAn audio or video file that is distributed over the Internet. The file can be listened to on a computer of mp3 player.

Youth and Advocacy

Youth have previously been handed a second-class ticket in democracy–they are not allowed to vote, yet pertinent policies and legislation are made that directly affect their health. For example, the alcohol industry is allowed to exploit adolescents by directing a disproportionate amount of its advertising toward this population (Jernigan, Ostroff, & Ross, 2005). The irony is that the alcohol industry is targeting a population that cannot legally drink. If youth were permitted a voice, instead of being silenced by their age, they could more effectively influence regulation of the alcohol industry. As it is, the industry holds on to the power and exposes underage teenagers to excessive amounts of advertising.

Delli Carpini (2000) suggests that young adults (ages 18–29) are, for the most part, disengaged in civic affairs. The author cites a lack of knowledge of political topics and processes, registering to vote, and participation in actions beyond voting, and so forth, to support this premise. The author notes that this lack of interest and involvement in civic affairs is not because young people are disinterested, but rather “because they are alienated from the institutions and processes of civic life and lack the motivation, opportunity, and ability to overcome this alienation” (p. 345).

However, engagement in civic affairs and social change need not be limited to young adults of legal voting age. It is possible for all youth to have a voice and be civically active. Adolescents ages 12–17 are a largely untapped resource within communities; they are part of the community and can become part of the solution to its problems. For example, Lifting New Voices, a demonstration project aimed at engaging 15- to 21-year-olds in community organizing and advocacy, has been very successful (Checkoway et al., 2003). Community projects have resulted in enhanced school environments, including improved quality of food, availability of books, running water in restrooms, and a change in a school suspension policy (Checkoway).

Providing opportunities for youth to successfully participate in social change, giving them a voice, and be involved in civic affairs may develop a generation of youth who carry these skills into adulthood. Armed with advocacy skills and empowered by previous successful experience, these youth may become adults who are involved in larger policy-based decisions that will address the social determinants of health. Furthermore, being involved in advocacy is likely to influence youths' health-related attitudes, beliefs, options, and behaviors (Winkleby, Feighery, Dunn, Kole, Ahn, & Killen, 2004).

In order to give youth a voice and encourage young people to become involved in civic affairs and social change it must be easy and convenient to participate. Common reasons people give for not being involved in advocacy include perceptions that they do not have the time or the skills and do not know where to begin (Galer-Unti, Tappe & Lachenmayr, 2004). Carver, Reinert, Range, & Campbell (2003) reported that some youth may lack confidence in their ability to participate in activism.

Individual participation in social change movements tends to be “stronger” when the activities are “easily integrated into daily life” (Mankoff, Matthews, Fussel & Johnson, 2007, pg. 4). Furthermore, an individual's social networks influence his or her involvement in social movements. Research shows that networks serve three purposes, “structurally connecting prospective participants to an opportunity to participate, socializing them to a protest issue, and shaping their decision to become involved” (Passy & Giugni, 2001, p. 123). In addition, people are more likely to be involved in a cause when they are recruited by close friends and other activists (Passy & Giugni). Being part of a network of family and friends who are already involved in the cause is also a predictor of personal involvement (Passy & Giugni).

Youth and Technology

The adoption and spread of cell phones in the early 1990s has been attributed to use by youth (Castells, 2006). Teens and young adults throughout Europe, the United States, Asia (Castells), and Brazil (Nielsen, 2009) have the highest rates of cell phone usage as compared to all other age groups. Near the end of 2007, the Worldwatch Institute estimated that there were 70 cell phone subscribers for every 100 residents of the United States (Chafe, 2007). More than 80% of all households in America have at least one cell phone; among households with married couples, 57% of children ages 7 to 17 have access to their own cell phone (Kennedy, Smith, Wells, & Wellman, 2008). Among younger populations, sending text messages on cell phones appears to be one of the most prevalent forms of communication. Sixty percent of 18- to 29-year-olds indicate that they send or receive texts every day (Horrigan, 2008). While this is not the adolescent cohort, it is likely that adolescent text messages rates are higher. Data indicate that the proportion of people who text daily nearly doubles with each decrease in an age group (Horrigan, 2008).

