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FindingTeensinTheirSpace:UsingSocialNetworkingSitestoConnectYouthtoSexualHealthServicesSpringer

Wereexperimentingwithanewversionofthispageandwouldlikeyouropinion!
Takealook

Article
SexualityResearchandSocialPolicy
March2011,Volume8,Issue1,pp3849
Firstonline:22February2011

FindingTeensinTheirSpace:UsingSocial
NetworkingSitestoConnectYouthtoSexual
HealthServices
LaurenJ.Ralph
,NancyF.Berglas
,SarahL.Schwartz
,ClaireD.Brindis
10.1007/s1317801100434
Copyrightinformation

Abstract
TheincreasingpopularityandwidespreaduseoftheInternethasmadeitanemergingvenuefor
deliveringhealthrelatedmessagesandinterventions.Thecurrentstudyexploredthepotentialforusing
socialnetworkingsites(SNS),specificallyMySpace,toconnectyouthtosexualhealthservices.Surveys
andfocusgroupswithyouthaged1419livinginlowincomecommunitiesinCaliforniarevealedhigh
levelsofoverallInternetaccess,frequentuseofSNS,andexperienceinsearchingforhealthinformation
online.However,disparitiesinfrequencyandlocationofInternetaccessbyrace/ethnicity,andhesitancy
amongsomeyouthtojoinaclinicsonlinesocialnetwork,mayaffectthesuccessofthisnewstrategyin
somepopulations.InterviewswithclinicstaffhighlightedthesuccessesandchallengesofusingMySpace
aspartoftheiroutreachefforts.Staffdescribedbalancingthebenefitsofwebbasedoutreach,including
itslowcost,widereach,andteenfriendliness,withitschallenges,includingovercomingtechnological
barriers,ensuringteenssafetyfrominappropriatecontact,andremainingtimelyandrelevantgiventhe
dynamicnatureoftheInternet.ThisstudyindicatesthatSNSandothertechnologieshavestrong
potentialforreachingdiverseyouthwithcriticalhealthinformationwhenimplementedaspartofa
comprehensiveoutreachstrategy.

Keywords
TeenpregnancypreventionAdolescentsReproductivehealthOutreachInternetEvaluation

Introduction
Overthepastdecade,adolescentsuseoftheInternetandothertechnologieshasincreaseddramatically.
In2009,thevastmajority(93%)ofAmericanyouthaged1217reportedusingtheInternet,asignificant
increasefrom74%in2000.TeensfrequencyofInternetuseanddiversityofonlineactivitieshasalso
increased,makingthemoneofthemostwireddemographicgroupstoday.TwothirdsofteenInternet
usersin2009reportedgoingonlinedaily,andofthose,36%didsoseveraltimesaday(Lenhartetal.
2010).

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AdolescentsusetheInternetformanypurposesaccordingtonationalsurveydata,theirmostfrequent
onlineactivityistheuseofsocialnetworkingsites(SNS)suchasMySpaceorFacebook(Rideoutetal.
2010).In2009,nearlythreequarters(73%)ofonlineteensreportedusingtheseinteractivesites,an
increasefrom55%in2006(Lenhartetal.2010).In2007,MySpacewasthemostpopularSNSamong
teensinthatyear,85%ofteenSNSusershadaprofileonMySpace,comparedto7%onthesecondmost
popularsite,Facebook(LenhartandMadden2007).
Adolescentsreportusingthesenetworksprimarilytoextendandstrengthenthefriendshipsand
relationshipstheyhaveestablishedintheirnonvirtuallives(SubrahmanyamandGreenfield2008Itoet
al.2008).TheirSNSactivitiesincludesendinggroup(50%)orprivate(66%)messages,posting
commentstoafriendsblog(52%)orpictures(83%),andcommentingonafriendspageorwallpost
(86%).Inaddition,overonethird(37%)ofteensreportjoiningagrouponaSNS(Lenhartetal.2010),
includinghealthrelatedinterestgroups(Versteegetal.2009).Accordingly,onlineinteractionviaSNS
mayhavemanypositiveeffectsonateen,offeringauniqueanddynamicvenueforselfexpression,
communication,andidentityformation(Bersonetal.2002Itoetal.2008Boyd2007).

ADigitalDivide?
WhileamongteensoverallInternetuseishigh,therehasbeencontinuedconcernabouttheexistenceofa
digitaldivide,withteensfromfamilieswithhighersocioeconomicstatus(SES)havinggreateraccessto
newtechnologiesthanthosefromlowerSESfamilies.Themostrecentdatasuggestthatdisparitiesin
accessmaybefinallyshrinking.A2009KaiserFamilyFoundationsurveyof8to18yearoldsandtheir
parentsfoundthatwhile91%ofhomeswhereatleastoneparenthadacollegeeducationhadInternet
access,thisfiguredeclinedto74%amonghouseholdswheretheparentseducationdidnotextendbeyond
highschool.However,despitebeinglesslikelytohaveInternetaccessathome,HispanicandAfrican
Americanteensreportedspendingmoretimedailyonlinethantheirwhitepeers,suggestingthatteens
havediversepointsofaccesstotheInternet,includingschool,friendshouses,andthelibrary(Rideoutet
al.2010).Inaddition,althoughthecomputerremainsthemostcommonsourceofInternetaccessfor
teens,agrowingminoritygainaccessthroughcellphones(27%)and/orgamingdevices(19%Lenhartet
al.2010).RegardinguseofSNSspecifically,nationalsurveydatafromthePewInternet&AmericanLife
Projectfoundthatteensfromlowerincomefamilies,definedasthoseearning<$30,000annually,were
morelikelytouseSNSthantheirwealthierpeers(Lenhartetal.2010).Still,locationmaycreatea
particularbarrierforlowSESteensasInternetaccessinpublicsettingsmaybemorelimitedduetotime
andresourceconstraints,filteringsoftware,andpotentiallossofprivacy.

