sex and the new media

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Reaching Teens Where They Are

The problems of teen pregnancy and STDs among adolescents and young adults are well-documented. According to the Centers for Disease Control and Prevention, after declining steadily between 1991 and 2005, the teen pregnancy rate is again increasing nationally. In 2007, there were 42.5 births per 1,000 females in the 15- to 19-year-old age group. It marked the second consecutive year the teen pregnancy rate increased.

Adolescents and young adults also account for the highest reported rates of two STDs—gonorrhea and chlamydia, according to statistics from the Centers for Disease Control and Prevention. Young people ages 15 to 24 have five times the reported chlamydia rate and four times the reported gonorrhea rate as the general population, the CDC reports.

Public health officials are discovering that using forms of the media popular with young people—such as cell phones, the Internet and social networking sites—is one way to provide information that might help prevent an unwanted pregnancy or an STD.

“We’re pretty slow, especially in public health, to get on the bandwagon,” admits Rachel Kachur, health communication specialist for the CDC. “And I feel we’ve done a decent job of figuring out how to be in these spaces, because we have to put accurate, useful information out there in order to compete with all that other stuff that’s out there.”

Kachur insists that adolescents want information about sexual health, but don’t always know where to access reliable and nonjudgmental facts. She believes the new media have the potential to reach many of them.

“Kids go online to get health information, and one of the main topics they’re looking for is sex and sexuality,” she said. “Kids are using the Internet for health information. … It’s up to us to provide them with reliable information and credible resources.”

Children and adolescents between the ages of 8 and 18 consume an average of 44 hours of media time per week, according to Albert from the National Campaign to Prevent Teen and Unplanned Pregnancy. He points out that’s more time than they spend in school and more time than most young people spend with their parents. “Teens are already knee-deep in cyberspace. Why would you not try to reach them there?” he asks.

Kachur believes the use of new media offers young people a way they can “feel normal” about their sexual development.

“When kids are coming into their own sexuality and trying to figure out who they are, they can find others like them online. That’s really important when you think back at how difficult it is to be a teenager and trying to fit in,” Kachur said.

Other Programs Join the New Media

Deb Levine, executive director of California-based ISIS Inc., a nonprofit organization focused on developing technology for promotion of sexual health and healthy relationships, was instrumental in the creation of GoAskAlice at Columbia University in 1993, believed to be the first Web site where people could anonymously ask questions about sexual health issues. More than 15 years later, she is still encouraging policymakers to embrace technology as a means of providing sexual information to young people.

“The computer and technology is not a panacea,” she said. “It works best in combination with other ways of reaching young people. … So it’s not that this is going to replace other ways that we communicate, but it’s a complement to other services that we’re providing.”

Through a CDC-funded program, the New Media Institute at the University of Georgia led an effort in 2008 for students from seven colleges to produce videos that can be broadcast onto someone’s cell phone to fight the spread of HIV. What came from that program is The AIDS Personal Public Service Announcement project, designed to increase awareness of the importance of HIV testing and to encourage young people to get tested.

“They’re spending more time on the phone than with any other medium. It’s a device that is constantly with them,” the institute’s director, Scott Shamp, pointed out. “That’s where they’re going for answers. That’s why we need to make sure that those answers are easily available and that they’re accurate. And that young people can make the right decisions based on that information.”

Nevertheless, technology hasn’t quite caught up with Shamp’s project. He says less than 5 percent of the population owns cell phones capable of receiving the videos broadcast by his students. Currently, the videos are primarily available on YouTube. As technology evolves, however, Shamp believes it will become easier to get the videos to young people’s cell phones.

Other projects using new media to provide information about sexual health issues include the ‘KnowIt’ campaign and HIV testing locator, a collaborative project between the CDC and the Kaiser Family Foundation. It allows users to text their zip code to “KnowIt” (566948) and receive a text message identifying the location of a nearby HIV testing center. Those without cell phones can receive the same information online at www.HIVtest.org.

In California, ISIS partnered with the California Family Health Council and the California Department of Public Health to create a text messaging program called HookUp. To use the service, users text ‘hookup’ to the phone number 365247 and are signed up for weekly health tips. Each tip provides information to help users locate local clinics for STD testing and reproductive health services.

Inspot.org, also run by ISIS, operates in 12 states and 12 metropolitan areas to allow users to find local STD testing resources. It also permits users who are diagnosed with an STD to notify past sex partners so they can be tested. The infected person has the option of remaining anonymous, as 80 percent of the site’s users do, according to Levine of ISIS.

