Sexual Studies: Sex and Facebook: Can Social Media Help Prevent STIs?

sex-while-on-facebookEvery Saturday, The CSPH highlights news or recent research in the field of human sexuality.  This week we’re looking at whether Facebook can be used as an efficacious tool to decrease sexual risk behaviors.  The study, featured in a recent issue of the American Journal of Preventative Medicine, sought to harness the power of Facebook to reach adolescents, a group that both uses the social media platform regularly and that is considered at high risk for STIs.
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Demographics and Methodology
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Over 1500 adolescents were recruited from the Denver, CO metro area and a college in Louisiana using a combination of online and print ads and in-person contact.  Particular attention was paid to recruiting African American and Latino youth as well as individuals in locations with the highest adolescent prevalence of chlamydia, gonorrhea, and HIV.  Participants had to be 16-25 years old, possess a Facebook account, be able to read and write in English, and be willing to “Like” the study’s page.  The majority of participants were non-white, most lived in the Southern or Western US, and had engaged in sex at some point in their lives prior to participating in this study.
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Each individual—called a “seed”—recruited through one of the above methods was asked to recruit three friends, each of whom was then asked to recruit three friends, and each of them, three more.  This allowed the study to grow more organically, reduced the healthy volunteer effect (healthy individuals are more likely to volunteer for research studies than more sickly individuals) and made it possible to recruit some hard-to-reach groups.  A seed was randomized into either the control or intervention group and all individuals recruited from that line remained in that group as well.  In the control group, participants “Liked” a page called 18/24 News that specifically lacked sexual health information, while participants in the intervention group viewed the page Just/Us that included information about eight broad topics related to sexual health (e.g.  how to access STI testing, condom know-how, etc.).  The material, including articles, quizzes, and games, was recycled every eight weeks to ensure that all participants received information from all eight topics, regardless of when they joined the study.  All participants completed a behavioral assessment of sexual risk at baseline and two and six months after the start of the study.
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What Did They Find?
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Primarily, the authors were interested in seeing if the posts could increase condom use, and this did occur in the short-term, with those in the intervention group reporting significantly higher rates of use than control participants.  Unfortunately, there was both a substantial drop in the number of participants who completed the final follow-up survey at six months and no significant increase in condom use between the two groups.
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Interestingly, there was no change in condom use self-efficacy, the construct thought to be among the most important in health behavior change.  This fact could represent the reason that condom use had decreased by six months: if participants did not feel that they could more easily negotiate and use condoms in the long-run, then they would not be likely to continue to do so during sex.
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Strengths & Weaknesses
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This study breathes new life into the world of STI prevention by offering a novel approach to delivering information into the hands of highly at-risk consumers.  By choosing to use a platform like Facebook, the authors thought similarly to advertisers who leverage adolescents’ online-lives to direct messages.  Though the research is completely new and much additional work needs to be done, this study provides hope that public health can begin exerting its messages among the numerous other ones we see each day.
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The biggest issue with the study was the fact that the intervention effect neither lasted very long nor improved self-efficacy with condom use.  Though the study had a fairly high retention rate, with 75% of the participants completing at least one follow-up survey, a large percentage of those who dropped out were among the highest risk participants.  Furthermore, the study’s Facebook pages did not show high levels of interaction.  This is in line with similar research, however it represents an area where steps can and should be taken to improve utilization.
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Conclusions
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Despite only representing a quarter of the sexually active individuals in the US, adolescents receive over half of the new STI diagnoses each year; therefore, finding innovative ways to bring sexual health information to them has many benefits and is often necessary to disseminate information that many are not receiving due to the lack of universal comprehensive sex education.  Though a clinical setting could be an ideal location to discuss such issues—after all, our trusted healthcare providers are supposed to be the individuals we look to for advice on living healthy lives—many healthcare providers do not discuss such issues with their young patients, especially if those patients are a sexual minority (e.g. LGBTQ youth).  Meeting adolescents where they already are, on the other hand, represents a unique, cost-effective, and potentially powerful approach to STI prevention.
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The results from this study, as well as others looking at the efficaciousness of online-based health interventions, are promising and need to be explored further as another way to fight against the spread of disease.  Researchers need to find ways to increase engagement with and use of the Facebook page so that the message can be continually reinforced on users’ News Feed.  One way of doing this may be tapping a social media marketer to help run a campaign as well as integrating the Facebook page with a newsletter and blog, similar to how many online businesses are run.  Another way would be to create dialogues on the page so that students and researchers alike are sharing information, asking and answering questions, completing polls, etc. Together, the three-pronged approach may help to strengthen and make permanent the desired, positive, and safe sexual health behaviors.
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Citation
Bull, S. S., Levine, D. K., Black, S. R., Schmiege, S. J., & Santelli, J.(2012). Social media delivered sexual health intervention: A cluster randomized control trial. American Journal of Preventive Medicine, 43, 467-474.
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