UsingtheInternetforHealthPromotion
Givenitstremendouspopularityandwidespreadavailability,theInternethasemergedasakeyvenuefor
deliveringhealthrelatedmessagesandinterventionstoadolescents(Stretcher2007Guanand
Subrahmanyam2009).Inherentadvantagesincludeitscosteffectivenessinreachingalargetarget
audience,convenienceandflexibilityforpotentialusers,capacityforpersonalizationbasedonuser
characteristicsorfeedback,timeliness,andabilitytoovercomegeographicandtimebasedbarriers
(Griffithsetal.2006Robertoetal.2007).
Moreover,surveysofteensdemonstratethattheyareinterestedinreceivinghealthinformationand
preventionmessagesonline,inparticularonsensitivetopicssuchassexualhealth,andhaveexperience
usingtheInternettosearchforhealthrelatedcontent(GrayandKlein2006YbarraandSuman2008
BorzekowskiandRickert2000,2001).TherelativeanonymityandprivacyofferedbytheInternetare
consideredaskeydeterminantsofitsappealtoadolescents(Griffithsetal.2006Gustafsonetal.1999).
Teensgenerallyfeelcomfortableassessingthetrustworthinessandsaliencyofhealthinformationfound
online,enablingthemtoavoidthetime,possiblecosts,andconcernsaboutconfidentialityassociatedwith
visitingahealthcareprovider(GrayandKlein2006KanugaandRosenfeld2004).
Despiteitsclearadvantages,usingtheInternettoreachteensandconveysensitivehealthinformationis
associatedwithcertainchallenges.Internetfilteringsoftware,lowbandwidthInternetconnections,and
difficultyfindingaprivatelocationfromwhichtoaccesstheInternetcanserveasbarrierstoaccessing
sensitivehealthinformationonline(Skinneretal.2003).Theprevalenceofonlinepornographyprovides
anadditionalobstacletofindingaccuratesexualhealthinformationonline.Ina2000study,when
investigatorssearchedkeywordsrelatedtoteensexualhealth,63%ofthereturnedsiteswerefoundtobe
pornographic(Smithetal.2006).Afurtherchallengemaybefindingasitethatiscomprehensivein
content,linguisticallyandculturallyappropriate,andalsoteenfriendly.Acontentanalysisof36
educationalsexuallytransmittedinfection(STI)/HIVwebsitesin2002revealednotonlydifficulty
locatingspecifictypesofinformationbutalsogapsintheinformationpresented.Additionally,the
averagereadinglevelofthesiteswasatninthgrade,whichmaybeabovethatofmanyteensatriskfor
contractinganSTI(Kelleretal.2002).Afinalchallengeinherentlyassociatedwithonlineinformation

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searchingisinformationoverload,whichcanleadtodifficultyfindingaccurate,trustworthy
information(KanugaandRosenfeld2004).

SocialNetworkingSitesasaVenueforHealthOutreach
AlthoughagrowingbodyofresearchhasstudiedthesuccessesandchallengesofusingtheInternetto
deliverhealthrelatedinformationandinterventions,lessisknownaboutusingSNSinparticular.Given
theirincreasingpopularityandmorerecentemergenceasacriticalelementamongteens,SNSmayhave
thepotentialtoreachalargeanddiversepopulationwithfrequent,quick,andtailoredmessages.
Inrecentyears,teenoriented,nonprofitorganizationshavebeguntousethistactictospreadtheir
messages.Sex,Etc.,anationalmagazineandwebsiteonteensexualhealth,hasaMySpaceprofilewhere
teenscanlearnabouttheorganization,becomefriendswiththeorganization,postcomments,and
exchangemessageswithSex,Etc.staff.ThepublicsectorhasalsobecomeinvolvedinusingSNSto
promotepublichealthmessages.In2008,theNewYorkCityDepartmentofHealthlaunchedaMySpace
pageinresponsetoincreasingratesofteendepressionandsuicide.Thepageinvolvesteencharacters
videobloggingabouttheirhealthitreceivedover11,000hitswithinthefirstfewdaysofitslaunch(NY1
2008).
Alongwiththeirtremendouspopularityamongyouth,SNShavereceivednegativeattentionbecauseof
theperceivedrisksassociatedwithhavingapresenceonline,includingexposuretosexuallyexplicit
materialandonlinevictimizationintheformsofsexualsolicitationandharassment(Guanand
Subrahmanyam2009).However,aminorityofonlineteensreporthavingbeenthevictimofonline
harassment(9%)orunwantedsexualsolicitation(4%Mitchelletal.2007Ybarraetal.2007).Perhaps
notsurprisingisthattheoccurrenceofthisunwantedcontactishigheramongteenswhodisplayrisk
behaviorinformationonlineaspartoftheirsocialnetworkprofile(YbarraandMitchell2007).
Thus,SNSmayprovetobeanimportantvenueforreachingteenswithbriefhealthpromotionmessages
andinformationaboutavailableservices.Similartoexistingformsofhealthoutreach,itfindsteenswhere
theyaremostcomfortable,inTheirSpace.However,eventhoughyouthservingorganizationsare
spendingtimeandresourcestoimplementSNSoutreach,littleisknownaboutthepotentialsuccesses
andchallengesofthisemergingstrategy.ThepurposeofthisstudywastoexploreInternetandSNSuse
amongasampleoflowincomeCaliforniayouthandtodescribeeffortsbyCaliforniafamilyplanning
clinicstoconducthealthoutreachusingSNS.

Methods
ThecurrentstudywasconductedaspartofanongoingevaluationofCaliforniasTeenSMARTOutreach
(TSO)Program,astatefundedteenpregnancypreventionefforttoincreaseaccesstoclinicalfamily
planningservicesforteenslivinginlowincomecommunitieswithhighteenbirthrates.From2004to
2008,21nonprofitandpublicsectorclinicswerefundedtodevelopandimplementvariedoutreach
strategiestoreachteensaged1419.AllclinicsalsoreceivedfundingthroughCaliforniasFamily
Planning,Access,CareandTreatment(PACT)Medicaidwaiverprogram,whichprovidesnocost,
confidentialsexualhealthservicestolowincomeuninsuredresidents,includingteens.AsofJanuary
2008,whenthisstudybegan,7ofthe21TSOclinicswereusingMySpaceasastrategyforreachingteens
withinformationaboutthesexualhealthservicesofferedattheirclinicsites.Noclinicsreportedusing
otherSNS(suchasFacebook)therefore,thisstudyfocusedontheuseofMySpace.
ThisstudywasdesignedbyresearchersattheUniversityofCalifornia,SanFrancisco(UCSF)toexplore
theseemergingeffortsandunderstandtheirpotentialasamodelforotheryouthservingprogramsin
California.Specifically,thestudyaimedtoanswerthefollowingresearchquestions:
1.
1.TowhatextentdoteensinlowincomeCaliforniacommunitieshaveaccesstotheInternetand
useSNS?Doesthisprofiledifferbyage,gender,orracial/ethnicbackground?

2.
2.TowhatextentdoteensusetheInternettofindinformationaboutsexualhealthandwhatare
teensperceptionsoftheinformationavailableonline?

3.
3.Fromtheclinicperspective,whataretheresourcerequirements,advantages,andchallengesof
implementingandmaintainingwebbasedoutreachusingSNS?