As with cell phones, social networking sites (SNS) are quickly becoming a pervasive part of American culture (boyd & Ellison, 2007). Preliminary data from early 2009 indicate that the use of social networking sites is expanding more significantly than any other online modality, including e-mail (Nielsen, 2009). Over half of all on-line American adolescents, ages 12 to 17, use some form of SNS (Lenhart & Madden, 2007). In a study of 18- to 19-year-old college students, 88% reported using a social networking site (Hargatti, 2008). Ninety-one percent of teenagers who use SNS use them to stay in touch with friends who they frequently see. Almost half of teens reported using SNS to make new friends, while 72% use SNS to make plans with their current friends (Lenhart & Madden, 2007). These numbers reflect the idea that while teens use SNS to find new friends, teens primarily use SNS to strengthen existing networks. These strengthened networks can easily translate into strong advocacy networks when used in an appropriate way.

Raynes-Goldie and Walker (2008) note that for social change to occur advocates need the following: information, people, and tools. Technology, including cell phones and SNS, can provide advocates access to these resources. Use of technology appears to cross ethnic and socioeconomic boundaries (Horrigan, 2008; Lenhart, 2009). Therefore, it appears that technologies are a viable means to engage youth in civic affairs and advocacy to address social determinants which may lead to a reduction in health disparities. Technology makes it easy for people to participate. It also lowers the nonfinancial costs, improves the quality of participation, and increases the types of advocacy activities in which they engage (Delli Carpini, 2000). These technologies also engage the individual's social networks.

Technology Options

Mobile technologies include communication devices that use wireless technology to send information or communication across distances to other devices. Cell phones are, perhaps, the most common mobile devices. Cell phones can transmit voice data, text data, also known as short message services (SMS) or text messaging (i.e., up to 160 characters sent from one mobile telephone to another) and audio or video data, known as multimedia services (MMS), (i.e., audio, pictures and video images). Cell phones are increasingly being used to send text messages, take photographs, play games, record and watch videos, and play music (Horrigan, 2008).

In addition, using wireless signals, Internet access is available through web-enabled cell phones. This connectivity allows for sending e-mails, browsing websites, accessing SNS, and receiving updates from websites and blogs through RSS feeds. In 2008, 40 million Americans used their phones to access the web (Critical Mass, 2008) and the number of people who accessed their SNS using a mobile device increased 260% (Nielsen, 2009). These mobile phone capabilities, from the most basic voice call to a technologically complex video, represent the future of communication.

People have been communicating through online discussion groups, message boards, and listservs since the early 1980s (Grier & Campbell, 2000). These programs were associated primarily with companies or social organizations (Grier & Campbell). The development of SNS has allowed a shift in focus from organization-based communication to individual interpersonal communication, among all age groups, but particularly younger people. SNS were specifically designed to help people make and keep connections with others who have similar interests (boyd & Ellison, 2008).

There are several different SNS. Facebook claims 200 million active users and estimate that their users spend 3.5 billion minutes on Facebook daily (Facebook, 2009). MySpace, another SNS, purports to have 184 million users, and Friendster, 50 million users (5 facts about social networking sites, 2008). In addition to Facebook, MySpace, and Friendster there are at least 130 other SNS (List of social networking websites, 2009). These range from SNS with broad target audiences to narrow target populations, such as an SNS for people interested in hospitality at home and abroad (The Hospitality Club, 2006).

A SNS is “an online location where a user can create a profile and build a personal network that connects him or her to other users” (Lenhart & Madden, 2007, p. 1).To join a SNS a person creates a personal account profile which becomes the person's page. On personal profiles, people share factual information about themselves, including preferences and the causes or groups they support. In each SNS people can invite other users to become their friend, or request that they be added as a friend. Some SNS, such as Facebook, will only allow individuals to create profiles, but organizations can create pages. The functionality for individuals' profiles and organization pages is essentially the same. The primary difference is that individuals have friends and organization pages have fans.

SNS have multiple ways for friends to communicate with each other. These options include walls, comments, groups, forums, and private messages. For instance, MySpace allows for people to write on others' profile pages in the comments section. Similarly, on Facebook a person can write on someone else's wall–a space connected to the person's personal profile. Any friend on Facebook can read any comment or wall post. Users can send each other private messages, which are just like e-mails.

All SNS allow people to join groups and participate in forums discussing various topics. SNS groups can be either public, meaning anyone can join, or private, meaning an invitation is required. Once a group member, the person is immediately connected to a network of people who feel passionately about the issue, who are easily accessible, and easily mobilized. Group members share recent news, give encouragement, share pictures and videos, and express opinions.