Kachur with the CDC believes policymakers are missing a tremendous opportunity if they don’t use new media for STD and pregnancy prevention programs.

“I think in any health promotion program that has any money going into any policy related to STD prevention or pregnancy prevention, there should be a new media component to it,” she said. “If you’re going to do a health campaign, there should be a piece that provides funding for new media. … It can’t be a novel thing anymore. It is what it is. Kids are the first ones to adopt it. If we want to reach them we’ve got to be in these places.”

—Tim Weldon is an education policy analyst with The Council of State Governments.

September 2009

sex and the new media

Sex education has taken on a whole new venue: Some states offer teens the ability
to ask questions and get answers through text messaging services and Web sites. Coverage of HOOKUP 365247 and inSPOT.

By Tim Weldon

The text comes in: I’m 14 and am going to lose my virginity but am not on birth control. Am I at high risk for pregnancy?

The response: Yes. A sexually active teen who does not use birth control has a 90% chance of becoming pregnant within a year. You need to use protection. Even if you don’t become pregnant you are still at risk of an STD.

This actual interchange is an example of information provided through the Birds and Bees Text Line, funded by the state of North Carolina. Teens can text a question about sexuality and get an answer, usually within 24 hours. The phone numbers are deleted and the entire process is anonymous.

Communicating information about sexual relationships, pregnancy and sexually transmitted diseases has come a long way from the days when teenagers learned about those topics through sex education textbooks or pamphlets in school, or, if they were fortunate, through face-to-face conversations with their parents in their living rooms after dinner.

Even the more recent and increasingly graphic sexual health information published in teen magazines or broadcast on television networks appear to be passé. Now, a growing number of teenagers send and receive text messages by the dozens, belong to multiple online social networking sites, and use blogs, widgets and Twitter, which have only recently joined the lexicon of tech-speak. These media have become new avenues to send or receive sexual information.

As teenagers turn to these digital sources of information—the new media—public health officials are finding a golden opportunity to inform young people about preventing unplanned pregnancy and STDs.

Birds and Bees Texting

In North Carolina, which has one of the nation’s highest teen pregnancy rates, the Adolescent Pregnancy Prevention Campaign of North Carolina developed the Birds and the Bees Text Line to answer questions about sex, relationships and STDs. North Carolina’s General Assembly earmarked approximately $250,000 for the campaign, and $5,000 of that funding is used to operate the Birds and Bees Text Line.

And the questions are still coming in.

Text question: Is it legal for a 17-year-old to be with a 14-year-old?

Text answer: It is legal but is it a good idea? …. It’s best to stick with someone your own age.

Text question: If you have sex under water do you need a condom?

Text answer: Yes, use a condom to protect against pregnancy and STDs every time you have sex.

In its first three months, the Birds and Bees Text Line received approximately 700 questions. Kay Phillips, the line’s director, said 11 staff members are trained to provide non-judgmental answers to the queries. “Our purpose is to reduce teen pregnancies and STDs,” she said. “The purpose is not to teach kids how to have sex. … Our purpose is to help these kids learn and make better decisions.”

Pushback from Parents

Phillips acknowledges, however, she has received criticism at meetings throughout North Carolina. That criticism often comes from parents who oppose a program that enables their children to receive information about sex, including contraception, from anonymous staff working for a publicly run program, particularly since North Carolina mandates abstinence-only sex education curriculum in schools.

“I totally agree that (talking about sex) should be done in the home, but the reality of that is that it is not being done in the home,” Phillips said. She adds, “If there is an opportunity, we … encourage them to talk to their parents. But as you know, not every person out there has a happy family life.”

Deb Levine has a quote featured in this excellent article by New York Times Sunday Styles writer Jan Hoffman. And her start in the field of technology and sexual health in 1993, Columbia University’s Go Ask Alice, is mentioned as well.

When the Cellphone Teaches Sex Education

Nicole Fineman/The New York Times

THE special cellphone, set on vibrate, begins to whir. Throughout North Carolina, anonymous teenagers are texting questions to it about sex.

Text Ed (May 3, 2009)

Online Resources

www.sexetc.org

www.goaskalice.columbia.edu

www.teenwire.com

www.stayteen.org/quiz

www.teenhealthfx.com

www.youthresource.com

www.mysistahs.org

Karen Tam for The New York Times

TEXTERS Sally Swanson and James Martin are two of the experts who answer questions at the Birds and Bees Text Line.

“If you take a shower before you have sex, are you less likely to get pregnant?” asks one.