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Toconductthisformativeevaluation,theresearchquestionswereaddressedusingamixedmethod
approach.AlldatacollectionstrategiesweredevelopedbytheUCSFresearchersspecificallyforthisstudy.
Whereverpossibleandtobuilduponpreviouslyuseditems,questionsmirroredthePewInternet&
AmericanLifeProjectssurveyinstrument(LenhartandMadden2007).Allresearchactivitieswere
approvedbyUCSFsCommitteeonHumanResearchandtheStateofCaliforniasCommitteeforthe
ProtectionofHumanSubjects.Activeverbalconsentwasobtainedfromallparticipants,followingreceipt
ofaninformationsheetdetailingtheriskandbenefitsofparticipationinthestudy.Parentalconsentwas
notrequiredduetothecontentandsettingofthestudy.

TeenInternetAccessandUseSurvey
Researchersdevelopedabrief(twopage,18item)surveydesignedtoassessteensaccesstoanduseof
theInternetandSNS,andinterestinseekingsexualhealthinformationonline.ProgramstaffatallTSO
clinics(N=21)wereaskedtoadministeratleast50surveystoteensparticipatinginoutreachactivities
overa3monthperiod(JulytoSeptember2008).Staffcollectedsurveysfromaconveniencesampleof
teenswhowere,totheextentpossible,representativeofthepopulationtheytypicallyservethroughtheir
TSOoutreachactivities.UCSFprovidedallmaterials,initialtraining,andongoingtechnicalassistanceto
supportsurveyadministrationandsubmission.Atotalof1,071surveyswerereceived,representingdata
from19of21TSOclinics.1
SurveydatawereanalyzedusingStata9.0software(StataCorp2005).Dataanalysiswaslimitedto
surveyscompletedbyteensaged1419(n=993,93%oftotalsample),thetargetpopulationforall
programactivities.Surveyweightswereappliedtoaccountfordifferencesinthenumberofsurveys
submittedbyeachclinic,thereforeensuringthateachclinicsdatawererepresentedequallyinthefinal
results.Datawereclusteredatthecliniclevelinordertoaccountforsimilaritiesamongteenrespondents
withineachclinicscommunity.

SiteVisits
AteamofthreeresearchersconductedsitevisitsatsixTSOclinicsthathadbeenidentifiedasconducting
webbasedoutreachactivitiesusingMySpace.ThesevisitstookplaceinMay,June,andJulyof2008.The
sixclinicsweregeographicallydistributedacrossCalifornia,locatedinbothurbanandruralcommunities,
andadministeredbynonprofitandpublicsectorentities.Eachsitevisitincludedtwoqualitativedata
collectionactivities:

InterviewswithProgramStaff
TSOprogramstaffatthesixclinicsparticipatedinonsitegroupinterviewswithUCSFresearchersusing
astructuredinterviewtool.Questionsfocusedonthedevelopment,implementation,resource
requirements,successes,andchallengesofwebbasedoutreach,aswellastheirperceptionofits
effectivenessasanoutreachstrategy.Allinterviewsincludedtheprogramcoordinatorresponsiblefor
overseeingoutreachactivitiesforthatclinic,aswellasanyadultorteenhealtheducatorswhowere
involvedintheclinicswebbasedoutreach.Groupinterviewswereconductedwith22staffatsixsites.
Thenumberofstaffpergrouprangedfromtwotofour.Allinterviewswereaudiorecordedwith
participantsconsent.

TeenFocusGroups
Focusgroupswithteensaged1419wereconductedatthesixclinicsbytheUCSFresearchersusinga
structuredtoolwithfollowupprobes.QuestionsaddressedteensperceptionsofSNS,useoftheInternet,
andattitudestowardreceivinghealthinformationusingnewtechnologies.Focusgroupparticipantswere
recruitedwiththehelpofTSOprogramstaffthus,mosthadparticipatedinanoutreacheventand/or
werefamiliarwiththeTSOprogram.Focusgroupswereconductedwithatotalof58teens.Thenumber
ofparticipantspergrouprangedfrom6to14,withanaverageoftenpergroup.Allfocusgroupswere
audiorecordedwithparticipantsconsent.Participantsweregivena$10giftcardfortheirtime.
Aftercompletionofthesixsitevisits,aUCSFresearcherwhohadnotbeenpresentatthesitevisits,but
whowashighlyfamiliarwiththeresearchprotocolandaims,reviewedeachoftheaudiorecorded
sessionsandcreatedageneraltranscriptofthatsession.Thesessionswerenottranscribedverbatimin
theirentiretyduetoresourceandtimeconstraintsrather,theresearcheridentifiedandtranscribed
verbatimkeyresponses,passages,andquotationsrelatedtoeachquestion.Researcherswhowerepresent
ateachinterviewandfocusgroupreviewedthesethematicnotesandquotesforaccuracyand
completeness.Thetranscribedinterviewsandfocusgroupswerethenorganizedintosectionsbasedon
questioncontentsothatrelatedthematicresponseswereassembledforanalysis.Teamsoftwo
researchersthenindependentlyreviewed,categorized,andsynthesizedkeythemesemergingineach

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section,returningtotheaudiorecordedsessionsforclarificationoradditionaldepthwhenneeded.This
reviewstructureensuredthatatleasttworesearchersreviewedalltranscriptsandindependently
identifiedsalientthemesfromthatsectionbeforemeetingtodiscussandsummarizefindings.Regular
teammeetingswereheldthroughouttheanalysistodiscussfindings,cometoagreementaboutkey
themesidentified,andaddressanydiscrepanciesinindividualinterpretations.

Results
TeensAccesstoandUseoftheInternet
AdiversesampleofteensparticipatinginoutreachactivitiescompletedtheTeenInternetAccessandUse
Survey.Respondentsrangedinagefrom14to19,withamedianageof16.Justunderhalf(49%)
identifiedasLatino,followedby12%white,12%mixedrace/ethnicity,11%Asian/Pacific
Islander/Filipino,and10%AfricanAmerican.Morethanhalf(60%)ofrespondentswerefemale.This
demographicprofileisrepresentativeofthestatessociodemographicprofileoflowincomeyouth
accessingsubsidizedfamilyplanningcareandcommunityhealtheducationefforts.
Thevastmajority(94%)ofteensreportedusingtheInternet.Youngerteens(aged1415)were
significantlymorelikelytoreporthavingusedtheInternetthanolderteens(aged16and17),butatleast
90%inallgender,age,andracial/ethnicsubgroupsindicatedthattheywereatleastoccasionalInternet
users.Moreover,teensreportedhavingregularaccesstotheInternet.Half(53%)ofInternetusingteens,
definedasthosereportingatleastoccasionaluse,indicatedthattheyaccesstheInterneteveryday.
However,thisproportionvariedsignificantlybyrace/ethnicity,withAfricanAmerican(41%)andLatino
(47%)teenssignificantlylesslikelytoaccesstheInternetdailycomparedtotheirwhite(64%)and
Asian/PacificIslander/Filipino(74%)peers.LocationofInternetaccessalsovariedsignificantlyby
race/ethnicity.Althoughtwothirds(67%)ofallInternetusingteensreportedaccessingtheInternetmost
oftenfromhome,thisfigurewasloweramongAfricanAmerican(47%),Latino(63%),andmultiracial
(66%)teensrelativetowhite(83%)andAsian/PacificIslander/Filipino(89%)teens(Table1).
Table1
DifferencesinteensoverallInternetuse,frequencyofuse,andmostcommonlocationofInternetaccess,
bygender,age,andrace/ethnicity

