STDS Sexuality Education Online

1. STDS.com Sexuality Education Online Home Heather LaBelle Master’s Candidate Health Communication Dept. of Communication Emerson College heather_labelle@emerson.edu Sarah N. Keller Assistant Professor Dept. of Communication Emerson College 120 Boylston St. Boston, MA 02116 (617) 824-8857 sarah_keller@emerson.edu

2. Background – US data • About 1 in 4 sexually active youth will be infected with an STD by age 24 (Cates & McPheeters, 1997) • 3 million new cases of Chlamydia in the U.S. every year (Cates 1999) • 40% of Chlamydia cases are in the 15 to 19 year old age group (Cates 1999) • 120,000 cases of Hepatitis B occur every year in the U.S. (Cates 1999) • 49% of high school students report having sexual intercourse • 58% of sexually active students reported using a condom during last sexual experience (1999 YRBS) Background

3. Background – Massachusetts(MDYRS 2000) • 1/5 of AIDS cases are among people in their 20s or younger • 44% of high school students have had sex • 57% used condoms during last sexual encounter • 17% used no form of birth control • Condom use dropped by grade level, but sexual activity increased Background

4. Background – US Internet data • 140 million people use the Internet (Richardson, 2000) • 52 million use the Internet for health information (Richardson, 2000) • 46% of 12 to 17 year olds have gone online in the past month (CyberAtlas, 2000) • 44% learn about sexual issues from the Internet (Kaiser Family Foundation, 2001) Background

5. Why use the Internet? • Offers anonymity • Specific message tailoring • Relays information on demand • Can facilitate decision-making skills and risk assessment • Provide online peer support through message boards, chat rooms, and e-mail • Ability to promote self-efficacy • Inaccurate or inappropriate information • Lack of Internet access Background

6. Internet access • Income gap (Cole, Suman et al., 2000). • 81 to 88% of families with incomes over $50,000 are using the Internet • 41% of families with incomes less than $14,000 use the Internet • With each passing year, this gap is narrowing (U.S. Bureau of Census, 2001) • Between December 1998 and September 2001 Internet use among people who earn less than $15,000 per year increased at an annual growth rate of 25%. • Internet use among people earning more than $75,000 per year or more increased at an 11% annual growth rate. Background

7. Other Studies • At least two articles have reviewed online HIV/AIDS resources (Brettle, 1997; Mallory, 1997) • One case study looked at www.iwannaknow.org (Keller, Gilbert et al., 2001) • Another examined websites that covered a range of STDS and HIV information (Smith, Gertz et al., 2000) • Research on how people use the Internet for sexual information is sparse; and most studies do not focus specifically on teen audiences (Bull et al., 2001; Reeves, 2001) Background

8. Other Studies • Few studies of effects of Internet use on adolescents’ sexual health • Studies document that sexual content exists, and that it is frequently explicit (Smith et al., 2000) • Few studies examine effectiveness of Internet for any health objective (AHCPR, 1997) • No studies to date have scientifically evaluated the impact of STD prevention sites on adolescent health outcomes Background

9. Interactive health communication studies • Some patients prefer online counseling to face-to-face interaction (Alemi, Alemagno et al., 1996) • People may be more likely to be truthful to a computer than a clinician in reporting HIV-risk factors (Locke et al., 1992; Erdman, Klein et al., 1985) • One study of 1,690 males ages 15-19 found that adolescents were three times more likely to report risky behavior when using audio computer-assisted self-interviewing (audio-CASI) technology compared to more traditional self-administered questionnaires (Turner, Ku et al., 1998) Background

10. Pilot Methods (Phase 1) • 6 search engines using 12 key words • Screened first 100 search results for web sites that were educational, contained information about both HIV and other STDs, and were specifically targeted towards teenagers • The remaining sites in our sample of 1,378 were categorized by type (for example) : -26% (n=359) “umbrella sites” (359), defined as lists of links to other sites -25% (n=350) “other” (e.g., sex education without STD information; discussion forums; pharmaceutical sites; etc.) -20% (n=276) news articles or press releases -8% (n=110) advocacy sites • Only 36 web sites met inclusion criteria Methods

