TTEEEENNSS,, SSEEXX AANNDD TTHHEE IINNTTEERRNNEETT AA PPiilloott SSttuuddyy oonn tthhee IInntteerrnneett aanndd iittss IImmppaacctt oonn AAddoolleesscceenntt HHeeaalltthh aanndd SSeexxuuaalliittyy
by Daran Cohn May 2009
A Community Based Master’s Project presented to the faculty of Drexel University School of Public Health in partial fulfillment of the Requirement for the Degree of Master of Public Health
Faculty Advisor: Nathalie Bartle, Ed.D
i
ACKNOWLEDGEMENTS
The research for and writing of my paper for my Community Based Master’s Project would not have been possible without the guidance of those who have helped me with this research and throughout my education at Drexel SPH, or without the support of friends and family. I am truly grateful that they have all allowed me to benefit from their expertise and kindness.
I would like to thank my esteemed advisor, Nathalie Bartle, for her insight, dedication to this issue, and her unrelenting support and encouragement that made this project possible. She has been the inspiration behind this research and I am privileged to have been a part of it.
My thanks and appreciation also go to Jesse Dougherty at Friends Select School for taking on this project, even in spite of the many responsibilities he already juggles on a daily basis at the school. Without him, I could not have done what I was able to do this year. My appreciation also goes to the students and parents at FSS who shared their experiences with us. They were kind, generous and made this project fun.
I am very grateful for the support of the many students and teachers who have helped me and given me advice for this project and throughout my time at Drexel. The assistance that Jen Breaux was able to give me in analyzing my data was invaluable. And the help with ideas and recommendations that Toti Villanueva offered when Nathalie and I were struggling with recruitment was inestimable. I am so grateful for the kindness and generosity that Lisa Ulmer showed me in developing my abstract when I was in a pinch to submit it on time – she did almost all of it for me! Lilliam Ambroggio was also a tremendous help to me in understanding and developing the methods for this research.
I must also acknowledge my mom, my dad, my sister, my younger brother, both of my grandparents, Sean, Naseem and Leila for always believing in me and cheering me along the way these past two years. I am blessed to have such people in my life.
ii TABLE OF CONTENTS
I. INTRODUCTION P.1 Significance of the Study p. 2 Statement of the Problem p. 3
II. BACKGROUND AND SIGNIFICANCE P. 4 Current State of Knowledge p. 4 Figure 1 p. 4 Figure 2 p. 5 The Youth Development Model p. 10 Figure 3 p. 14 Figure 4 p. 15 Anticipated Contribution p. 17
III. PROJECT AIMS P. 18 IV. RESEARCH DESIGN AND METHODS P. 18 Overview of Approach and Study Design p. 18 Figure 5: Study p. 20 Sampling Methods p. 20 Figure 6: Sampling Plan p. 21 Measurement Methods p. 22 Table 1: Project Timeline p. 23 Proposed Plan for Analysis p. 25 Figure : Specific Aims and Proposed Analysis Plan pp. 26-27
V. HUMAN SUBJECTS CONSIDERATIONS P. 28 VI. RESULTS AND ANALYSIS P. 29 Study Participants p. 29 Analysis Methods p. 29 Parent Survey p. 30 Figure 7: p. 30 Figure 8: p. 31 Figure 9: p. 31 Figure 10: p. 32 Figure 11: p. 32 Figure 12: p. 33 Figure 13: p. 33 Figure 14: p. 34
iii Student Survey p. 34 Figure 15: p. 34 Figure 16: p. 35 Figure 17: p. 35 Figure 18: p. 36 Figure 19: p. 36 Figure 20: p. 37 Figure 21: p. 37 Figure 22: p. 38 Figure 23: p. 38 Figure 24: p. 39 Parent Focus Group p. 40 Girls Focus Group p. 41 Boys Focus Group p. 42
VII. DISCUSSION P. 43 The Gap in Communication Between Parents and Teens p. 44 The Internet and Explicit Material p. 45 Double Standards p. 46 Limitations p. 49
VIII. RECOMMENDATIONS P. 49 IX. CONCLUSION P. 50 X. APPENDICES P. 52 Appendix A: p. 54 Appendix B: p. 73 Appendix C: Tables of Correlation Coefficients p. 93 XI. REFERENCES P. 94
iv
ABSTRACT Teens, Sex and the Internet: A Pilot Study on the Internet and its Impact on Adolescent health and Sexuality
PROBLEM: Parents, teachers, and healthcare providers have been struggling to negotiate their changing roles and responsibilities with adolescents who are now growing up in a digital world. This study explored the ways that the Internet may both help and harm adolescent health and development, including adolescent understanding about human sexuality, attitudes about the sexual world, and sexual behaviors. METHODS: High school students and their parents/primary caretakers from a private urban school with a diverse student body participated in a mixed methods study. For the quantitative component, a convenience sample of eight high school students and their parents/primary caretakers completed a survey with five general themes: demographics, communication, knowledge, attitudes/beliefs and Internet behaviors. Teens’ responses were compared to parent responses. For the qualitative component, nine high school students and four parents/primary caretakers of high school students participated in focus group discussions (one focus group with three teen girls and one focus group with six teen boys for the student focus groups, and one focus group with four parents for the parent focus group). The focus groups used a semi-structured format to explore three themes: learning about health, using the Internet, and determining the nature and extent of what is learned from the Internet about health and sexuality. RESULTS: The results of this study indicate that among teens who participated, a primary resource for learning about sex and obtaining sexual health information was the Internet. A popular online source for learning was Internet pornography, particularly among boys. Parents were unaware of this as well as their teens’ use of the Internet for learning about sex. While parents and teens were somewhat comfortable talking to each other about sex in general, parents were not a primary resource teens referred to when they had questions about sexual behavior. SIGNIFICANCE: The quantitative and qualitative components provided further insight into why and how teens are learning about sex from the Internet and how the Internet affects adolescent sexuality, sexual health and development. Results will guide the development of future research and materials provide guidance for parents and other adults in effectively helping teens navigate the benefits and dangers to adolescent health that exist in the online environment.