SNS also allow for creating events and sending personal or group invitations to an event. The event invitation indicates the event description, date, time, location, and contact person. With event invitations, people can respond with a RSVP, letting the organizer know in advance how many people will attend.

Tactics for Using Technology in Advocacy

Advocates using these technologies can share information at a faster pace, recruit more people and use a variety of tools to implement the necessary action for social change. Specifically, youth advocates can use cell phones and SNS for 1) recruiting people to join the cause, 2) organizing collective action, 3) raising awareness and shaping attitudes, 4) raising funds to support the cause, and 5) communicating with decision makers. While both cell phones and SNS can be used for these advocacy-related purposes there are advantages and disadvantages to using one over the other in various situations. Table 2 outlines the comparative qualities of each.

Table 2.  Comparative qualities of social networking sites and cell phones in advocacy
TechnologyAdvantages for AdvocacyDisadvantages For Advocacy
Social Networking SitesMessage sent on SNS can be stored indefinitelyNot all advocates may be able to attend in-person events because of geographic distances inherent in an online community
 Easy to invite friends and fans to join the advocacy causeOlder decision makers may not give as much credence to this form of communication
 Can organize events and post specifics about location, time, and purposeRequires Internet access
 Reach a large number of people quickly 
 One central location for advocates to find information about the advocacy cause 
 Can post videos or photos 
 Unlimited space to post information 
 Can update posts from a web-enabled cell phone or mobile device 
 Can check posts from a web-enabled cell phone or mobile device 
Cell PhonesReach a large number of people quickly in real-timeA text or video message may be quickly erased
 Text or video message will be received immediatelyDecision makers may not be able to answer the phone when in a meeting
 Can use phones to take photosHave to limit messages to 160 characters
 Decision maker can read a text message while in a meetingAdvocates cell phone calling plans may be limited by the number of text messages they can send
 Can be used to send quick, brief reminders of eventsNot all advocates may own a cell phone.
 No need for Internet accessCell phones numbers may be changed and contact with advocates is lost.
 Can talk to the other individual in-person. 
 Can forward text or video messages to friends and other advocates 

Recruit people to join an advocacy cause. Although individuals can participate in personal advocacy efforts, collective action of a larger group is generally more efficacious. For advocates, either individuals or organizations, who are interested in using technology, one of the first steps is to create a network of individuals. Advocates who use cell phones will want to gather cell phone numbers and program these numbers as a group in the phone. On SNS an organization might create a page and invite people to become fans.

Once networks are established, there are several ways to recruit people to join a cause. Using cell phones, most simply, a call or text message inviting someone to become a member is all that may be needed. On SNS an advocate can send a message to friends or fans with whom they are linked. Another way to recruit people to join a cause on a SNS is to create a group. These groups are a natural means of recruiting advocates. An adolescent can create a group supporting a certain policy issue and proceed to show a decision maker how many people support the cause. Focus groups conducted with state senators and representatives revealed that hearing from as few as three or five their constituents influences their position on an issue (March of Dimes, 2001).

Another way to recruit people on a SNS is through applications. Applications are features on SNS that allow people to interact with one another. Applications may include things such as virtual gifts, games, and the most popular, causes. Sending a friend a cause application demonstrates one's support of the cause. Causes can also be designed to raise funds. For example on Facebook the application (Lil) Green Patch raises awareness about global warming and encourages people to take action to make a difference (http://apps.facebook.com/greentrees/send-plants.php). Through this application people can plant fruit with their friends while sponsors contribute money each time the application is used. Individuals using the application can also make donations to other global warming-based causes.

Organize collective action. Using technology to organize collective action has been proven successful. The Howard Dean 2004 primary U.S. presidential campaign is frequently cited as an example of the power of technology to mobilize groups for political action (Hindman, 2005). During the 2008 presidential election, all the major candidates successfully leveraged cell phones and SNS to recruit and organize political supporters (Sanson, 2008). Research shows that nearly two-thirds (66%) of Internet users under the age of 30 have a SNS, and during the 2008 election, half of them used that site to “to get or share information about the candidates and the campaign” (Smith & Rainie, 2008, p.ii). In addition, international political action campaigns have used text messages to effectively mobilize people that affected the outcome of an election (Hong, 2005).