Overall(N=
993)

AmongInternetusingteens(N=927)

Percent
reporting
dailyInternet
use

Percentoffrequent
Internetusers(at
leastdailyuse)

Percentaccessingthe
Internetmostoften
fromhome

94

53

67

Female

95

54

68

Male

92

53

70

97

53

76

Overall

Gender

Age

1415

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1617

93**

53

65*

1819*

90

54

60*

AfricanAmerican

95

41*

47***

Asian/Pacific
Islander/Filipino

98

74

89

Latino

93

47*

63**

Biracial/Multiracial

92

56

66*

Other

92

59

71

White

96

64

83

Race/ethnicity

Source:TeenInternetAccessandUseSurvey
*p<0.05,**p<0.01,***p<0.001(comparedtofemale,1415yearsold,andwhitereferencegroups)

TeensUseofSocialNetworkingSites
Thevastmajority(90%)ofInternetusingteensreportedusingSNS.TheiruseofSNSwasfrequent,with
nearlyhalf(46%)reportingthattheyvisitthesesitesdaily.OlderteensandAfricanAmericanteenswere
morelikelytoreportusingSNSthantheirpeers(resultsnotshown).ThemostpopularSNSwas
MySpace,reportedby93%ofthosesurveyedasthesitethattheyuseorupdatemostoften.Othersites,
suchasFacebook(3%),Bebo(<1%),andXanga(<1%),wereselectedbyonlyahandfulofteenssurveyed.
FocusgroupsconfirmedthisfindingparticipantsuniversallyagreedthatMySpacewasthemost
commonlyusedSNSamongtheirpeers.Infact,MySpacesoverwhelmingpopularityandfrequencyofuse
hadmadeitaregularpartofteenseverydaylives.Asoneteencommented:Ifyoudonthave[aMySpace
page],itsweirdnow.Anotherexplainedhowintegralitwasforstayingconnectedintheirnonvirtual
life:Ifyoudonthaveone,youreleftout.Ininterviews,programstaffalsogavetheirimpressionson
howMySpacehadchangedsocialinteractionamongtheyouththattheyserve.Onestaffmember
describedatypicalinformationexchangebetweenteenssincetheonsetofMySpace:Inpublic,insteadof
CanIgetyournumber?Ihear,CanIgetyourMySpace?

TeensUseoftheInternettoFindHealthInformation
Surveysrevealedthatteenshadexperiencesearchingforinformationonline,mostoftenrelatedto
currenteventsornews,butalsoabouttheirhealth.Overhalf(58%)ofInternetusingteensreported
goingonlinetosearchforinformationabouthealth,dieting,orphysicalfitness,and40%hadusedthe
Internettolookspecificallyforsexualhealthinformation.Fewer(21%)hadsoughtspecificinformation
aboutaccessingsexualhealthservicesintheircommunities.Femaleteensweremorelikelytohave
lookedonlineforgeneralhealthinformation,sexualhealthinformation,andcliniclocationsthanmale
teens(Fig.1).Similartrendswereseenforolderteenswhosoughtinformationonlinemoreoftenthan
theiryoungerpeers.Therewerenodifferencesininformationseekingbyrace/ethnicity,withone
exceptionAsian/PacificIslander/Filipinoteensweremorelikelytoreportlookingforhealth
informationonline(73%)thanthoseofotherrace/ethnicities(5262%).

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Fig.1
Teenswillingnesstosearchforgeneralhealthinformation,sexualhealthinformation,and
cliniclocationsonline,overallandbygender.Source:TeenInternetAccessandUseSurvey,
analysislimitedtoInternetusingteens(N=927,94%ofthetotalsample).Differencesby
gendersignificantforallcategoriesatp<0.05
Infocusgroups,teensdescribedtheadvantagesanddisadvantagesofusingtheInternettofindhealth
relatedinformation.Privacyandconveniencewerethemostoftencitedadvantages.Teensgenerally
agreedthattherelativeanonymityoftheInternetmadeiteasiertosearchforanswerstopotentially
sensitiveorembarrassingquestions.Asoneteensaid,Youcanbeanonymous.Itslikeyourejusttyping
ittosomebodyyoucantsee.TeensalsoappreciatedthattheInternetwasavailable24/7anddescribed
scenarioswheretheymightneedtofindtheanswertoahealthquestioninthemiddleofthenightoron
theweekend.Atthesametime,somewereuncomfortablewiththeprospectofrelyingoninformation
foundonline,notingthatitmightnotbecompletelyaccurate.Theypreferredinsteadtospeakdirectlyto
someoneandfeltitwasimportantforthepersoninvolvedintheconversationtoseetheirbodylanguage
orhearthetoneoftheirvoice.Asoneteennoted,Whenyoutypeonthecomputer,theywontknowyour
actions.Whenyoutalkonthephone,theycanknowwhetheryoureangryorsad.
Whetherornottheywerewillingtoaccesshealthrelatedinformationonline,teensdescribedtaking
specificstepstoverifytheaccuracyoftheinformationtheyfoundontheInternet.Theyexpressedgeneral
distrustoftheinformationavailableonline,acknowledgingthatanyonecancreateawebsiteorpost
informationonline.TeensconsideredcertainwebsitesmoretrustworthythanothersbasedontheirURL
typeforexample,sitesthatendedin.eduor.orgweregenerallyseenasmorereliablethanthose
endingin.com.Usergeneratedsites,includingWikipedia,werecitedasuntrustworthy.Teenswanted
toseesomesortofcredentialsonasite,orlinkswithcitationsandprofessionalreferences,inorderto
trusttheinformation.Teensexpressedspecificfrustrationwithsearchingforsexualhealthinformation
online,notingthatmuchoftheinformationtheyfoundonlineonthistopicwasinconsistentorunreliable.

TeensWillingnesstoReceiveInformationOnlinefromaFamilyPlanningClinic
Teensweresurveyedabouttheirwillingnesstoreceivesexualhealthinformationfromadoctororclinic
throughvariousformsoftechnology.Half(50%)wereveryorsomewhatinterestedinreceiving
informationviaMySpaceoranotherSNS.Agreaterproportionpreferredtoreceiveinformationthrough
othermedia,suchasthroughaclinicswebsite(70%)orviaemail(60%,Fig.2).