v
I. INTRODUCTION
The rapid growth in the use of the Internet and related communication technologies among young people over the past decade was mirrored not by a set of strategies for guiding youth in this complex, dynamic world, but rather, a clearly unprepared adult population who had just one question: What can teens even do online? Technology has the tendency to be self-accelerating. And because the capabilities of the Internet and its use by adolescents have outpaced our ability to effectively keep up, a lack of knowledge and understanding may pose certain risks to teens. This has, in recent times, created a situation in which parents of teens, teachers and healthcare providers alike are struggling to negotiate their changing roles and responsibilities in the lives of youth who are now growing up in a digital world. Indeed, technology has changed the experience of growing up. But it has also significantly changed the job of being a parent, as well as the jobs of the many individuals involved in child and adolescent health promotion.
While the benefits that recent advances in communication capabilities have conferred upon society at large have been widely touted in recent years, discussion of the impact that these new technologies have had on the well-being and development of children and adolescents has, until recently, been comparatively minimal. Throughout the 1990’s, research efforts that aimed to address the impacts of increasing Internet availability with respect to adolescent development centered primarily on access to a computer and the Internet. Many of these studies reviewed the existing disparities between access and the different socioeconomic (SES), ethnic/racial, gender, religious and sexual identity groups living in the
United States. The current literature indicates that more than 73% of the US population uses the Internet, and that more than 60% of low-income households and between 80-95% of middle- and high-income households have Internet access at home.1 Although an understanding of the various social variables that determine accessibility of the Internet are absolutely relevant, it is essential to also recognize two important factors: first, the
1 availability of Internet access today is so widespread that the vast majority of American teens are online; and second, a large proportion of the contemporary research reveals that it is less the usage of a particular technology and more an adolescent’s psychosocial profile and behaviors while online that influence his or her online experiences.2 The specific nature of
Internet use and the experiences young people have online can in turn influence their social development. Thus, it is imperative that studies from this point forward begin to examine
Internet use in the context of variables such as its nature and quality, social conditions, cultural practices and personal meanings so that we can better reach today’s online youth.3 In summary, we must attempt to reach beyond the concept of access and begin to investigate the specific features of the Internet that create varying social contexts for adolescent development.
SIGNIFICANCE OF THE STUDY
Currently, the many ways that the Internet influences the development of adolescents are still uncertain. However, for now at least, we can say with a great deal of certainty that the Internet has the potential to provide a new social environment in which universal teenage concerns related to identity formation and sexuality can be explored privately.4 This raises a number of problematic issues. Claims of online victimization by older “sex-seekers,” the negative impact that viewing pornography can have on a young person’s psychosexual developmental process5 and the potential harms caused by accessing inaccurate health- related information represent only a small fraction of the myriad of common fears parents harbor about teen Internet use today. While parents and other adults may be inclined to censor teenagers’ use of the Internet for these reasons, restricting their access poses a whole new set of problems. Content filters often limit access to information about terms such as
“penis” or “vagina,” which are words commonly used by young people searching the Internet for information related to sexual health. This could make the so-called “digital divide” even deeper as it would limit the number of allowable search terms that adolescents could use at
2 public facilities if they do not have home access to the Internet.6 Rather than focusing on restricting access, therefore, adults must begin to explore other ways in which they can help to guide adolescents through these turbulent years in the face of both the benefits and dangers that exist in the complex virtual world the Internet has created. By developing trusting relationships with teens as well as strategies that encourage safer and more positive uses of the Internet, parents and other adults may be able to help teens increase their self- efficacy with respect to becoming effective Internet users6 and develop into healthier adults.
The significance of this study lies in the opportunity it affords to develop a deeper understanding of the ways that the various features of the Internet affect adolescent behavior, health, sexuality and development. Significantly, this study also provides a means for opening up discussion with teens and parents of teens regarding the realities of adolescent
Internet use and exploring the possible ways that parents can ensure that the Internet has a productive role in their teenagers’ development.
STATEMENT OF THE PROBLEM
As a pilot study, the primary purpose of this project is to inform future research related to the Internet and its role in the health and development of adolescents. This study explores the increasing number of issues that growing up with the Internet presents for
American adolescent health and development and aims to identify and define the struggles that many parents are experiencing as they attempt to uncover their new responsibilities toward their teenagers. More specifically, this study will focus on the problem posed by the dual nature of the Internet. For teens, the Internet is frequently described as a “double- edged sword” that has the potential to both help and harm them.6 The ways in which adolescents and their parents can effectively and appropriately cope with this reality is a matter that is now, more than ever, in need of comprehensive examination.