11. Survey Measure Development (Phase 1) • Building on a content analysis conducted in conjunction with the American Social Health Association, coding tools were developed to assess usability characteristics (e.g., criteria for credibility) and sexual health content • Categories for measurement of sexual health content were based on The Guidelines for Comprehensive Sexuality Education, Kindergarten- 12th Grade • Categories for usability were obtained from national standards for web evaluation and assessment from the American Library Association (Alexander & Tate, 1999). • Researchers in this project converted the guidelines to serve as standards for Web-based sexuality education curricula. Methods

12. Results (Phase I) Results

13. Objective (Phase II) • To find out which educational messages and usability features of safe sex web sites are important to teenagers Phase II

14. Sample • Ages 13 to17 • English language proficiency • Internet access • High Schools in Boston Area Methods

15. Sample Boston’s Teenage Population • 23% of the is African-American • 13% is Hispanic • 58% is Caucasian Stratification approach • We will choose only half of students from predominantly Caucasian neighborhoods (Andover high school is 91% white) • The other half of the students we are recruiting from have primarily African-American and Hispanic populations • Cambridge Rindge and Latin students are 38% African-American; 14% Hispanic; and 40% Caucasian • Boston High School is 55% African –American; 24% Hispanic; and 15% Caucasian (Massachusetts Department of Education, 2002). Methods

16. Sample • Within each school, we will work with health education teachers and after-school program coordinators to recruit and disseminate parental consent forms to students, as well as to recruit teachers who are willing to allow us to conduct the survey in their classroom times. Methods

17. Methods • Written questionnaire given to 500 teenagers (ages 13 – 17) about what they look for in STD websites • Usability test given to a smaller group (n=20) of teenagers to assess the usability and navigability of certain websites Methods

18. Survey If you went to the Internet for sex education, what topics would be most important to you? Please rate each of the following items on a scale from 1-10, 10 = most important and 1 = least important: Methods

19. If you went online to find out specifically about Sexually Transmitted Diseases or HIV, which of the following topics would be most important to you? Please rate each topic on a scale from 1-10, 10 = most important and 1 = least important: Methods

20. Survey Which of the following web site characteristics are most important to you? Please rate each feature from 1-10, 10 = most important and 1 = least important: Methods

21. Survey • Ask them to tell how much sexual health information they have gotten from different sources such as friends, parents, health classes in school, doctors, newspapers, magazines, the Internet, and TV shows • Ask how often they go online for information about certain topics such as HIV or AIDS, other sexually transmitted diseases, pregnancy and birth control, smoking, weight loss and weight gain, violence, and depression or mental illness • Ask them what search engine they used the last time they looked for health information online and when finding sexual health information what key word(s) they are most likely to use Methods

22. Discussion • Phase 1 findings: • The study demonstrated the difficulty of finding websites with teen-oriented sex education • It also demonstrated the need for improved safe sex negotiation education online • And a confusion among sexual health educators about what content to put online • It also pointed to a need for better cataloguing educational information online, perhaps sorted by age-appropriateness and content. • An online clearinghouse of reproductive health information for teens might be useful (Smith, Gertz et al., 2000). Discussion Discussion

23. Discussion • Phase I findings (cont’d) • Sites geared towards adolescents that were analyzed in Phase I used language that may have exceeded the abilities of most adolescents (an average of 9.3) • Sites that used adolescents’ input in generating content were the most teen-friendly • Health educators need to do a better job of presenting online information in formats and styles appealing to young people • Information on websites needs to encompass all aspects of STD.HIV information from information about the disease, to where to get help, to how to talk about with your partner, parents, counselors Discussion

24. Discussion • Phase II goals: • To find out what key words teenagers use • Generate valuable advice about the key words adolescents use when searching for sexual health information on the Internet • Conduct workshops with participants to educate young people on efficient search strategies and key word selection for health issues Discussion

25. Discussion • Phase II goals (cont’d) • To find out which topic are most important to teenagers, so they are not overloaded with information form websites • To give as much information as possible about how to proceed when evaluating educational websites for adolescents • Outcomes of this study will be used to inform future research involving user testing of STD/HIV education websites Discussion