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Fig.2
Teensinterestinreceivinginformationaboutsexualhealthfromthedoctororclinic
throughvariousmethods.Source:TeenInternetAccessandUseSurvey,N=993
WhenaskedspecificallyiftheywouldbewillingtoacceptafriendrequestonMySpacefromaclinicthat
providessexualhealthservices,41%indicatedthattheywould.Asimilarpercentage(37%)werenot
certain,andapproximatelyonefifth(22%)saidtheywoulddeclinesucharequest.
Focusgroupdataclarifiedthesedifferencesinopinion,withteensexpressingvariedperspectivesontheir
willingnesstobefriendswithacliniconMySpace(Fig.3).Similartotheirprocessforscreeningfriend
requestsingeneral,mostteensagreedthattheywouldhavetoverifythetrustworthinessandvalidityof
theclinicanditsprofilebeforeaddingitasafriendtotheironlinenetwork.Severalteensmaintainedthat
theywouldneedtoknowtheclinicstafforhavevisitedtheclinicpreviouslythatis,thefirstcontactmust
bemoredirect.Othersnotedthattheirpersonalinteractionwiththeclinicwaslessimportantaslongas
someoftheirfriendshadalreadyjoinedtheclinicsnetworkofMySpacefriends.Oneteendescribed:If
theyhavesomebodyIknow[asafriend],Illaccepttheir[invitationtobeafriend].Iftheydont,Illblock
them.

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Fig.3
KeyfindingsfromsixfocusgroupdiscussionswithteensatTeenSMARToutreach(TSO)
clinicsinthesummerof2008
Eventhosewhohadalreadyfriendedaclinicorwerereceptivetotheideamentionedbarriersthat
mightpreventothersfromdoingso.Onefrequentconcernwasthatfriendsorparentsmightseetheir
onlineconnectionandmakeassumptionsabouttheirsexualactivityorhealth,althoughteens
perspectivesvaried.Someagreedthatfriendingaclinicwouldbemoreacceptableifitwassomethingthat
thepopularkidsinschoolweredoingotherwise,teensmightriskrumorsbeingspreadaboutthem.
Someteenswereconcernedabouttheirparentsreactions,withonenoting:Ifyouhaveaclinicthere[on
yourfriendlist]andtheyrepostingbulletinsaboutteenpregnancy,[aparent]maythink,Youmightbe
pregnant?Severalteenshadnoconcernsabouttheirparentsknowingabouttheirconnectiontothe
clinicand,infact,feltthattheirparentswouldbesupportive.Otherswerecertainthattheirparentsdid
notknowhowtoaccessoruseMySpaceandthereforehadfewconcernsaboutbeingdiscovered.
Finally,andasseenthroughthesurveydataaswell,someteensexpressednointerestinconnectingwith
aclinicthroughaSNSfortheirownreasons.TheydescribedthepurposeofSNSaspurelysocialandwere
notinterestedinreceivinghealthmessagesthroughthismanner.Asoneteenexplained:Comeon,who
wouldtalkaboutcondomsandbirthcontrolonaMySpacepage?Thepointistohavefriends,tomeetnew
people,nottotalkaboutsex.

TeensPreferencesforSNSFeatures
TeenswereaskedtodescribewhatfeaturesofaclinicsSNSwouldmakethemmorereceptiveto
becomingfriendswiththesite.Teensagreedthatsomeinformationshouldbetransparent,suchasthe
clinicsaddressandservicesprovided,whileotherinformation,suchasdetailedinformationonsexual
healthtopics,shouldbeprovidedmorediscreetly.Teensexpressedvariedopinionsonhowteenfriendly
tomakethesite.SomepreferredthattheSNSbeprofessionalandbusinesslike,whereasothersfeltthat
thesiteshouldhavemoreofahip,youthfriendlytone.Assurancesofconfidentialityandnon
discriminationwerealsoimportanttoteens.Asonenoted,itshouldbeclearthattheclinicisopento
everyoneregardlessofwhoandwhatyouare.Inafewfocusgroups,teensmentionedthatbeingableto
askquestionsofclinicstaffconfidentiallythroughtheSNSmessagingfeaturewouldbeuseful.

TheProgramPerspective:Resources,Advantages,andChallenges
Ininterviews,TSOprogramstaffindicatedthattheirprimarymotivationforusingSNSasatoolfor
outreachwastokeepupwiththetimes.GivenMySpacesoverwhelmingpopularityamongadiverse
populationatthetimeofthisstudy,staffsawdevelopingtheirpresenceonMySpaceasanecessarywayto
reachteensintheircommunitywithmessagesaboutsexualhealthservices.Asonenoted,Itsareally
easywaytocommunicatewiththeyouth.TheyreconstantlyontheInternetviaphoneorcomputer.
Anotherdescribedtheimportanceofreachingteensontheirownterms,Insteadofdeveloping
somethingthat[teens]havetogetusedto,wegotothem.ThecontentandfeaturesofclinicsMySpace
pagesgenerallyreflectedthepreferencesdescribedbyteens:aneyecatchingandteenfriendlydesign,
openlynamingthehostorganizationtodemonstrateprofessionalreputation,offeringinformationabout
availableservicesatclinicsites,andreferencestoresourceswhereteenscouldfindanswerstospecific
sexualhealthquestions.
Formostclinics,theideaforcreatingaMySpacepagecamefromyoungstaffteenpeereducatorsor
youngadulthealtheducatorswhorecognizedthepopularityofMySpaceamongtheirpeers.Thesestaff
wereoftenenlistedtoleadtheinitialdevelopmentofthesites.Asonecoordinatorexplained:Ifwe[adult
staff]weretodoit,wefeltitwouldnotbeveryfunoranimatedoranything.Andshe[apeereducator]
hasexperiencebecauseshehasherownMySpaceandalotofherfriendshaveMySpace.
Evenwithexperiencedteenoradulteducators,moststaffagreedthattheinitialtimeandexpertise
necessarytodevelopandbuildthesitewasthemostchallengingandtimeintensiveaspectoftheir
efforts.Forsomeclinics,theinitialdevelopmenttooksignificantlylongerthananticipatedastheyworked
togarnersupportfromhigherleveladministratorswithintheirorganizationandovercometechnical
hurdles.Threeclinics,forexample,hadtoaddressinternalorganizationalpoliciesthatblockedaccessto
MySpace(andotherwebsites)onofficecomputersduetoconcernsaboutvirusesandspam.Staffalso
describedspendingconsiderabletimedecidingwhatcontenttoincludeontheirMySpaceprofileandthe
overalltoneitshouldadopt.Manystruggledwithwantingtobalancerepresentingthegoals,policies,and
valuesoftheirorganizationwhilestillallowingforaflexible,dynamic,andteenfriendlysite.Intheend,
fourofsixclinicsdecidedtohaveteenoryoungadultstafftakeresponsibilityfordecidingoncontentand
updatingthesite,withregularoversightbysupervisorsforaccuracy,appropriateness,spellchecking,and

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formatting.Onlyoneclinicengagedinaformalprocesswherebystandardsforwebsitecontentwere
developedandapprovedbyhigherlevelstaff.Allstaffagreedthatoncethesitewasupandrunning,
significantlylesstimewasrequiredformaintenanceandupdates.