Individuals can organize collective action on a SNS by sending an alert or message to all group members. A post can also be made to a SNS wall. This post is received by all friends or fan members.

Using cell phones, text message can be sent to all group members. For example, the Energy Action Coalition, which works with thousands of youth on the topic of clean energy and alternative energy sources, hosted PowerShift 09, an effort aimed at influencing climate legislation. During their visits to Capitol Hill in Washington, DC the youth used text messaging and cell phone to keep their counterparts up to date on events (Teplitzky, 2009). When the legislative committees were on break, a message was sent to all group members telling them that now was the time to call their representative (PowerShift09, 2009)

In addition, organizing advocates can be accomplished by a person creating an event invitation on his or her SNS and sending it to all of his or her friends and fans. An event could be a meeting, a rally, a press conference, and so forth. As mentioned previously, the organizer can request RSVPs for the event. If the turnout will be high, the media should be invited to the event, as part of a media advocacy strategy. For instance, youth could text their friends to attend the local board of health meeting that night to show support for the proposed local ordinance of no smoking in the public park.

Raise awareness and shape attitudes. As noted earlier, successful advocacy results from people changing how they think about an issue. SNS and cell phones make it easy for people to engage in conversation to debate and discuss the issues. Through text messages, posts to SNS discussion boards, wall posts, or e-mails to groups people begin to become more informed about the issues, think about them in a new way, and how it affects their environment. For example, youth may dialog on a SNS discussion board about the lack of neighborhood street lighting and its impact on crime rates.

In advocacy efforts, a tactic referred to as media advocacy has been used for increasing public awareness about a topic and garnering mass media coverage. Technology allows for additional grassroots efforts by advocacy group members through citizen journalism. Citizen journalism encompasses reporting of news, investigative blogging, hyperlocal journalism, and digital storytelling by the lay public (Rheingold, 2008). Engaging in citizen journalism on a SNS a person can post copies of communication sent to mass media, including letters to the editor, op-ed pieces, or news releases. A person can also upload related photos, videos or podcasts. For example, youth could write a letter to the editor about the lack of fruits and vegetables at the neighborhood grocery store and then post it on his SNS where his friends and others can read it. The potential impact of exposure to events from lay public sharing their experiences on the Internet was illustrated during the 2006 election cycle when a volunteer for Jim Webb's senate campaign in the U.S. state of Virginia followed his opponent, incumbent Senator George Allen, around filming his stump speeches. The senator referred to the volunteer, who was of Indian descent, as “Macaca”. The volunteer posted this video on YouTube (http://www.youtube.com/watch?v=r90z0PMnKwI). The incident resulted in an apology from the senator (Craig & Shear, 2006).

A related, and particularly powerful, advocacy strategy to raise awareness is photovoice. Photovoice is the process of using photographs to depict a community and using that as a catalyst for change. The goals of photovoice are “(1) to enable people to record and reflect their community's strengths and concerns, (2) to promote critical dialogue and knowledge about important community issues through large and small group discussion of photographs, and (3) to reach policy makers” (Wang & Burris, 1997, p. 370). A powerful of example of photovoice in the recent past happened during Hurricane Katrina. A blog was created for people to upload photos and videos of Hurricane Katrina and the aftermath and write their feelings about what occurred (http://hurricane-katrina-pictures.com/). This same type of arena could be created on a SNS.

Typically, a photovoice campaign supplies a target population with cameras. The individuals return to their home environment to take pictures and write their impressions or feelings about their situation. Supplying each person with a camera creates a financial barrier to photovoice; however, most cell phones can be used as cameras. Youth participate in photovoice by uploading pictures of their environment and posting on their SNS how that environment impacts their lives.

One of the key improvements that mobile technology makes to photovoice is the ability to upload pictures in real time. If the phone has Internet access, the picture could be immediately uploaded to a blog or SNS and the photographer could record his or her impressions instantaneously. It would be more effective for a decision maker to receive a video of cars speeding down the neighborhood street rather than hearing about it anecdotally a few weeks later.

