Adolescent and Young Adult Sexual Health
Behavioral, biological and cultural characteristics put sexually active adolescents and young adults at greater risk of acquiring STDs than older adults. Though 15–24-year-olds represent only one-quarter of the sexually active population, they acquire nearly half of all new STDs. Moreover, black and Hispanic adolescents and young adults are disproportionately likely to receive diagnoses of HIV and other STDs. Despite young people's disproportionate risk of acquiring STDs, regular testing is not widespread. Only one-third of sexually active teenagers and half of sexually active young adults report ever having been tested for STDs.
Teenage pregnancy continues to be a pressing concern, particularly among racial minorities. By age 20, some 32% of Latinas and 24% of black women have had a live birth, compared with 11% of white and Asian American women. Pregnant and parenting adolescents and young adults have an especially high risk for STDs: Between 19% and 39% of adolescents contract one during pregnancy, and 9–39% of adolescent mothers contract an STD 6–12 months postpartum.[5-8] Therefore, young minority parents represent a high-risk population in need of effective prevention interventions.
Promoting Sexual Health Through New Media
The growth of information and communication technologies in the United States since the 1990s, and the ubiquitousness of mobile phone and Internet use, has expanded the options for delivering health interventions. A vast amount of health and medical information exists online, and 61% of adults aged 18 years and older regularly use the Internet to find it. In the last five years, mobile phones have begun to be used in similar ways. Moreover, text messaging has been used to remind patients about appointments, increase adherence to medication regimens, educate people about health issues, promote preventive behaviors and, in some circumstances, even conduct partner notification regarding STD testing.[10-17] New media have the potential to reach communities that have relatively poor access to health education and health care, which are the frequent targets of behavioral interventions to reduce STD risk.
These technologies are especially well suited to young people for several reasons. Adolescents and young adults are frequently early adopters of new technologies, and use is widespread among them. Three-quarters of 12–17-year-olds own mobile phones, and 88% regularly text message; 14–17-year-olds typically send and receive as many as 60 text messages a day.[19, 20] Thus, researchers and health organizations can use these communication technologies to reach adolescents directly.
The growing popularity of smartphones has increased Internet access to health information: Twenty-nine percent of 19–29-year-olds have used their mobile phone to look up health or medical information, and 15% have a mobile health application, or “app,” specifically designed to help them track or manage their health (e.g., by encouraging treatment adherence).[19-21] A handful of organizations are already using mobile phones to promote education about sexual health. For instance, the San Francisco Department of Public Health has partnered with the nonprofit Sexuality Information Services to create a text message service that promotes awareness of gonorrhea among black adolescents in San Francisco. Participants opt in via text message to receive information about topics such as pregnancy, HIV and the decision to have sex. The program, having reached its target audience, has been considered culturally acceptable.
In the last few years, some health organizations have begun to use social networking sites, such as Facebook, MySpace and Twitter, to conduct health campaigns and interventions. Social networking sites are popular among adolescents: Almost three-quarters who use the Internet regularly use sites like Facebook and MySpace. Furthermore, some sites (e.g., Facebook, Foursquare and Gowalla) include geolocation mobile applications, which allow users to tell friends of their current location, such as an STD clinic, and therefore encourage conversations about STDs and related topics.
Health organizations can use social networking sites not just to educate people about health issues, but also to change related norms, stigmas and beliefs. Because these sites rely on peer-to-peer networking, they may be able to promote behavioral change in the same way that off-line peer networks do.[24, 25] On this assumption, in 2010, MTV and Foursquare, in partnership with the Kaiser Family Foundation, the Centers for Disease Control and Prevention, and the Planned Parenthood Federation of America, created a social networking geolocation campaign to promote STD testing and reduce its stigma by facilitating online conversations about it. The program encouraged users to publicly “check in” (identify that they were at an STD clinic) via Foursquare and announce to their social networks that they had gotten tested. Results of the campaign have not yet been released.
Similarly, in the same way that programs have used popular opinion leaders to influence health behaviors through face-to-face interactions,[27-31] interventions could use popular opinion leaders to promote sexual health through their online networks. However, little is known about the potential of these leaders to promote sexual health using social media.
The Current Study
Several groups, including the Kaiser Family Foundation and the Pew Research Center, track general new media consumption among adolescents and young adults. However, no research, to our knowledge, has examined how these young people use new media technologies to communicate about sexual health; understanding the ways in which they communicate with each other about sexual health is important for developing interventions that use new media to address related social norms and stigmas.
Because sexual health topics tend to be more sensitive and stigmatized than other topics of conversation, it is important to understand which ones adolescents and young adults feel comfortable discussing via new media technologies, and within which social groups. For example, adolescents’ and young adults’ potential willingness to discuss birth control but not STDs with their friends on MySpace may affect the success of new media–based sexual health interventions. Similarly, if adolescents and young adults are willing to discuss sexual health topics with close friends, but not with casual friends, an intervention that encourages participants to post updates on Facebook about their sexual health status might not be as successful as one that encourages participants to send private messages to individual friends.
The current study investigates how low-income, parenting adolescents and young adults—a subpopulation at especially high risk for STDs—use new media to communicate about sexual health with close and with casual friends. It describes young parents’ willingness to receive and share sexual health information with peers via new media technologies, as well as the differences between those who are willing to communicate this way about sexual health and those who are not.