BuildingaNetworkofOnlineFriends
ProgramstaffdescribedusingdifferentapproachesforbuildingtheirnetworkoffriendsonMySpace.
FourclinicsaskedteensfortheiremailorMySpaceaddressesonsigninsheetsatoutreacheventsand
automaticallysenttheseteensafriendrequestthroughtheMySpacesite.Othersreliedonteensfinding
thesiteontheirownandbuilttheirnetworkbyacceptingrequestsinitiatedbyteens.Oneclinicdecided
nottoacceptanyfriendsintheirnetworkasaresult,theirprofileservedasmoreofaninformationalweb
sitethanaSNS.
Clinicsalsodevelopeddifferingpoliciesonwhethertoreviewthepagesoftheirfriendsforappropriate
content.Oneclinicsstafffeltthiswasnecessarytoensuretheteenfriendlinessandsafetyoftheirsite.
ThepeereducatorresponsibleformaintainingtheMySpaceprofilescreenedallfriendrequestsand
regularlyreviewedtheprofilesofexistingfriends,deletingcontactswhohaddisplayedinappropriate
content,suchasunderagedrinking,substanceuse,orsexuallysuggestivebehavior.Incontrast,two
clinicsdecidednottoreviewtheMySpaceprofilesoftheirfriends,notingthatthereisanunderstanding
amongMySpaceusersthatonesfriendsarenotnecessarilycloseassociatesandthatfriendsonline
behaviorsdonotnecessarilyreflectonespersonalbeliefs.

AdvantagestoUsingSNSforOutreach
ProgramstaffdescribedtheirMySpaceeffortsasonecomponentofacomprehensiveplantoreachteens
intheircommunitywithhealthinformation.AllagreedthatSNSoutreachshouldnotreplacetraditional
inpersonoutreachstrategiessuchasgrouppresentations,streetoutreach,orcommunityevents.Similar
toteens,programstaffemphasizedtheimportanceofbuildinganinterpersonalconnectionfirst:With
realprivatestuff,youneedthathumanconnectionbeingabletorelatetoavoiceoraperson.
However,staffrecognizedseveralstrengthsuniquetowebbasedoutreach.First,fromalogistical
perspective,programstaffmentionedthelowcostofdeveloping,monitoring,andmaintainingthesite
relativetoinpersonoutreachstrategies.Second,MySpaceallowedthemtoengageteenswhomightnot
beresponsivetoinpersonoutreach.Asonecoordinatorexplained,Alotoftimestheyreembarrassed
tojustpayattention[duringpresentations].Theydontwantsomebodytolaughatthem.OnMySpace,
theyreontheirown,theycanlookupsomethingthattheyreinterestedin.Asaresult,MySpacealso
servedasawayforstafftoreinforcemessagesandbuildanongoingrelationshipfollowinganinperson
contact,enablingstafftoconnectwithteensevenwhentheywerenotphysicallyaccessible.
Additionally,stafffeltthattheviralnatureofMySpaceprovidedanopportunitytoconnectwithalarger
numberofteensthanispossiblethroughinpersonoutreach.Afterreachingasmallnumberofteenson
MySpace,staffnotedthattheironlinenetworkquicklyexpanded.Asonestaffpersonexplained,You
knowthatthosefriendsthatyouhavewillseethat,andtheirfriendswillseethat,andtheirfriendswill
seethat.Yourereachingachainofteens.Theimpactforoneclinicwasimmediate,Thekidsare
comingafterschooltothefrontdeskandsaying,CanIgetsomecondoms?.IsawonthecomputerthatI
cangetsomehere.
Finally,havingapresenceonMySpacehelpedsomeclinicsbuildtheirreputationasateenfriendlyplace.
ProgramstaffatoneclinicdescribedteensexcitementuponlearningthattheclinichadaMySpacepage,
leadingonetoexclaim,Maybeyouarecool!Thestaffrecognizedthisandmadespecificeffortstotailor
theirsiteaccordingly,MySpaceisaboutentertainment,aboutbeingontheedge,beingsocial,and
connectingwithpeople.So,weretryingtomakeitmorecruisingfriendlyifyoureonthecomputerjust
tryingtohaveagoodtime.

ChallengesinUsingSNSforOutreach
Oneofthemostsignificantchallengesdescribedbystaffwaslearninghowtoadaptthisnewtechnologyto
reachteenswithhealthrelatedmessages.WithoutpriorexperienceusingSNSasanoutreachstrategy,
thestaffdescribeddevotingsignificanttimeandenergytodecidinghowtheirprofileshouldlook,what
contentshouldbeincluded,andhowoftentoupdatethesite.Inaddition,manyhadtogainthesupportof
higherleveladministratorswithintheirorganizationwhowereunfamiliarwithorhadnegative
perceptionsofSNS,overcometechnicalchallengestoaccessingandusingthewebsite,andlearnhowto
takeadvantageofMySpacefeaturesthatinterestteens.Withouttheinvolvementofyoungstaff,the
technologicalaspectsofdevelopingandmaintainingthesitewouldlikelyhavepreventedoneclinicfrom
developingaMySpacepage,Wedependonour[peereducator],andevenshehasalimitationonwhat

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shecandoonMySpaceandus,werejustbearheadedwhenitcomestoit.Wetry,wegetfrustrated.
Anotherclinicdescribedongoingdiscussionstodecidewhatcontentshouldbeincludedontheirprofile,
questioning,Will[teens]shyawayifwetalkaboutbirthcontrol?
NegativepublicperceptionsofMySpacealsopresentedachallengetosomeclinics.Althoughnonehad
encounteredanysignificantproblemswithhackingorvictimization,allremainedconcernedaboutthe
possibilityofsuchevents.Allclinicsreportedspendingtimereviewingtheirprofilestoensurethatthe
contentwasappropriatetoawiderangeofteenshowever,somestruggledwithfindingabalance
betweenallowingvisitorstohavecreativefreedominusingthesiteandensuringthatthesitescontent
wasappropriateandreflectedtheclinicsmission.Severalstaffweresurprisedbythefrequencywith
whichtheyhadtoupdatetheirMySpacecontentinordertokeepteensinterest.Onecoordinator
expressedconcernaboutthelongevityofMySpacespopularity,Theminuteyoufigureoutwhattheyare
upto,theyvemovedontothenextthing.

