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Adolescent Use of Social Networking to
Gain Information Regarding Sexual Health
Nationally, adolescents are at greater risk than any other age group for contracting a
sexually transmitted infection (STI) 1. Nearly 3 million adolescents in the United States (US)
acquire an STI every year, with almost 62% of these cases occurring in individuals under the age
of 25 years 2. Common sexual behaviors of adolescents increase their risk of contracting an STI
including concurrent sexual partnerships, number of sexual partners, age of first sexual encounter
and lack of condom use 3.
The consistently high national rates of adolescent STIs demand more effective
interventions to increase knowledge about sexual health in this age group. Adolescents face
innumerable barriers regarding sexual health care such as confidentiality, obtaining information
about STIs, cost of screening and treatment, and accessibility to these health care services 4.
Health care providers and adult caregivers may also find it hard to balance the need to protect
versus the need to empower the adolescent population to be responsible in regards to their sexual
health 5.
Chlamydia is the most frequently reported STI in the United States (US), with an
estimated 2.8 million cases reported annually 6. In 2009, as in previous years, women aged 15–
19 years had the highest rate of chlamydia compared with any other age or sex group. From
2008 to 2009, chlamydia rates for women in this age group increased 1.8%, from 3,269.5 cases
per 100,000 to 3,329.3 cases per 100,000 7. Many infected individuals do not realize they are
infected as chlamydia frequently has no symptoms. Left untreated, chlamydia can lead to an
infection of the fallopian tubes referred to as pelvic inflammatory disease (PID) with potential
permanent damage to reproductive organs and a woman’s ability to have children 6.
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Gonorrhea in the US is a very common STI as well. CDC estimates more than 700,000
individuals contract gonorrhea yearly; however, cases of gonorrhea reported to the CDC in 2009
were only 301,174 8. Low reporting of gonorrheal infection may be attributed to a lack of
understanding regarding the spread of infection through contact with the anus, the vagina, the
mouth or the penis. In addition, many of those who have contracted gonorrhea may not have
symptoms. Gonorrhea can also be spread from mother to baby during delivery of the newborn.
Perinatal transmission of gonorrhea can cause blindness, a life-threatening blood infection and
joint infections in the newborn 8.
Healthy People 2010 and Healthy People 2020 have addressed adolescent STIs within
their health care agendas. Healthy People 2010 targeted gonorrhea and chlamydia rates with
goals to decrease gonorrhea rates to 19.0 cases per 100,000 and to reduce the chlamydia test
positivity to 3% among females and males 15–24 years of age who visit family planning and STI
clinics 9. The Healthy People 2010 evaluative report stated despite some progress toward
controlling a number of STIs, compared to other industrialized nations, the United States has to
move far enough or quickly enough in its national attempt to successfully manage acute STIs and
STI-related complications; STI rates in the U.S. exceed all other countries of the industrialized
world 9. Thus, it is not surprising to see Healthy People 2020 discuss promotion of healthy
sexual behaviors, strengthening of community capacity to screen for and treat STIs, and an
increase in access to quality services to prevent STIs and their complications 10.
PURPOSE
The purpose of this project was to develop and evaluate a social networking site that
would provide STI information as well as testing and treatment sites for adolescents, 13 to 18
years of age in a metropolitan county in a Midwestern state. The aim of this project was to
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empower the adolescent who viewed the Business Facebook site entitled Teen Sexual Health
Information, with confidential information to help them remain sexually healthy if they
choose/have chosen to become sexually active.
LITERATURE REVIEW
Adolescence is a tremendous time of growth and development in the physical, cognitive
and psychological realms. There are significant changes in the adolescent as they change from
child to adult including developing habits, relationships and behavior patterns that will affect
health outcomes throughout the rest of their lives 11. Adolescents believe they are invincible yet
have not developed mature judgment skills. These beliefs may lead to risky behaviors in
general. Rapid physical changes and hormonal fluctuations during adolescence add to the
likelihood that they may engage in risky sexual behaviors 3.
During adolescence increased participation in initiation of sexual activity and increased
involvement in other risky behaviors include experimentation with drug and alcohol 12. It has
been reported that by the age of 18, over one half of adolescents have had sexual intercourse.
Inconsistent use of contraception and condoms places these adolescents at increased risk for
unplanned pregnancy and the acquiring of an STI 13. Initiatives that focus on decreasing
adolescent STI rates must take into consideration all of the developmental changes that this
population is experiencing in order to tailor their interventions so that they will be well received
and produce the planned outcomes.
It is apparent that early experiences with sexual intercourse may be influential on the
adolescent’s subsequent sexual health choices. Thus, it would seem important to have sexual
health education taught to all adolescents before they initiate sexual intercourse, with the goal to
decrease the negative health outcomes of early sexual intercourse including STI risk reduction 2.
