POTENTIAL INFLUENCE OF A SOCIAL MEDIA INTERVENTION ON RISKY SEXUAL BEHAVIOR & CHLAMYDIA INCIDENCE. Krista Jones DNP, ACHN, MSN,RN

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1 POTENTIAL INFLUENCE OF A SOCIAL MEDIA INTERVENTION ON RISKY SEXUAL BEHAVIOR & CHLAMYDIA INCIDENCE Krista Jones DNP, ACHN, MSN,RN

2 EBP Question Among year olds living in a Midwestern community, does STD prevention education transmitted via a social Internet site (Facebook ) decrease the incidence of risky sexual behavior & reported Chlamydia cases?

3 Background Most commonly reported sexually transmitted disease (STD) in US 19 million cases reported annually 50% attributed to persons aged (25% of sexually active population) 47% HS students sexually active 37% HS students report no condom use (CDC, 2007)

4 College Students 67% of college students report having had sexual intercourse (oral, vaginal, and or anal) within the last 12 months 53.5% of those engaging in sexual activity report using a condom or protective barrier during intercourse. ACHA, 2008

5 Background Chlamydia Cases per 100,000 Champaign County 635 Illinois 460 United States yr old Composition of All Reported Chlamydia Cases Champaign County 57% Illinois 71% Failure of Local health district interventions prompted a Re-design of educational strategies (IDPH, 2009; CUPHD, 2009)

6 Social Media Stats 69% of Facebook users are yrs Among teens: 47% (12-17 years) average 11 ½ hours weekly online seeking information 28% (15-17 years) list Internet as primary source of sexual information 90% have computer access 80% use social networking site Sources: Social Media Optimization, 2009; AC Nielsen, 2009; Kaiser Family Foundation, 2002; Teen Checkup, 2008

7 Literature Review Limited research (N = 5) focusing on outcomes associated with the use of social media sites for preventive health education. Limited existence of this technology (Facebook was launched worldwide in 2006) Lack of exposure by academia to this form of interface Conclusions Need for preventive information to decrease STD incidence & prevalence Need for Internet-based interventions to reach at-risk populations

8 Conceptual Framework Pender Health Promotion Model guided the design of this study. This model has been used previously to examine internal and external factors leading to an individual s decision to engage in high risk behaviors Examined those factors measured by YRBSS instrument (Calvert & Bucholz, 2008; Grubbs & Carter, 2002; Pender, 1996)

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10 Caryn Forya Developed April 2009 Site Content Signs, symptoms, complications of Chlamydia infection Treatment and screening information with links to area providers Myths and facts of Chlamydia contagion and spread STD prevention and transmission including correct condom application and safe sex practices How to talk to your partner and/or parents once a diagnosis occurs.

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15 Instrumentation

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17 Survey Questions 1. Have you ever had sexual intercourse? 2. How old were you when you had sexual intercourse for the first time? 3. During your life, with how many people have you had sexual intercourse? 4. During the past year, with how many people did you have sexual intercourse? 5. Do you feel the information provided on this site encouraged a reduction in the number of your sexual partners? 6. Did you drink alcohol or use drugs before you had sexual intercourse the last time?

18 Survey Questions 7. Prior to reading the information provided on this site did you or your partner use a condom during sexual intercourse? 8. Following reading the information provided on this site do you intend to use a condom during sexual intercourse? 9. The last time you had sexual intercourse, what one method did you or your partner use to prevent pregnancy? 10. Do you feel the information provided on this site influenced your decision to use sexual protection? 11. Were you diagnosed with a sexually transmitted disease/infection prior to accessing this Facebook site? 13. Were you diagnosed with a sexually transmitted disease/infection after accessing this Facebook site? 15. Do you plan to seek testing for any sexually transmitted disease/infection following reading the information provided on this site?

19 Questionnaire Adaptation Expanded # of pregnancy prevention methods under study in Question 9 to more accurately reflect the extent that these methods were being used by our target population. YRBSS limited their inquiry to condoms and birth control pill use. Our study expanded options to include Depo- Provera (injectable birth control), Withdrawal, Some other method, Not sure

20 Questionnaire Adaptation We choose to look at the number of sexual partners for each participant over the past year as opposed to the past 3 months (YRBSS) to more fully capture the extent to which this population engages in this risky sexual behavior.

21 Data Collection Survey link posted on CF Site Direct only to year old friends of CF site. Survey data collected using Askpeople Software Survey completed January 2011

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26 Population & Sample Population = all participants yrs accessing Facebook site (N=896) Convenience Sample (n=70) 70% Female, 97% Champaign Cty, 87% (18-24 yrs) 11% (15-17 yrs), 1% Under 15

27 Results

28 Findings Age of First Intercourse 17 years and older 26% Never had sex 13% < 13 years old 10% 14 years old 11% 16 years old 23% 15 years old 17%

29 Findings Pregnancy Prevention Methods Other Method 3% Withdrawal 6% No Method 10% Birth Control Pills 16% Condoms 53%

30 Findings Partners over Lifetime Never had sex 1 partner 2 partners 3 partners 4+ partners 87% Sexually Active 81% 2 or more partners over lifetime 36% Alcohol/Drug Use Prior to Sex

31 Findings 83% of respondents engaged in intercourse with one or more partners in the past year Never had sex Partners Past Year 1 partner 2 partners 3 partners 4+ partners

32 Sexual Behavior Changes Measures Sexual Behavior Champaign Survey subjects n Prior to Intervention % After Intervention % Condom Use 40*(prior) 56*(after) 57% 80% Reduction in Partners Decision to Use Protection 52* N/A 74% 57* N/A 81% Diagnosed with STD 5* (prior) 0 (after) 7% (Chlamydia-3, Gonorrhea-3 and HPV-1). 0% Plan to Seek STD Testing 5* N/A 7% (Chlamydia-1, Gonorrhea-1,Syphilis-1 and HPV-2). Note * Negative responses from participants are not included in this measure.