3 II. BACKGROUND AND SIGNIFICANCE
CURRENT STATE OF KNOWLEDGE
The frequently paradoxical nature of the Internet that characterizes young people’s
online experience becomes most obvious when one looks at common online searches by teens
for health information. With approximately 71% of US adolescents having Internet access at
home7 and 80-92% consistently using the Internet either at home or elsewhere,1,7 the large
majority of teens have the ability to go online whenever they choose. As noted by Kanuga and
Rosenfeld,5 in this way, the Internet offers the advantage of cutting out the time and costs
associated with visiting a healthcare provider to answer health-related questions. An added
benefit may be that the Internet provides a forum through which socially sensitive issues can
be discussed anonymously. These features clearly influence teens’ use of the Internet as a
source for learning about and discussing uncomfortable subjects. For example, research
indicates that out of all of the topics that adolescents investigate online, traditionally
difficult to discuss issues relating to sexuality and sexual health tend to be the most popular
(Figure 1). Kanuga and Rosenfeld: Adolescent Sexuality and the Internet 119
2 Fig. 2. Health topics researched on the Internet. 5 FIG. 1. TOPICS RESEARCHED ON THE INTERNET is clear that people of all ages turn to the Internet for One such website is www.TeenHealthFX.com, a health-related advice much more often than they make project funded by the Atlantic Health System of New appointments to see their doctors. Furthermore, adoles- Jersey and winner of the HRET award in 2001 from cents who engage in risky behaviors are more likely the American Hospital Association. The goal of this to have neglected their healthcare.5 Therefore, while site is to provide adolescents and young adults much information on the Internet is flawed in one way with a fun way to obtain factual health and medical or another, the benefits to an adolescent of having 4information. The site also aims to provide additional access to this information may outweigh the risks of resources where further medical/mental health evalua- not addressing the problems at all. tion and other support services can be obtained. By Another benefit of online health searches is the using websites such as this one, adolescents are em- availability of information regarding the experiences of powered to improve their health through individual others in a similar age group. There are numerous responsibility. This is illustrated by a survey of 2300 adolescent peer web pages that not only contain pro- TeenHealthFX.com visitors in which 23% of respon- fessional advice to ensure quality, but also provide dents indicated that the site led them to seek medical links to questions and stories submitted by adolescents or social services. to whom users can relate. Some of these web re- The appeal of websites such as TeenHealthFX.com sources even have “chat rooms” by which adolescents can communicate with each other somewhat directly lies in the ability to read questions and responses posted and share their experiences. This is a powerful resource by others who have written to the site with similar for adolescents, especially since it tends to be a time in issues. In addition to making answers quickly avail- one’s life when many health-related issues can result able, it provides a reassuring feeling of normalcy, and in feelings of confusion, fear, loneliness, or embar- removes the inhibition felt by many adolescents in rassment. (Table 2). approaching a health care professional with such questions. Table 2. Helpful Health Websites for Adolescents With so many adolescents using the Internet, it is an exciting new tool to use in the struggle for health TeenHealthFX.com Q&A format, chat room, professionals promotion in this age group. Standards for what quali- Teenshealth.org Topics posted on health issues fies as a high quality site, however, have yet to be Youngwomenshealth.org Health information for female teens universally defined and accepted. Certain criteria (English & Spanish) Iwannaknow.org STDs and sexual health should be sought as a minimum standard for asses- Teenwire.com Message board definitions sing general overall quality. Such characteristics as (English & Spanish) having health professionals writing content or provid- Sxetc.org Teen writers, Q&A, stories on ing oversight to material posted, and avoidance of health topics providing specific medical analysis, such as diagnosis Cyberisle.org Links to other health education and treatment recommendations, are key components websites of a reputable health website. Quality sites such as those Teengrowth.com Q&A articles listed in Table 2 provide a valuable resource to adoles- Teencentral.net Health topics with links to narratives cents and young adults by offering a balanced medium APPENDIX
5 Fig. 1. Topics researched on the Internet Kanuga and Rosenfeld: Adolescent Sexuality and the Internet 119
Fig. 2. Health topics researched on the Internet.2
At TeenHealthFX.com, a website that is intended to provide adolescents with factual health is clear that people of all ages turn to the Internet for One such website is www.TeenHealthFX.com, a health-related advice much more often than they make project funded by the Atlantic Health System of New and medical information and other associated support5 services, 41% of the questions teens appointmentsFig.2. Questions to see their doctors. asked Furthermore, at TeenHealthFX.com adoles- Jersey and winner of the HRET award in 2001 from cents who engage in risky behaviors are more likely 5 the American Hospital Association. The goal of this write in with relate to their5 sexual health (Figure 2). to have neglected their healthcare. Therefore, while site is to provide adolescents and young adults much information on the Internet is flawed in one way with a fun way to obtain factual health and medical or another, the benefitsSports to & anNutrition, adolescent 11% of having information. Emotional TheHealth, site also15% aims to provide additional access to this information may outweigh the risks of resources where further medical/mental health evalua- not addressing the problems at all. tion and other support services can be obtained. By Another benefit% of online health searches is the using websites such as General, this one, 2% adolescents are em- availability of information regarding the experiences of powered to improve their health through individual others in a similar age group. There are numerous responsibility. This is illustrated by a survey of 2300 adolescent peer web pages that not only contain pro- TeenHealthFX.com visitors in which 23% of respon- fessional advice to ensure quality, but also provide dents indicated that the site Health led them & Illness, to seek medical15% links to questions and stories submitted by adolescents or social services. to whom users can relate. Some of these web re- The appeal of websites such as TeenHealthFX.com sources even have “chat rooms” by which adolescents can communicate with each other somewhat directly lies in the ability to read questions and responses posted by others who have written to the site with similar and share their experiences. This is a powerful resource for adolescents,Sexual especially Health, since 41% it tends to be a time in issues. In additionAlcohol, to making Cigarettes answers & quickly Drugs, avail- 4% one’s life when many health-related issues can result able, it provides a reassuring feeling of normalcy, and in feelings of confusion, fear, loneliness, or embar- removes the inhibition felt by many adolescents in 5 rassment. (Table 2 ). FIG.2. QUESTIONS ASKEDapproaching AT TEENH aEALTH healthFX. careCOM professional with such questions. Table 2. Helpful Health Websites for Adolescents With so many adolescents using the Internet, it is an exciting new tool to use in the struggle for health TeenHealthFX.comThis is concerning Q&A format, in light chat room,of the professionals fact that thepromotion most incommon this age group.topics Standards discussed for whatby teens quali- with Teenshealth.org Topics posted on health issues fies as a high quality5 site, however, have yet to be Youngwomenshealth.orgtheir healthcare Health providers information for are female nutrition, teens weightuniversally and definedexercise and as accepted. it