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National surveys have revealed close to 50% of sexually-active females reported that they
had a sex partner who was two or more years older 2. Adolescent females’ experience with an
older sexual partner has been linked with negative sexual health results and correlates with a
number of poor health outcomes in the adolescent population. Having an older sexual partner is
associated with less desire of first intercourse, more substance use, more suicide attempts, and
more delinquency among these female adolescents 14. Furthermore, when adolescent females
have older male sexual partners, it has been noted that other unwanted sexual risk behaviors such
as decreased use of contraception, less likelihood of utilizing condoms, higher chance of
unwanted pregnancy and much greater likelihood of contracting an STI are more likely 12.
Adolescents have been acknowledged as early adopters and major users of the World
Wide Web (www). They have integrated this technology into their daily lives and made the
Internet a chief source of information about a wide range of topics 15. Use of the www continues
to be immensely popular with adolescents and over the past ten years their use of all types of
technology has increased. Internet use by American youth aged 12-17 years was reported at 93%
in 2009, compared to only 74% using the Internet in 2007 5. Technology is simply second nature
to adolescents and an engaging way for adolescents to communicate and locate information on
what interests them.
Adolescents use the www for numerous purposes. According to national survey data,
adolescents most frequently use social networking sites such as MySpace or Facebook 16. Of the
90% of adolescents who report having access to the Internet most report daily use. About half of
these adolescents use online social networking websites such as Facebook and MySpace.
Twenty-five percent of the profiles created by Facebook and MySpace users belong to
individuals younger than 18 years 17.
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A social networking site is a very public venue potentially placing the adolescent at risk
for unwanted and dangerous contact from other site users 17. Small studies and anecdotal reports
have suggested that some adolescents display risky material on social networking sites. To date,
no large-scale systematic studies have been conducted to explore an association between
adolescent viewing of sexual health information and subsequent risky behaviors on social
networking sites 17.
Low cost of accessing the www, accessibility of health information without having to see
a provider face-to-face, and teen friendliness of the Internet are all reason cited by teens to search
the www for health information 5. Health websites for adolescents are plentiful but it is
important for Internet users to evaluate the quality of the material on the website and remember
that even the most accurate and developmentally appropriate health information can be biased in
the way that the information is presented 18. In addition to the fundamental knowledge of
Internet usage, there is a strong requirement for self-efficacy, or confidence in using the
computer, which adolescents in the 21st century appear to possess. According to the Pew
Research Center’s Internet and American Life Project (2010) the divide between Caucasians and
African Americans closed 8% between 2009 and 2010. This represents an approximate 22%
growth rate of Internet use for African Americans, while Caucasian use increased by 2% within
the same period.
Teens and young adults 13 to 24 years of age were surveyed online to explore how they
used the Internet for health and wellness issues. More than 50% used the Internet to search for
health information and the top sources were WebMd and The Google search engine 19. Given the
immense popularity of social networking sites among adolescents these websites have become an
essential part of their lives; thus, an integral part of their health and safety 17. As adolescents
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increasingly turn to the Internet for health information, parents and health care professionals are
critical links in helping the adolescent identify accurate health care information and critically
appraise the websites they access 20.
Many “good” websites exist for adolescents 20. Government portals such as the CDC are
good places to begin searching for health information; however, these sites are not always the
most inviting designs for adolescents 20. A website entitled ‘Iwannaknow” provides information
about prevention of STIs for adolescents. Topics of interest to adolescents such as teen such as
teen sexuality and contraception were the most frequent topics of interest and STI information
was the least popular topic on this particular website. There are challenges to providing health
information via websites such as overcoming technological barriers, ensuring safety from
inappropriate contact while on the Internet and keeping relevant data on the websites 21.
There are National, state and county health initiatives aimed at decreasing the STI
prevalence of these adolescent. Yet, STI rates remain high in this population. Adolescents are at
a developmentally challenging stage of life in which they tend to engage risky behaviors,
including sexual intercourse. The topic of STIs is likely uncomfortable for adolescents to
discuss with their health care provider and perhaps their parents as well. A number of studies
report some health care providers struggle to develop a therapeutic relationship with their
adolescent patients 22; 23. Adolescents report being embarrassed to ask for sensitive information
such as sexual health issues from their health care providers and fear a breach of confidentiality
by the providers for the information and the health care services 22.
Adolescent’s capacity to navigating health information websites for sexual health
information has been established. Are these adolescents acquiring adequate information to make
informed decisions about sexual health? The adolescent STI statistics point towards gaps in this
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much needed information. It is vital to reach these adolescents with developmentally appropriate
sexual health information.
METHODS
The purpose of the proposed project was to develop and evaluate a social networking site
that provided STI information and testing and treatment sites for adolescents, ages 13 to 18
years. The setting was a metropolitan county in a Midwestern state. The adolescent STI
statistics for this Midwestern state and the metropolitan county were reviewed. The County data
revealed an alarmingly high incidence, exceeding US numbers, of both chlamydia and gonorrhea
among their adolescent population.
The creation of a social networking site began with a meeting with two STI Specialists
from the County health department to discuss pertinent information to include on the social
networking site. The information gathered at these meetings and a review of the literature led to
the choice of using social media to reach out to the adolescent population and educate them on
STI prevention. Adolescents are very adept with computers and mobile devices for accessing
social networking sites. Therefore, the decision was made to create and implement a Business
Facebook site, Teen Sexual Health Information.