Discussion
AsnotedrecentlybytheInstituteofMedicine,thecurrentsystemofhealthservicesandsettingsinthe
USAispoorlyequippedtomeetthediversehealthneedsofadolescents(Lawrenceetal.2009).Forsexual
healthcareinparticular,adolescentsfacenumerousbarriersrelatedtoconfidentiality,cost,and
accessibilityofservices(Brindis2006).Itiscriticaltofindnewandinnovativemodelsforincreasing
accesstosexualhealthservicesforallteens,specificallythoseatgreatestriskforunintendedpregnancy
andsexuallytransmittedinfections.EveninCalifornia,wheretheFamilyPACTProgramensuresthat
comprehensiveandconfidentialsexualhealthservicesareavailabletoteens,awarenessofthisresourceis
oftenlimitedamongthepopulationsmostinneed.Thus,outreachbecomesanimportantsteptoward
increasingaccesstohealthservicesandimprovinghealthoutcomes.
Akeyfeatureofsuccessfulhealthoutreachisconnectingwithtargetpopulationsintheirown
environmentswheretheylive,learn,work,andplay.ThisstudyexploredthepotentialofSNSasan
outreachstrategyforconnectingteenstothesexualhealthservicesavailable,butoftenunknown,tothem
intheircommunities.ItexaminedthepatternsofInternetandSNSuseamongteensinselect
communitiesinCalifornia,aswellastheirwillingnesstobereachedbyaclinicthroughaSNS,inorderto
betterunderstandthelikelihoodforsuccessofwebbasedoutreachinthesesettings.Thestudyalso
describedtheresourcesrequiredforundertakingsuchaneffortandthecommonchallengesinits
developmentandimplementationfacedbyprogramstaffatsixgeographicallydiversefamilyplanning
clinics.
Whileconcernsoveradigitaldividehavebeenextensivelydiscussedinthepast,thisstudyfound
widespreadaccesstoanduseoftheInternetamongadiversesampleofteenslivinginlowincome
communitiesacrossCalifornia.Thesefindingsareconsistentwithagrowingbodyofresearchsuggesting
thatinequalitiesinoverallInternetaccessbysocioeconomicstatusandgenderareshrinking(Livingstone
andHelsper2007).Nonetheless,thisstudyfoundracial/ethnicdisparitiesinthefrequencyofuseand
locationofaccesstotheInternet,withAfricanAmericanandLatinoteenssignificantlylesslikelyto
frequentlyusetheInternetandaccesstheInternetfromhome.Suchdifferencesinfrequencyandlocation
ofaccessmayhaveasubstantialimpactonthetypesofonlineactivitiesthatteenscanengageinandthe
extenttowhichtheycanobtaininformationquicklyandprivatelyatatimethatmightbemostconvenient
forthem,forexampleonweekendsandlateatnightwhenaccesstopubliclocationswouldbemore
restricted.AdditionalresearchonhowlocationofaccessimpactsteensuseoftheInternet,especially
givenrapiduptakeofmobiletechnologybydiverseyouth,isnecessarytobetterunderstandtheimpactof
thesedisparitiesandhowthesearechangingovertime.
Findingsalsoconfirmedteenswillingnesstoseekinformationabouttheirpersonalhealthonline.Four
outoftenteenssurveyedhadlookedspecificallyforsexualhealthinformationonline,andoneinfivehad
usedtheInternettolocateaclinicintheircommunitywheretheycouldaccesssexualhealthservices.
Notably,thesefindingsweresimilaracrossdiverseracial/ethnicgroups,mirroringotherstudieson
informationseekingbehaviorsamongteens(Zhao2009).Theteensinthisstudydescribedunique
advantagestousingtheInternettofindhealthrelatedinformation,includingitsprivacy,anonymity,and
convenience.Atthesametime,theyexpressedconcernsabouttheaccuracyoftheinformationavailable
online,afindingthatisnotsurprisinggivenotherresearchhighlightinginconsistenciesinthequalityand
comprehensivenessofonlinehealthinformation(Grayetal.2005).Giventhewealthanddiversityof
informationalreadyavailableonline,itiscriticalthatthosedevelopingnewwebsitesaimedatyouth
considertheiruniquecontributionandrole.
Usergenerated,interactivewebsitessuchasMySpaceandotherSNSclearlyhavetremendousappealfor
teenstoday.ThisstudyhighlightedthenearlyuniversalpresenceofMySpaceandothertechnologyinthe