Another: “Does a normal penis have wrinkles?”

A young girl types: “If my BF doesn’t like me to be loud during sex but I can’t help it, what am I supposed to do?”

Within 24 hours, each will receive a cautious, nonjudgmental reply, texted directly to their cellphones, from a nameless, faceless adult at the Adolescent Pregnancy Prevention Campaign of North Carolina, based in Durham.

There goes the phone again.

“Why do guys think it’s cool to sleep with a girl and tell their friends?”

James Martin, the staff member who has text-line duty this week, is 31, married and the father of a toddling son. He hesitates. How to offer comfort, clarity and hope in just a few sentences? He texts back. “Mostly it’s because they believe that having sex makes them cool,” he types, adding, “Most guys outgrow that phase.”

The Birds and Bees Text Line, which the center started Feb. 1, directing its MySpace ads and fliers at North Carolinians ages 14 to 19, is among the latest efforts by health educators to reach teenagers through technology — sex ed on their turf.

Sex education in the classroom, say many epidemiologists and public health experts, is often ineffective or just insufficient. In many areas of the country, rates of teenage pregnancy and sexually transmitted diseases remain constant or are even rising. North Carolina — where schools must teach an abstinence-only curriculum — has the country’s ninth-highest teenage pregnancy rate. Since 2003, when the state’s pregnancy rate declined to a low of 61 per 1,000 girls ages 15 to 19, the rates have slowly been climbing. In 2007, that rate rose to 63 per 1,000 girls — 19,615 pregnancies.

In the last 15 years, school officials and politicians in many states rancorously debated whether sex-ed curriculums should mention contraception. Meanwhile, public health officials became alarmed about the fallout of risky adolescent sexual behavior and grappled with how to educate teenagers beyond the classroom.

A few universities and hospitals set up blunt Web sites for young people, like Columbia’s Go Ask Alice! and Atlantic Health’s TeenHealthFX.com, allowing them to post questions online. More recently, researchers have explored how to reach teenagers through social networking sites like MySpace and YouTube.

Now, health experts say, intimate, private and crucial information can be delivered to teenagers on the device that holds millions captive: their cellphones.

Programs in Washington, D.C.; Chicago, Toronto and San Francisco allow young people to text a number, select from a menu of frequently asked questions (“What 2 do if the condom broke”) and receive automated replies, with addresses of free clinics. Last month, California started HookUp 365247, a statewide text-messaging service. The texter can type a ZIP code and get a local clinic referral, as well as weekly health tips.

“Technology reduces the shame and embarrassment,” said Deb Levine, executive director of ISIS, a nonprofit organization that began many technology-based reproductive health programs. “It’s the perceived privacy that people have when they’re typing into a computer or a cellphone. And it’s culturally appropriate for young people: they don’t learn about this from adults lecturing them.”

The North Carolina program, with a $5,000 grant for the cellphone line and advertising from the State Department of Health and Human services, takes these exchanges a step further. The Birds and Bees Text Line offers one-on-one exchanges that are private, personal and anonymous. And they can be conducted free of parental scrutiny.

That lack of oversight is what galls Bill Brooks, president of the North Carolina Family Policy Council. “If I couldn’t control access to this information, I’d turn off the texting service,” he said. “When it comes to the Internet, parents are advised to put blockers on their computer and keep it in a central place in the home. But kids can have access to this on their cellphones when they’re away from parental influence — and it can’t be controlled.”

While some would argue that such programs augment what students learn in health class, Mr. Brooks believes that they circumvent an abstinence-until-marriage curriculum. “It doesn’t make sense to fund a program that is different than the state standards,” he said. (The State Legislature is now considering a bill permitting comprehensive sex education.)

As Mr. Brooks suggested, parents who believe these conversations belong in the home could cancel their teenager’s texting service (at possible grave risk to domestic tranquillity).

But they can’t exactly cancel adolescent curiosity about sex. At the very least, said Professor Sheana Bull, an expert on sexually transmitted disease infection and technology at the University of Colorado School of Public Health, “The technology can be used to connect young people to trusted, competent adults who have competent information.”

The Adolescent Pregnancy Prevention Campaign of North Carolina, which runs the text line, has been helping to set up teenage parenting workshops and after-school programs around the state for 24 years, financed mostly by the state and by the federal Centers for Disease Control and Prevention. The nine staff members who take shifts with the text line have graduate degrees in public health or social work, or years of experience working with teenagers.