Teen Sexual Health Information and was developed to help adolescents make informed
decisions about their sexual health. The Administrator of the Business Facebook site was a
family nurse practitioner (FNP) experienced in adolescent STI care. The FNP was the only
individual who could add new information and delete inappropriate posts. This ensured that
accurate information was made available to those who visited the Teen Sexual Health
Information site.
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Sources of information for the Teen Sexual Health Information site Facebook site
included websites and agencies that promoted teen sexual health behavior. After careful
consideration, it was decided that videos, photographs, Fact Sheets about STIs, free and reduced
cost clinic locations for testing and treatment of STIs, and links to other STI information
websites would be included. The Teen Sexual Health Information site and a participant survey
were presented to the Institutional Review Board (IRB) at Creighton University. Upon receiving
IRB approval, the Teen Sexual Health Information site was officially opened on Facebook. The
majority of recruitment for participation and viewing of the Teen Sexual Health Information site
was by word of mouth.
An evaluative survey was created using surveymonkey.com and linked directly to the
Teen Sexual Health Information Facebook site. The survey included two demographic
questions: participant’s age (within a range) and their gender. The remaining six questions on
the survey were open-ended questions designed to evaluate the Facebook site. The administrator
of the Teen Sexual Health Information site monitored and revised the content of the Business
Facebook page throughout Summer and Fall 2011. Decisions to add or remove content from the
Teen Sexual Health Information site was also based on responses from participants who
completed the evaluative survey or by consensus of the STI content experts.
RESULTS
A total of 39 evaluative surveys were completed. The 16-17 year old age group had 15
completed surveys, 14- 15 year olds had 14 completed surveys and both the 13-14 year old and
18-20 year old groups each had 5 completed surveys. The 5 surveys completed by 18- 20 yearolds were not used, leaving 34 surveys for analysis. The ratio of females to males completing
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the survey was 51% to 49%. Analysis of the results was completed by grouping the answers to
the six opinion questions into categories based on response similarities.
Responses to the survey question, “How was the Facebook site helpful to you?” were
compiled into three major categories: “I learned more about STIs” (58%), “Good overall sexual
health information provided” (15%), and “I learned more about STI testing locations” (12%).
The survey question, “How will you use the information on this Facebook site to keep you
healthy?” produced very specific responses such as “I will be getting myself and my girl tested
this week, thanks for letting us know where the free testing clinics are located”. Another reply to
this question was, “I plan not to have sexual intercourse until I get married”. In the final survey
question, “What information would you recommend to be added to this Facebook site?” 50%
answered, “No additional information needed”. This final question also had specific responses
such as, “What is the average cost of medications to treat STIs?” and “Could you provide some
information on resources for teens that are pregnant”. Results revealed the Teen Sexual Health
Information Facebook site was a valuable source of information for the adolescents who read the
information on the site and chose to complete the survey.
DISCUSSION
Strengths of this project included the ease with which information on a social networking
site can be accessed. In addition, increased connections were made between adolescents and a
heath care professional via the Teen Sexual Health Information Facebook site. Evaluative
surveys indicated an interest in the information and there were requests for more information to
be put on the Teen Sexual Health Information Facebook site. This project suggests that using a
Facebook site to circulate information to the adolescent population is a viable option. A
limitation of this project was the brief time period in which the project was implemented and
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evaluated. Another limitation is the dearth of literature reporting the use of social networking
such as a Facebook site for adolescents to access sexual health information upon which to
compare this project’s results. It is evident there needs to be more research on the use of social
networking sites to provide sensitive information to adolescents on topics such as sexual health.
IMPLICATIONS FOR ADVANCED PRACTICE NURSING
This project opens the possibility of using social networking for health care professionals
to augment the management of any disease. Results of this project indicated that continuation of
the Teen Sexual Health Information site would likely be beneficial and information on the site
could be used by innumerable public health organizations. Sustainability of this particular
project could be accomplished through potential partnerships with County Health Departments,
Public Health Associations, the CDC, and/or the World Health Organization (WHO). Concerns
with using social networking for health information must also be considered including privacy
and protection of vulnerable teens. Nurse Practitioners in collaboration with parents should help
adolescents identify accurate health care information on the Internet.
Clearly adolescent rates of STIs remain a national concern. Nurse Practitioners, in
partnership with their communities, should be involved in developing relevant adolescent STI
prevention programs within the context of the national health care agenda. The use of social
networking to acquire age-appropriate and helpful information on sexual health and sexual health
services may serve to augment the health care provider’s services. Accessing adolescents
through social networking platforms such as Facebook and Twitter may prove to be may be an
effective modality to reach this audience. The Internet has become a very popular way for
adolescents to acquire health information that is sensitive and in the past required meeting in
person with a health care provider.
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The future of providing health information through social networking appears promising.
Awareness of the potential risks and benefits of using social networking with the patient
population need to be fully understood before dissemination of information via this medium
becomes common practice. Further research is needed to evaluate the use of social networking
to provide population-based health care information.
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