indicates Certain an criteria important (English & Spanish) should be sought as a minimum standard for asses- Iwannaknow.orgdiscrepancy. STDsAlso andwor sexualth noting health is the fact that when asked what their top areas of interest Teenwire.com Message board definitions sing general overall quality. Such characteristics as having health professionals writing content or provid- are, teens often(English place & Spanish)drugs, STDs and smoking rather than nutrition or exercise at the top of Sxetc.org Teen writers, Q&A, stories on ing oversight to material posted, and avoidance of the list.5 The health reasons topics for such inconsistenciesproviding remain specific unclear. medical analysis, However, such the as diagnosis difficulties Cyberisle.org Links to other health education and treatment recommendations, are key components websites adolescents have with discussing sensitive topicsof a reputable with healthothers, website. namely Quality health sites suchcare as providers those Teengrowth.com Q&A articles listed in Table 2 provide a valuable resource to adoles- Teencentral.net Health topics with links to narratives and their parents, may be partly responsible.cents Because and young teens adults tend by to offering be concerned a balanced mediumwith having
their parents find out about sensitive issues such as sexual behaviors or drug or alcohol use,
the confidentiality the Internet offers adolescents likely provides them with the opportunity
to learn about subjects that may otherwise go without adequate discussion.5 Kanuga and
Rosenfeld5 additionally highlight some of the barriers that may prevent teens from
comfortably talking to health care providers: a question posted by one teen on the
TeenHealthFX website in 2001 asked, “When you say, ‘see your doctor and don’t be
embarrassed,’ how do I know that they won’t think I’m weird and laugh behind my back? Have
they really seen everything?”5 The preference that teens may have for using the Internet to
5 learn about sensitive health issues suggests that it may be an important opportunity for health promotion. At the same time, however, it also draws attention to the reluctance teens seem to have discussing uncomfortable issues with the adults in their lives.8 Because some online sources may be inaccurate and unreliable, there should be concern regarding their potential to perpetuate the many myths and fallacies that tend to inform adolescent beliefs about sexuality. How parents and other adults will contend with these challenges is a question that is only beginning to emerge in literature pertaining to adolescent health.
An additional problem that has recently received a substantial amount of both public and scholarly attention is the frequency with which teens accidentally come across adult websites and other explicit material while online. Much of this unintentional exposure happens when young people are searching the Internet for health-related information such as information about sexuality or sexual health. According to the Kaiser Family Foundation,9 approximately 70% of young people 15-17 years of age have been unintentionally exposed to pornography on the Web. The effects that frequent viewing of pornography might have on adolescents’ psychosexual development have been examined in research a number of times.
Previous studies have demonstrated that prolonged exposure of a young person to such sexually explicit material can lead to a skewed perception of “normal” sexual activity, loss of hope in sexual exclusivity and normalization of promiscuous lifestyles.5 In addition, studies have found Internet access to be associated with younger ages for first oral sex and first sexual intercourse.10 Effective strategies that adults can use to help their children avoid overexposure to explicit material while online without limiting their abilities to research sexual health information are lacking.
Online communication is perhaps the most favored of Internet activities among adolescents. Via e-mail, instant messaging (IM) and blogging, young people are able to easily communicate with their friends and meet other Internet users. Almost half of online adolescents say that they feel that the Internet improves their relationships with their friends.7 Furthermore, research indicates that because the Internet allows youth to communicate information with other Internet users about civic engagement and political
6 participation, it may afford young people opportunities to exercise leadership skills and become stakeholders in their communities.4 However, online communication simultaneously poses the problem of “stranger danger,” a threat that arises from the high prevalence of adults who are seeking sex online.9 And of relatively recent concern is the increasing use of online communication mediums by teenagers for the purposes of harassing and bullying someone else. Anecdotal accounts of depressed or socially isolated teens who have resorted to online communication as a substitute for real life socialization are also very prevalent and may require closer examination. The extent to which any of these risks are real is a question that deserves closer attention, as do the different ways that adults can assist in guiding the online risk-taking behaviors of young people.
Recently, a considerable amount of public attention has focused on the potential vulnerability of teenagers who visit or use social networking sites such as MySpace and
Facebook when online. While creating a homepage to represent oneself can require an adolescent to analyze and then attempt to articulate his or her self identity to others, thereby providing an opportunity for teens to engage in identity exploration and self expression, the frequency of pretending (usually to be older) and identity play is considerably high. The effects that creating fake identities have on a young person’s self identity and self- image should be of concern yet is currently uncertain given the relative absence of research on the issue. Previous studies on adolescent health and the Internet have provided cursory assessments as to whether, as suggested by Erikson, the confidentiality of the Internet in this way allows adolescents to accomplish the critical task of “resolving the crisis of identity.”3,12
However, many experts seem to agree that there is still a great need for clarification regarding the extent to which online identity play and pretense is developmentally specific,3 and if so, how it may help or hinder teens throughout their development.
Pretending in the context of online relationships may, for teenagers, be somewhat problematic. While social networking sites are likely responsible for a great deal of relationships that are established online, chat rooms, IM and e-mail may also play a role.
Fifty-four percent of girls in a 2002 national poll4 revealed that they could be in some sort of
7 cyber relationship online without their parent’s knowledge. And according to E.F. Gross,3 over
90% of teens who engage in online pretending have pretended to be older. Given the increasing prevalence of older online sex-seekers, the fact that girls tend to be at greater risk for online sexual solicitations and the possibility that many young girls may be pretending to be older while online, the potential for adolescent females to engage in developmentally inappropriate sexual relationships via the Internet could be a significant problem. The media has already drawn a great deal of attention to the dangers that young people are vulnerable to when meeting in person someone with whom they have been having a “cyber romance,” claiming that adult predators commonly use the Internet in this way to lure in their victims.
However, the FBI reports that only 3% of solicited youth actually respond to such requests.11
The reality that some young people may be deciding to meet with online sex-seekers in person is absolutely important to address. Yet for the majority of teens who do not follow up these sexual solicitations with a face-to-face meeting, the coercive sexual experiences that they may still be at risk for while communicating with others online is also an issue that is in need of examination. In particular, the possibility that young people may be engaging in developmentally inappropriate conversations about sex or having sexual relationships with older adults should be investigated.