Raise funds to support a cause. Advocacy groups require budgets to support their efforts. As mentioned previously, SNS cause applications can raise funds. In addition, both cell phones and SNS could be part of a larger marketing campaign to raise money. The ability to organize groups, communicate with group members, invite people to events are all available through a SNS. Cell phones could be used for a text message campaign to solicit donations. For instance, people would be asked to send a text message to 55555 with the word help. Doing so would contribute a predetermined amount to the advocacy cause. The American Red Cross successfully used this strategy to raise funds to help victims of Hurricane Katrina (Nobles, 2006). While youth may be less able to donate financially, a campaign could be designed as a collaborative effort between parents and youth.

Communicate with decision makers. Success of advocacy efforts requires persuasive communication with decision makers. Traditional advocacy efforts include calling or writing a policy or decision maker to ask for support or to educate him or her about an issue. With technology, advocates are not limited by time and space or method. A phone call can be made or text message sent from anywhere at any time; a message can be posted on the decision maker's SNS page. These features make it easy for people to be involved in a simple advocacy action. For instance, a youth could post a message on the mayor's SNS page asking for her vote at the town council meeting where a skate park is being discussed.

Youth Advocacy and Technology Case Studies

Youth can use technology in a variety of ways to become more involved in advocacy. The following are three case studies. The first one is hypothetical, illustrating an ideal way to combine advocacy and technology. The second and third case studies are actual examples of youth advocacy.

Case Study 1. Paola's younger brother was recently hit and killed by a car while playing near his house in San Diego, California. The apartment complex where he lived had no sidewalk and nearly no grass. The road running in front of their apartment is busy and the speed limit is 55 MPH. As part of Paola's grieving process, she called her friend Laura. As Laura heard about Paola's living situation, she was incensed. After their conversation, Laura posted an entry on her blog about it, which appeared on her MySpace profile. Several of Laura's friends made comments on her page regarding the situation, so Laura started a group, “Citizens for Safe Streets,” within MySpace. One of the group members heard a podcast regarding the need for safer, slower streets near residential areas, which he subsequently posted on the group page. After listening to this podcast several group members demanded that the group take some kind of action. One member took the initiative to post Frogger, a game that can be downloaded to a personal cell phone; however, the cost of downloading the game was a call to a city council member to talk to them about the problem in Paola's neighborhood. Once they could enter in a city council member's name and details from the conversation, they could download the game (which incidentally is about crossing a street safely).

After the city council had received over 50 calls, Laura thought it would be a good time to organize a rally. She uploaded a video news clip from Paola's brother's funeral and asked each group member to download it to their cell phones and then forward it with a message about attending the rally at the city council office as a text to three contacts. Laura also contacted the local news stations and asked them to attend. Over 400 people attended the rally. While there, they signed a petition asking the city council to allocate funds to lower the speed limit, put in speed bumps, and build a sidewalk in Paola's neighborhood. One member of the rally sent constant Twitters (i.e., miniblogging in real time) to a group blog from his cell phone to inform interested parties about what was going on at the rally. Many people commented on the blog in support of the rally. At a designated time the leaders were able to meet with the city council members. When the leaders showed the council members the petition, the support on the blog, and the reporters outside, the council members agreed to reduce the speed limit, put in speed bumps, and build a sidewalk in Paola's neighborhood.

Case Study 2. High school students Jake Beech and Graham Horn from Bexley High School in Ohio found a way to make a political difference. They felt strongly about supporting then Senator Obama in his campaign for the presidency. They created a grassroots movement dubbed “every one counts.” The principle idea was to motivate everyone, whether they could vote or not, to make a $1 contribution to Barack Obama's campaign. They asked for people to send a picture of themselves with their one dollar contribution to be posted on their website www.everyonecounts.org.

To spread the word about this campaign, Jake and Graham created a Facebook group under the political organizations heading (http://hs.facebook.com/group.php?gid=22511340530). The page states their purpose as follows: “Ohio high school students are finding a way to be part of the change we have been waiting for. Although not all of us can vote, we have a voice, and we are uniting to use our collective voice in support of Barack Obama.” They knew that they could advocate for a cause they believed in using a medium with which they were familiar. Their group has 199 members. On the wall of their group several of their peers affirmed what a good idea this was and how they were planning to contribute.

Case Study 3. The 2009 Utah Legislative session included a bill (House Bill 444) which aimed to eliminate $4 million from the Tobacco Prevention and Control Program funds. After hearing about the issues at hand, a young adult named Peter Moosman started Project 1200 in February 2009 (P. Moosman, personal communication, April 17, 2009). About three-fourths of the group members are high school students, with the rest being junior high students and adults. The name of the group came from the fact that 1200 people die every day due to tobacco.