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livesofteens,eventhoselivinginlowerincomecommunities.Thevastmajorityofteenssurveyedhad
developedaprofileonMySpace,andinfocusgroups,theydescribedcommunicatingwithfriends,sharing
information,andexploringnewintereststhroughthesite.WhethertheyviewedSNSasasuitableforum
forreceivinginformationaboutsexualhealthvaried,withhalfshowinginterestinreceivinghealth
informationthroughaSNS.Whenaskedspecificallyiftheywouldbewillingtoacceptafriendrequeston
aSNSfromaclinicthatprovidessexualhealthservices,41%indicatedthattheywould.Thereisstilla
largeproportionofteenswhoarenotreadytoengageinthisapproach,eitherbecausetheyviewSNSas
moreappropriateforsocialinteraction,haveconcernsaboutpeerorparentalreactions,orpreferto
connectwithhealthprofessionalsfacetoface.Thesevariedpreferenceshavebeennotedinotherstudies
(Bamblingetal.2008)andwerereflectedinprogramstaffsdescriptionoftheirchallengesbuildingtheir
networkonMySpace.ContinuedattentiontothisissueiswarrantedgiventhedynamicnatureofSNS.
Recently,numeroussocialnetworkingwebsiteshavebeenatthecenterofcontroversyregardinghowto
protectusersprivacywhilemaintainingthepublicandsocialnatureofthesites.Theseongoingchanges
mayincreaseanindividualswillingnesstosharehealthorotherpersonalinformationonline,ortheymay
driveusersawayfromthesiteentirely.
Still,theabilitytoengageevenhalfofteensthroughSNSmaybeconsideredasuccess,particularlyif
complementedbyotheroutreachapproaches.Inmakinghealthrelateddecisions,individualstypically
consultmultipleresourcesandmayhavetohearmessagesthroughmultiplevenuesbeforechangingtheir
behaviors.Althoughphysiciansandparentsconsistentlyrankasthemosttrustedsourceofinformation
forteens,thereisincreasingevidencethattheInternetservesanimportantfunctionofreinforcingor
triangulatingtheinformationconveyedthroughothersources(Ohetal.2005Eysenbach2008).Asa
result,althoughtheInternetmaynotbethemosttrustedsourceofhealthinformation,itappearstobean
increasinglypopularpartofanindividualshealthdecisionmakingprocess,includingdecisionmaking
aroundreproductivehealth(YeeandSimon2010).
TherearemanypotentialbenefitsofSNSoutreach.ThroughaclinicsSNS,teenscanfindinformation
vettedbyareputablehealthprovider,reducingthechallengesofinaccuracyandinformationoverload
offeredbytheInternet.Teensinparticularvalueinformationthatisquicklyaccessible(Ybarraand
Suman2008),andSNSarewellsuitedtodeliverinformationinthisformat.HavingapresenceonaSNS
canalsoestablishaclinicsreputationasateenfriendlyplace,allowingyouthtofamiliarizethemselves
withtheclinicpoliciesregardingconfidentialityandcost,servicesavailabletothem,andsometimeseven
staffmemberswhotheywillencounterduringtheirclinicvisit.SNScanalsoserveasauniquewayin
whichtoengagehardtoreachyouth,includingthosethatarehesitantorunabletoaskquestionsduring
inpersonoutreachandwhoprefertheprivacyandanonymityoftheInternet.Finally,usingSNSasan
outreachstrategyoffersprogramstheopportunityforyouthinvolvementbyengaginglocalteensinthe
development,review,andmaintenanceoftheirSNSefforts.
However,beforeengaginginSNSoutreach,itiscriticalforprogramstoconducttheirownneeds
assessmentsensuringthatteensintheircommunitieshaveaccesstothetechnologyandarewillingto
engagewithahealtheducatororclinicianthroughthesemechanisms.Thisformativeworkisparticularly
criticalgiventherapiddevelopmentofnewtechnologiesandfluidityinteenspreferencesforonline
activities.Asnewandvariedformsoftechnologybecomeestablishedinteenculture,youthserving
programsneedtostayattunedtothesechangesandconsiderwhethersuchtoolsshouldbeusedin
conjunctionwiththeirtraditionalapproaches.RegardingSNSspecifically,arecentstudyfounddeclining
useofMySpaceinasampleofover1,400adolescentsfollowedoveraperiodof2years(Patchinand
Hinduja2010).Itisunclearatthistimewhethertheseyoutharejoiningotheronlinesocialnetworkssuch
asFacebookorsimplylosinginterestinSNSsitesaltogether.Thesechangesinsocialmediaareclearly
organicandmovequickly,soitiscriticalthatthelessonsandinsightslearnedfromMySpaceorany
specifictechnologybeconsideredinthedevelopmentofthenextgenerationsofsocialmedia,whichare
likelytocontinuetoevolveovertimeandinnewcohortsofadolescents.
Severallimitationsofthecurrentstudymustbeconsideredwhileinterpretingthesefindings.First,survey
andfocusgroupparticipantswereselectedwiththehelpofprogramstaffandthusrepresenta
conveniencesample.Specificguidelinesregardingrepresentativesamplingstrategiesweresharedwithall
programstaff,butintheend,theprogramstaffadministeredsurveysattheirdiscretion.Asaresult,the
findingsfromthisstudyarenotnecessarilyrepresentativeofallteensparticipatinginTSOprogramsorof
teensinCaliforniamoregenerally.Second,althoughtheTSOprogramwasdesignedtoserveteensinlow
incomecommunities,socioeconomicdatawerenotcollectedtoconfirmincomestatus.Third,timeand
resourceconstraintsprohibitedverbatimtranscriptionofallfocusgroupandinterviewdata.Independent
reviewsofalltapedsessionsandnotesbyatleasttworesearchers,aswellasregulardiscussionamong
studystaffregardinginterpretationoffindings,wereconductedtoensureaccurateandconsistent
reportingofresultsdespitethismethodologicallimitation.Fourth,datacollectionforthisstudyoccurred
inthesummerof2008whenMySpacewasthemostpopularSNSamongteens.Recognizingthedynamic
andevolvingnatureoftheInternetandSNS,itisimportantthatthesefindingsbeconsideredinthe

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contextofthetimeperiodinwhichthedatawerecollected.Finally,theresearchersmadeanexplicit
decisiontodesignanexploratorystudygiventherelativeinfancyofthisapproachamongtheclinicsbeing
evaluated.Thatis,thisstudyrepresentsaninitialattempttoexplorethepotentialforSNS,specifically
MySpace,tobeusedasoneinaportfolioofstrategiestoreachteenswithcriticalhealthmessages.Should
sucheffortscontinueandexpandbasedonthefindingsofthispreliminarystudy,aninvestmentina
comprehensiveevaluationiswarranted.
Overcomingthemultitudeofbarriersthatteensfaceinaccessingsexualandothertypesofhealthservices
willrequirethatyouthservingprogramsadoptinnovativeanduniquestrategiesandvenuesfor
connectingwithteensintheircommunities.Onlineapproaches,includingtheuseofSNS,havethe
potentialtoengagediversesegmentsofthepopulationandprovideyouthwiththeresourcestheyneedto
navigatetheiradolescenceandavoidpregnancyandSTIs.Otherwebbasedtools,includingtextande
mailremindersforcontraceptiveuseorclinicappointments,anonymousnotificationofexposuretoSTIs,
linkstolocalsourcesoftreatment,andpodcastsand/orothershortvideosonreproductivehealthtopics
couldbeintegratedintoMySpaceorotherSNS,furtherincreasingyouthsaccesstothisimportant
information(Levine2009).Althoughtechnologyshouldneverreplacetheinpersoninteractionbetween
youthandhealthcareeducatorsandproviders,ithastremendouspotentialtocomplementandreinforce
healthmessagesandreachyouthontheirownterms.

Footnotes
1
FundingfortheTSOProgramendedabruptlyinSeptember2008priortotheanticipatedcompletionof
thisstudy.Asaresult,notallclinicswereabletosubmitthetotalnumberofsurveysrequested.

Acknowledgments
ThisstudywasfundedbytheStateofCaliforniaDepartmentofPublicHealth,OfficeofFamilyPlanning,
throughacontractwiththeUniversityofCalifornia,SanFrancisco.Dr.Brindistimeissupportedinpart
bygrantsfromtheMaternalandChildHealthBureau,HealthResourcesandServicesAdministration,
U.S.DepartmentofHealthandHumanServices(U45MC00002,andU45MC00023).Theauthorswish
tothanktheformerTeenSMARTOutreachgranteesfortheirinnovativeworkandcontributionstothis
study,aswellasAyeshaAppaforherresearchassistanceduringdatacollection.

OpenAccess
ThisarticleisdistributedunderthetermsoftheCreativeCommonsAttributionNoncommercialLicense
whichpermitsanynoncommercialuse,distribution,andreproductioninanymedium,providedthe
originalauthor(s)andsourcearecredited.

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