The extent to which social networking sites are used by teens as a way to discover their emerging sexualities may be another reason they have caused concern about their impact on adolescent health and safety. Worries have been intensified by the reality that many American teens negotiate their developing identities while immersed in different cultures, each of which have been differentially influenced by mainstream media. Sexual scripting theory (SST), initially developed by Simon and Gagnon in 1973, describes three different levels of sexual “scripts” that may serve to provide a conceptual framework for understanding how sociocultural and individual factors guide adolescent sexual script development: cultural scenarios, interpersonal scripts and intrapsychic scripts.13 Cultural scenarios are present at the societal or cultural level and provide guidelines for sexual behavior. Some obvious examples may be the media, family and friends. As young people
8 interact with others in a society or culture at the interpersonal script level, their behaviors are informed both by what they learn from various cultural scenarios and the intrapsychic scripts that are formed by their own personal desires and feelings.13
Various cultural-level scripts seem to influence the scripts that young people like to use represent themselves online. For example, Stokes13 notes that certain misogynistic sexual scripts that are popular in the media and hip hop culture play a role in shaping the sexual scripts that Black adolescent girls use to express themselves in their homepages on social networking sites. Cultural-level sexual scenarios that “portray Black female sexuality using images of a hypersexual Jezebel or a loyal Mammy”13 are common in hip-hop culture and may cause young Black girls to adopt similar interpersonal scripts online. Indeed, some girls advertise on their Web pages that they are “down for whatever” (sexually adventurous) or
“down for their man” and willing to “hold his stash, hide his gun, take the weight and go to jail for him – all in the name of love.”13 According to Stokes, these sorts of scripts are often glamorized in songs by various rap and R&B artists. Certainly, the possibility exists for such scripts to shape behavior by encouraging risk-taking. Additionally, because some girls appear to react to the “oppressive gender politics” that pervade hip hop culture by adopting “short- term survival strategies,” these scripts may have the potential to impair healthy development.13 Perhaps of greatest concern is that, for girls, such forms of sexual self- expression tend to attract unwanted attention from online sex-seekers. Research indicates that adolescents who experience unwanted sexual solicitations on social networking sites are much more likely to be female (80%) than youth solicited via IM, chat rooms or other places online (53%).2 Despite these data, the varying ways that adolescent males and females use the
Internet to rehearse sexual scripts to others online and as a medium through which teens define their sexuality has not been adequately researched.
Seeing the potential dangers of social networking sites, policymakers have been quick to take steps toward protecting adolescents from potential harm. Declaring that social networking sites were “virtual hunting grounds for predators,” Congressman Michael
Fitzpatrick (R-PA) introduced a bill titled the Deleting Online Predators Act as a part of the
9 Protecting Children in the 21st Century Act in 2006. This bill was passed recently, in October of 2008.2 Schools and libraries are now required to restrict minors’ access to social networking sites or any sites that allow users to create profiles or Web pages about themselves. While these legislative initiatives may provide a temporary fix to the problem, it has been argued that they may, in the long run, distract parents and healthcare professionals from the real issue – their child’s or patient’s online behaviors. Certainly, it seems that online pretending and using one’s homepage for sexual self-expression are behaviors that have the potential to put adolescents at risk for a number of problems. Thus, social networking sites provide yet another opportunity for adults to become active participants in the online lives of adolescents.
THE YOUTH DEVELOPMENT MODEL
Although the concept of youth development has been a part of efforts aimed at adolescent health promotion for many decades, it is currently receiving renewed national attention as a strategy for improving health, developmental, education and employment outcomes for youth.14 Defined as the level of comfort and confidence youth associate with their emotional, psychological and social transition to adulthood, youth development aims to discover and give credence to the potential which children and adolescents possess and seeks to build upon their strengths.14,15 Activities related to health promotion that are guided by the concept of youth development often use a variety of strategies to engage and retain youth including outreach and mentoring. Additionally, education and training on specific subject matters such as sports have frequently been used as a “hook” to attract youth. Technology has recently surfaced as another possible content area.15 For this reason, current research has begun to focus on the intersection between youth development and technology and the potential such an approach may have for assisting youth to improve and transform their lives.15
10 A review of national data from the Centers for Disease Control and Prevention’s
National Youth Risk Behavior Survey (2007)16 and by the Adolescent Project Team of Partners for Children (2001)14 reveal a mixed picture. On one hand, there are many positive trends:
✎ 86% of youth report wanting to make meaningful contributions to their communities.14
✎ Youth who feel connected to their families and schools engage in fewer risk behaviors and
do better academically.14
✎ 48% of high school students report never having had sex (up from 45% in 2001 but down
from 59% in 1997).16
✎ 61% of sexually active high school students used a condom during their last sexual
intercourse (compared to 58% in 2001 and 56% in 1997).16
✎ 80% of high school students had not used tobacco in the last 30 days and 55% had not used
alcohol in the same time period.16
✎ Individual children and adolescents perform acts of courage and creativity every day, often
without recognition or reward.14
On the other hand:
✎ Only 20% of youth feel valued by their community.14
✎ 1 out of 6 high school youth have considered suicide at some point in their lives.16
✎ About one-third of girls in the United States become pregnant before the age of 20. In
2006, a total of 435,427 infants were born to a mother aged 15-19 years, a birth rate of 42
per 1,000 women in this age group.17 More than 80% of these births were unintended.18
✎ Of the 18.9 million new cases of STIs each year, 9.1 million (48%) occur among 15-24-year-
olds.19
✎ When asked what first comes to their minds when they think about today’s teenagers, 67%
of adults describe youth as “rude,” “irresponsible” and “wild.”14
As can be seen, adolescence is a challenging time for today’s youth. Because adolescence is often marked with exploration and experimentation,15 teens today may find themselves in situations that present them with choices about whether or not to engage in high-risk
11 behaviors, such as substance use or unsafe sex – choices that they may not yet be equipped to make.