33 Discussion

34 Participant Demographics Female Male Participants Age of Participant Under Champaign County Resident Demographics/YRBSS Comparisons Champaign Survey subjects n (%) 49 (70%) 21 (30%) 1 (1%) 8 (11%) 61 (87%) 68 (97%) IL YRBSS 2007 (%) 2009(%) 48% 52% 34%* 52%* 14% 51% 49% 33% 52% 15% Note * YRBSS (Youth Risk Behavioral Surveillance Survey) ages are calculated for categories age 15 and younger, year olds and age 18 and over.

35 Risk Factor Frequencies Risk factor Age (1st time) Not Active < 13 years or older Use Alcohol /Drugs Before Sex Pregnancy Prevention Methods No Method Birth Control Pills Condoms Withdrawal Other Method Champaign Survey subjects n (%) 9 (13%) 7 (10%) 8 (11%) 12 (17%) 16 (23%) 18 (26%) Frequencies IL YR BSS 2007 (%) 2009 (%) 7% 5% 25* (36%) 22% 22% 7 (10%) 11 (16%) 37 (53%) 4 (6%) 2 (3%) 18% 65% 23% 63% Note * Participants who reported no alcohol use are not included in this measure.

36 Risk Factor Frequencies (cont) Risk factor Champaign Survey subjects n (%) Frequencies IL YR BSS 2007 (%) 2009 (%) # Partners Lifetime Never Had Sex (13%) 4 (6%) 19 (27%) 16 (23%) 22 (31%) 16% (4+ partners) 14% (4+ partners) # Partners Past Year Never Had Sex (16%) 36 (51%) (83%) 15 (21%) 1+ 6 (9%) 2 (2%) 37% (1+ partners- 3months) 36% (1+ partners- 3months)

37 Condom use during sex increased 23% 57% Prior to reading info on website 80% After reading info on website 23% 81% felt website influenced their decision to use sexual protection 74% were encouraged to reduce the # of their sexual partners. 54 % reduction in positive Chlamydia cases among year olds in Champaign County

38 Conclusions Demonstrated that social media can be an effective tool for information dissemination to year olds. Supports the potential for this method to produce positive behavioral changes among this population.

39 Recommendations Reinforce participants knowledge-cf site interaction reminders Work with school districts to expose students to site & perform evaluations in classroom similar to YRBSS processes

40 Recommendations Expand intervention to sister counties in Illinois with increased STD incidence among yr. olds Explore outcome measures among targeted college population-partner with University health center

41 IRB Concerns Any subject who has "friended" the site will receive messages. The content of these s, if intercepted by a parent, could put a child at risk. If a subject "friends" the site, all other "friends" can see "who" is on the site. Will the fact that they completed the survey be hidden on the site?

42 IRB Concerns Nothing stops a parent or partner from "friending" this site to see "what's going on"...could this put someone at risk? Survey Monkey privacy policy/confidentiality concerns

43 Peoria Community STD Collaborative Formed to address the high rate of STD incidence in Peoria County among adolescents and young adults. Collaborative consists of teens and young adults as well as Peoria area health and social agency members. Conduct focus groups of adolescents and young adults residing in Peoria County. Purpose: Critique of the Caryn Forya Facebook site. Design Facebook intervention for Peoria County

44 Social Media Potential WIC Facebook site Breastfeeding Partners and Mothers site Diabetes Educator Site SexInfo San Francisco Dept of Public Health-texting intervention Stayteen.org-Twitter and Facebook feed

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50 Social Media Potential How might you use social media to reach your targeted population? Interventions? Measureable outcomes? Data Collection? Evaluation?

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52 Thank You

53 References AC Nielsen. (2009). How teens use media. Retrieved from How-Teens-Use-Media-June-2009-Read-in-Full-Screen- Mode American College Health Association. (2008). American college health association national college health assessment II: Reference group executive summary Retrieved from Summary_Fall2008.pdf Centers for Disease Control and Prevention (2004). Methodology of the youth risk behavior surveillance survey system. Retrieved from Centers for Disease Control and Prevention. (2008) sexually transmitted diseases surveillance. Retrieved from

54 References Champaign Urbana Public Health District. (2009). Infectious disease reports. Retrieved from Illinois Department of Public Health (IDPH). (2009). Health Statistics. Retrieved from Kaiser Family Foundation. (2002). Generation Rx.com: How young people use the Internet for health information. Menlo Park, CA: Henry J. Kaiser Family Foundation. Social Media Optimization. (2008). Social network user demographics. Retrieved from Teen Checkup. (2008). Shocking statistics about internet use. Retrieved from

55 Author Contact Information Krista Jones DNP, RN UIC College of Nursing 408 S. Goodwin Urbana, Illinois