Modeling their service on a similar city program in Alexandria, Va., the North Carolina staff members worked up guidelines: No medical advice — urge questioners to speak with a doctor. Do not advocate abortion. When necessary, refer questioners to local clinics, Web sites or emergency hot lines. Give reasoned, kind advice. Read answers twice before sending. No sarcasm.

The North Carolina center permitted a New York Times reporter to read through some phone logs, after cellphone numbers and towns were redacted. The questions span the spectrum of adolescence itself, from the goofy to the ghastly. Many ask how to talk with parents about sexuality. Combining a teenager’s capacity to cut to the chase with the terseness of texting, they are often brutally direct:

“Do I love her or do I love the sex?”

“What happens if you swallow a piece of condom?”

Some questions could have been written to teen magazines 50 years ago:

“Why don’t girls like short guys?”

“how do u move yr tongue when u tongue kiss?” (“Kissing is not a science,” the reply notes. “Go at your own pace and you will figure it out.”)

But many questions vault past the basic training manual: “I like boys but I also like girls. What should I do?” (“Some people just like who they like. … Only you can know for sure and only you know what is right for you.”)

Some reveal dangerous chasms of ignorance. Girls and boys alike ask about anal intercourse: Will it prevent pregnancy? Let a girl remain a virgin?

“If ur partner has aids,” one teenager asks, “and u have sex without a condom do u get aids the first time or not?”

Parents haven’t complained yet, perhaps because they haven’t seen the exchanges.

Sally Swanson, a staffer and mother of two teenagers, said if parents did read them, “It would highlight how much disconnected information kids are already getting at younger ages than we did.” The questions can be salacious. The staffers try to answer them all, said Mr. Martin, but discreetly and always urging protection. In offering this service to teenagers, he said, “you can’t say ‘I’ll be honest except or until.’ ” That’s often what happens with parents, he added, “when the child brings up something shocking, the parents tend to shut down.”

Last week, Ms. Swanson answered a flurry of questions from someone who finally identified herself as a 12-year-old girl. She texted, “Do u think its awkward txtin things about sex to kids?”

Ms. Swanson’s reply, in part: “I think communicating with teens in whatever way they need to ask a question is important.” Ms. Swanson gets questions about practices and body parts using slang that is unfamiliar to her. Her reference source: urbandictionary.com.

What pulses powerfully through the phone logs is the teenagers’ longing to unburden themselves. One night, as Mr. Martin was getting ready for bed, the cellphone vibrated. He read it and sat down abruptly. His wife asked what was wrong.

The texted question: “If I was raped when I was little and just had sex was it technically my first time when I was raped or when I recently had sex?”

He wrote three drafts. An hour later, he texted back: “Your first time is whatever you make it. There is no ‘right’ answer: I believe your first time can be many things (good, bad, fun, embarrassing, wonderful) but it should never be nonconsensual. Your first time is the first time you choose to have sex, not when some horrible person forces you.”

Professor Bull, the Colorado expert on technology and reproductive health information, says that such services have benefits but also limitations.

They are great for referrals and short answers to quick questions, she said. But unlike the California model, which can reach thousands automatically, these one-to-one text lines rise and fall on human interaction.

But it’s not an alternative form of therapy. Although some texters ask Ms. Swanson to reveal her age and gender, she refuses. “I don’t want them to feel connected to me,” she said, “because I’m never going to be real to them. I’m a texter. I want them to find someone real to talk to.”

Even so, the voices of an anonymous few, their thoughts floating across that text screen like a 21st-century Magic 8 Ball, haunt her.

A certain 15-year-old.

Last week, the girl texted that she had taken four pregnancy tests. Two negative, two positive. Which were wrong?

“I just recently moved in with just my dad,” the girl continued. “I can’t tell him.” She is an only child. The family has been through turmoil.

Ms. Swanson asked whether the girl could turn to other adults.

The teenager texted: “I talked to my sex ed teacher but she wasn’t much help. She made me feel ashamed.”

Ms. Swanson replied: “I am sorry to hear that. Please don’t feel ashamed. That won’t help anything and this situation certainly does not determine your worth as a human being. Life is full of twists and turns and difficult times — it’s how we handle them that matters — at least that is what I believe.”

Ms. Swanson promised to send her phone numbers for public health clinics in her area.

“Be easy with yourself,” she texted. “You’ll be O.K.”

The next morning Ms. Swanson texted her the contacts. “I hope these numbers can connect you with somebody who can take more time thinking this through with you.”

The cellphone vibrated in reply.

“Thanks.”

Ms. Swanson has not heard from her since.