Most young people experience the process of development among their families and peers, and within their schools, neighborhoods and communities.15 While such support systems can assist youth through their difficult teenage years, the challenges presented by adolescence can, at the same time, be amplified by those who are marginalized or even find themselves rejected by family, peers or society at large.15 However, research centered on the concept of youth development reveals that when given opportunities to participate in social networks in positive and meaningful ways, teens gain not only a sense of civic duty, but also an enhanced sense of connection with other members of that social network and increased self-esteem.15 In this way, youth development approaches address many of the common causes – low self-esteem, lack of coping skills, poor or inappropriate use of time, inadequate supports, problematic relationships, lack of personal goals – that contribute to high-risk behaviors.14 Youth development approaches accomplish this in two ways: first, by taking advantage of the available opportunities present at the family, school and community levels, youth development builds protective factors and reduces risk; and second, by using a cross- system, collaborative approach, youth development engages and mobilizes a community’s collective resources.14 Recognizing that creating real opportunities for youth in homes, schools and communities is the core of successful prevention and intervention efforts,14 youth development strategies ultimately seek to both build internal competencies with respect to being an active participant and strengthen the long term stability of the natural supports offered by the families and communities. As summarized by Cohall et al,15 overall, youth development strategies attempt to offer unique challenges, experiences and opportunities for learning that help youth reach their full potential by emphasizing competency building, personal and social development and encouraging engagement in social networks.
While the majority of online activities in which teens participate are aimed at communication or accessing information, Internet technologies may offer a unique opportunity for building self-esteem, enhancing self-efficacy around technologic literacy and
12
extending and sustaining social networks.15 In fact, the Internet may provide a significant opportunity for youth development. According to Cohall et al15 and the Adolescent Project
Team of Partners for Children,14 youth who use technology have increased self-esteem, higher educational levels and better socioeconomic prospects than those who do not. Valatis20 found that participants of a school-based community development project felt that learning and mastering technology decreased their social anxiety about working and communicating with adults and enhanced their sense of self and control over their environment.15,20 Youth also reported increased opportunities for self-reflection and decision making, which are important contributors to positive youth development.15
A number of youth development programs nationwide have used technology as the cornerstone of their efforts. More than 100 Intel Computer Clubhouses worldwide provide after-school learning programs for urban youth to explore their interests by using computers and Internet-related technologies. Similarly, HarlemLive, an Internet publication that is produced for and maintained by youth and Lehman Brothers Health Promotion Learning Lab
(HPLL) at the Harlem Children’s Zone Promise Academy based its program design on the Youth
Development Model, which has operationalized many of the concepts of youth development.
The program director of the Harlem Children’s Health Project noted that “in comparison to sports or other similar activities, technology can be more applicable to each youth’s future regardless of the direction they choose,” and that “the computer… is merely the vessel in the journey toward community-based health advocacy.”15 Because activities around adolescent health promotion are increasingly incorporating technology in efforts to increase technologic literacy, self-esteem, personal development and adolescent health, it is essential that future research begins to explore the connection between youth development and technology and the many ways that technology can enhance outcomes with respect to youth development and adolescent health. A Model for Youth Development is shown in Figure 3 and some of the general outcomes of using technology to enhance youth development are shown in Figure 4.
13 • Directors and instructors have to commit to “check at the door” any personal prejudices that they carry with them. Common prejudices such as “leading ladies should always be thin,” “only boys should move heavy scenery,” and “a 12-year-old cannot lead a group as well as an 18-year-old” are not tolerated. • Young people develop trusting relationships with peers and adults, leading to the development of positive social networks and social capital.
EMPOWERMENT: engaging youth through active participation, providing opportunities for them to learn to make life choices. • Young artists at Mosaic are involved in every element of production including music composition, playwriting, historical research, stage management, set design, lighting design, fundraising, public relations and marketing. • Mosaic’s young artists were awarded the State of Michigan History Award for creating original plays based on oral history interviews conducted with older Detroit residents for the playHastings Streetabout Detroit in the 1940s andNow that I Can Dance– a play about the early days of Motown. • Youth are given leadership roles and responsibilities autonomous from adults. • Mosaic young artists contribute to their community by providing performances for nursing homes, homeless shelters, juvenile detention centers, domestic abuse shelters and hospitals. • Mosaic Youth Ensemble members serve as goodwill ambassadors for metropolitan Detroit, both locally and internationally.Detroit Monthly magazine named Mosaic “Detroit’s Best Role-Models.”
ADDITIONAL RESEARCH SUPPORT FOR THE MOSAIC MODEL • A number of studies report a significant relationship between high involvement in the arts and better academic achievement, as measured by academic scores, drop out rates, and grade point average. Research also reports that the arts contribute to lower recidivism rates, increased self esteem, the acquisition of job skills, and the development of creative thinking, problem solving, and communication skills. • The use of arts processes have been shown to improve academic self-regulatory behaviors, such as paying attention, persevering, problem solving, self initiating, taking positive risks, cooperating, using feedback, and being prepared. • Based on a national sample, students involved in arts programs who come from troubled family situations and attending violent schools are more likely to excel in academics and school life than youth from less troubled backgrounds. • Research demonstrates that high school “high achievers” exhibit patterns consistent with the Mosaic Model including 1) developing a strong belief in self 2) having supportive adults around them such as teachers or counselors, and 3) having a network of other high achieving peers. • Mosaic’s focus on developing of strong trusting relationships with adults is supported by research that shows that positive adult relationships can play a significant role in the lives of disadvantaged urban youth, thus minimizing risks for substance use, gang involvement, and violence.