Peter started Project 1200 as a way to get youth involved in the advocacy process and have a group they could be affiliated with as they went to Capitol Hill to lobby. Project 1200 utilized technology in various ways. Project 1200 used several features of Facebook to assist their advocacy work. Peter created a Facebook group. On his own Facebook page he put Project 1200 as his status. He invited his friends to join the group, encouraged them to tell their friends; “the word of mouth spread it.” The Facebook page explained the cause in more detail. They used an events page and included the meeting time, location, and to contact Peter if they have any questions. Project 1200 joined forced with the Utah Phoenix Alliance, a statewide antitobacco group for youth advocacy. The Phoenix Alliance would send text messages and e-mails to their entire youth group about an event and inviting them to come.

Project 1200 used text messaging to contact legislators. The representative, who sponsored the bill to increase the tobacco tax, told Project 1200 that the best way to get a hold of him was through text messaging. He said they cannot always pick up the phone when in a committee meeting and they may not always have their computer to check e-mail. On their Facebook page they posted all the e-mail addresses and phone numbers of the legislators who they were targeting. Then they would tell their youth group members to “send a message to your representative.” Group members would also do a cell phone blitz sending text messages every 5 minutes to legislators.

The efforts of Peter Moosman and Project 1200 had a significant impact. On the last day of the legislative when the committee was voting on the bill to reduce tobacco funding, the representative who was the appropriations cochair said that “due to the many, many, many, many, many [count them: FIVE “manys”] e-mails we received we have decided to strike down our own bill.”

Though Project 1200 started to preserve tobacco prevention and control funding, the group expanded to focus on bills aimed at increasing the tobacco tax, smoking in cars with children, and Internet tobacco sales. And even though the legislative session is over, they have continued to do various advocacy activities throughout the Salt Lake Valley.

Limitations of Technology in Advocacy

Though the advantages of using technology in advocacy are apparent, it is not without limitations. In the 1990s, concerns were expressed about the digital divide, or in other words, the gap between demographic groups who had access to computers, telephones, and the Internet and those who did not (National Telecommunications and Information Administration, 1999). Researchers estimate that the digital divide still exists but is perhaps more narrow than in the past, at least in the United States (Katz, Rice & Aspden, 2001). However, Internet and cell phone penetration is lower in several other countries, particularly developing countries (Castells, 2006; Chinn & Fairlie, 2007). Researchers suggest that the global divide is explained in part income, but also by other economic factors such as quality of regulation (Chinn & Fairlie, 2007). Therefore, although researchers have used cell phones in developing countries to deliver health care services (Vital Wave Consulting, 2009), use of technology in advocacy may not be applicable across the globe.

One potential negative aspect of employing technology for advocacy is the possibility for selective filtering of messages. Because a person has continual access to information through Internet news sites, personal and professional blogs, Twitter, SNS, cell phones, podcasts, and so forth, it is possible that advocacy causes may get lost in the masses, making it more difficult to recruit and maintain supporters. However, on the upside, with the increased communication channels that technology provides, there is the likelihood that an increased number of people will be reached and overall awareness increased.

Engaging in advocacy efforts through use of technology is not intended to replace traditional advocacy efforts such as face to face meetings with decision makers, but rather enhance and augment them. Knowing the communication preferences of decision makers will be vital. While youth are familiar with, adept at using, and regularly use technology, some decision makers, particularly those in older age groups, may not be. So while technology may be a useful tool for organizing advocates it may not be the decision maker's preferred communication channel. However, with a continued an increase in cell phone and Internet penetration, and expanded reach of SNS, this disparity may narrow over time.


To make a significant change in the social determinants of health will require strategic advocacy on the part of all individuals. Youth as advocates is an essential part of this strategy. Technology makes it easy and convenient for youth to participate. It allows for integration of advocacy into their daily route. As a generation who is both comfortable and fluent with using technology, the key for public health is to harness these skills and direct them toward use in health advocacy. Making deliberate efforts to combine technology and youth advocacy will give youth a voice, increase their personal efficacy for participating in advocacy, and impact the social determinants that affect the health status of people in their communities and throughout the world.