THE MOSAIC MODEL Providing Opportunities for Positive Youth Development through Performing Arts Training
EXPECTATIONS ENVIRONMENT EMPOWERMENT • Standard of Excellence • Total Acceptance of Individual • Active Participation • Commitment • Support: Personal, Academic, • Autonomy from adults • Professionalism Career • Risks and Life Choices • Family Atmosphere: Joy, Humor, Love, Belonging
POSITIVE YOUTH DEVELOPMENT OUTCOMES
SKILLS SELF SOCIETY • Arts Discipline and Skills • Positive Self-Image • Respect for Diversity • Academic Achievement: • High Self-Expectations • Community Involvement Higher Education • Ambitious Goal-Setting • Positive Social Capital • Employability Skills
5. 26 FIG. 3. THE MOSAIC MODEL OF THE YOUTH DEVELOPMENT MODEL
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!"#$%&'()*&)+&,-'".$)+$&."(/&,+&$%/&0#$#./&"0& 1"2,/$,/13&4567&'."8.)-1&2./)$/& "''".$#+,$,/1&0".&*"#+8&'/"'(/&$"&9#,(:& '.)2$,2)(&1;,((1&)+:&;+"<(/:8/&,+&".:/.&$"& 2"+$.,9#$/&$"&$%/&/2"+"-,2&)+:&2"--#+,$*& :/=/("'-/+$&"0&$%/,.&2"#+$.*3&&4567&)(1"& <".;1&$"&'."$/2$&$%/&.,8%$1&"0&2%,(:./+3&&
02345*6789:*;<=>?*@5A5B
'K!L***+***O6O6*Y*0&K!!&:*)T:*0#'&!*ZPP:*T%0[')\&():*"$*OPPQZ***+***&*]6*OPO*8O9*9699***+***^*]6*OPO*8O9*9697***+***'K!L_'K!LN(27 K\***+***TTTN'K!LN(K\* FIG. 4. USING THE INTERNET TO ENHANCE YOUTH DEVELOPMENT
The Youth Development Model is used as a framework for this project because it has the capability to bring together many of the factors that contribute to positive youth development and the opportunities the Internet offers for engaging and guiding youth through adolescence at the family and community levels. The ways that the Internet affects adolescent sexual development is given particular emphasis. The five C’s of the Youth
15 Development Model – confidence, competence, character, connections and caring – are addressed in this study as follows:
• Confidence refers to one’s self-esteem, which may vary according to one’s knowledge-level and skill-level.15 Teen’s knowledge level regarding sexuality and sexual health and their perceived abilities to communicate with others in their lives about sexual matters may affect one’s level of confidence. Likewise, one’s ability to use the Internet to access relevant health related information when necessary or one’s ability to decipher between what is advertised in
Internet media or other media about sex and what is reality may also affect confidence. This study explores many of these issues.
• Competence refers to one’s self-efficacy in specific skilled areas.15 Asking teens about the issues that they face today or the issues that make them anxious or are problematic highlights areas in which teens lack self-efficacy. The ability to communicate with specific individuals about sex or their behaviors indicate areas in which teens perceive themselves as skilled.
Overcoming the barriers that prevent teens from feeling as though they have self-efficacy in certain areas of their lives can, in turn, increase self-confidence and self-worth.
• Character is defined as a respect for right and wrong and the traits that help individuals make these distinctions.15 By asking teens about their beliefs regarding sex and sexuality and their online behaviors, this study aims to capture features of the varying levels of character development teens possess. Communication and interactions with the adults in their lives is expected to enhance adolescents’ ability to problem-solve and make good decisions based on their abilities to decipher between what is right for them and what is not.
• Connections refer to positive strong bonds that teens have with other individuals or institutions.15 By asking both parents and teens about their communication, this study intends to shed light on the connections teens feel they have with other important people in their lives.
• Caring can be defined as the level of empathy or sympathy one has for others and feels from others in return.15 By inquiring about the types of interactions teens have with their parents, romantic partners, friends and other online individuals, this study aims to discover
16 how teens feel about their relationships and what role the Internet has in this. The development of empathy is an important part of adolescent development and the Internet offers teens many opportunities to understand, communicate and show compassion and care for others.
The sexual development of today’s adolescents will inevitably be shaped not only by family and community values, but also by the Internet and the online experience. Recognizing this reality, this project takes a youth development perspective in order to analyze the effects that both social networks and the Internet have on adolescent sexuality in hopes that these two influential factors can come together to enhance adolescent sexual development and sexual health in the future.
ANTICIPATED CONTRIBUTION
As long as the capabilities of the Internet and other mediums for virtual communication continue to evolve – which they undoubtedly will – use among adolescents is inevitable. And while we may appreciate the ability of new technologies to make our lives easier, it is likely that they will continue to present new risks that may threaten the welfare of our children. Nevertheless, we must remember that the Internet and its related technologies also have the potential to serve as a supplement to the existing needs of developing youth. The ease with which adolescents can access information about sensitive health-related issues or communicate with their friends and community members is just some of the evidence that supports this notion. However, it is still necessary to develop a more comprehensive understanding of the numerous ways that online communication impacts adolescent health and development. In light of the inclination among young people to use the
Internet for purposes such as identity construction and the exploration of one’s own sexuality, it seems as though there are many avenues that may both present certain risks for teens and offer the opportunity for the adults in their lives to assist in the process of their development. This pilot study represents beginning efforts aimed at identifying these risks and opportunities.
17 III. PROJECT AIMS
Aim 1: Evaluate teens’ knowledge level, attitudes and beliefs about sex and sexuality.
Aim 2: Learn how teens are communicating and learning about sexuality, including how they are communicating with or learning from their parents, other adults, peers, the media and the Internet.
Aim 3: Examine what parents think their teenagers’ knowledge level, attitudes and beliefs about sexuality are and identify thematic differences between what parents think and what teens are reporting.
Aim 4: Examine how parents feel they are communicating with their teens about sex and sexuality, determine what parents think teens learn about sexuality from the Internet and identify thematic differences between parents’ opinions and teens’ opinions.
Aim 5: Identify possible ways that parents today can begin to become more active and supportive in their teens’ online lives and sexual development, as well as possible ways that parents and other adults can use the Internet to enhance the sexual development of adolescents.
IV. RESEARCH DESIGN AND METHODS
OVERVIEW OF APPROACH AND STUDY DESIGN
This project is intended to be a pilot study involving the administration of surveys to teens and the parents of teens as well as the use of semi-structured focus group discussions with teens and parents of teens. Approximately 50 9th through 12th grade students and 50 parents of 9th through 12th grade students will participate in the survey. Approximately 10 9th and 10th grade female students, 10 9th and 10th grade male students, 10 11th and 12th grade female students and 10 11th and 12th grade male students will participate in a total of four
18 student focus groups. Ten parents of 9th and 10th grade students and 10 parents of 11th and
12th grade students will participate in the parent focus groups. The analysis of the results of the surveys and focus group discussions will identify salient themes that indicate important dimensions related to adolescent sexual development, Internet use, parent-teen communication and possible guiding strategies for parents and youth leaders. The results of this pilot project will be used to refine survey items as well as the focus group discussion questions so that these instruments can be used in more in-depth studies on this topic in the future. Additionally, these results will be used as a basis and rationale for conducting a more extensive study with a greater number of participants in the future.
This study uses a cross-sectional research design. The surveys and focus group discussions will be used to collect descriptive data as well as data related to the prevalence of particular issues around teen Internet use. Of particular interest to this study are the relationships between certain variables such as teens’ Internet use and their knowledge about and attitudes toward sexuality and sexual activity. Therefore, the main exposure of interest will be the frequency of Internet use, with frequent users going online seven days/week and typically more than once/day, moderate users going online every few days and typically for less than one hour/day, and infrequent users having very little access to or experience with the Internet. Another exposure of interest will be levels of parent-teen communication about sensitive issues, with high defined by who are very comfortable with talking to adults about sex and consider their parents a primary resource on issues around sexuality, moderate defined by teens who are somewhat comfortable talking to adults about sex and would consider their parents as one of the primary resources on information relating to sexuality, and low defined by teens who are very uncomfortable talking to adults about sex and would not go to their parents for information about sexuality. The outcomes of interest are accurate knowledge, positive attitudes and beliefs about sexuality, safe sexual practices, and healthy and constructive use of the Internet. For example, it is expected that teens who are frequent and proficient Internet users would use the Internet as a resource on sexual health information and would be able to locate accurate (correct) information about this topic
19 online. Teens who are able to do this should have high levels of knowledge regarding sexuality and sexual health. Additionally, teens who are exposed to online pornography or sexual harassment by other Internet users may have more negative attitudes, misconceptions or distorted perceptions about sexuality (as described/defined in the literature). And parents who have more open lines of communication with their children may also have teens who exhibit safer and healthier online behaviors. Below (Figure 5) is a diagram of the basic study design, where X indicates an independent variable, such as parent-teen communication, and
O1 indicates a dependent variable, such as the safety of teens’ online behaviors.
After
✕ 1
FIGURE 5. CROSS-SECTIONAL STUDY DESIGN
Because this project is a pilot study, and because little is known about the relationship between the Internet and the sexual health and development of adolescents, this research only aims to begin exploring potentially relevant associations and gathering data related to the frequency and nature of teen Internet use. A cross-sectional design is likely the most suitable and economical means of obtaining this data. Although this design suffers from certain methodological weaknesses, with regard to internal validity, data analysis techniques such as cross-tabulation, bivariate percentage analysis and covariate adjustment using the exposures and outcomes of interest will allow for an assessment that gives reasonably informative assessment of the relationship between different variables. With regard to generalizability, it is understood that as a pilot study with a limited population, the results obtained may shed light on the current situation but will likely not represent it completely.
SAMPLING METHODS
Friends Select School is an independent, college-preparatory school with approximately 500 students in grades pre-kindergarten through twelve. There are
20 approximately 180 students in the Upper School (grades nine through twelve). The student body is drawn from close to 90 zip codes, approximately half from Center City Philadelphia and half from suburban Pennsylvania and New Jersey; 36% are students of color (African
American, Asian, Latino and other); 5% are Quaker; 4% are international students. The school’s community is diverse in terms of gender, age, race, ethnicity, religion, sexual orientation, belief system, family structure, and economic background.
Adolescent students and parents of all racial and ethnic backgrounds at Friends Select
School will be invited to take part in this study. The subjects included in this study will be all adolescent students between the ages of 13 and 19 who are attending high school at Friends
Select School from whom consent/permission and assent is obtained, and the parents of these students from whom consent is obtained. The researchers have chosen the target number of
50 for survey participants. Thus, this study aims to recruit a total of 100 subjects for the surveys: 50 students for the teen survey and 50 parents for the parent survey. Additionally, because focus groups can become unmanageable when conducted with too many participants, the researchers have chosen the target number of 10 participants for each of the focus group meetings. As there will be 6 focus group meetings, the focus groups will include a total of approximately 60 participants. The sampling plan (Figure 6) is shown below.
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FIGURE 6. SAMPLING PLAN
21 Although Friends Select School is a very diverse population, it is possible that the household incomes and education levels of the families included in this study will not be representative of the entire population. In particular, because this is a convenience sample, it is possible that the subjects will differ from the general population in important ways. It has already been noted that most of the parents of Friends Select students have at least a college education. Most students at Friends Select School finish high school and also continue on to college. In addition, the small sample size used in this study may limit the generalizability of its results. However, because this is an exploratory study, non-probability sampling is not expected to introduce significant bias. The results of this study are primarily intended to guide future research rather than generalize the associations discovered to the general population. This sample is being used because it is expected that most participants will have access to the Internet and frequently use the Internet at school or at home. The
Head of the Upper School at Friends Select has also stated that most families are very involved in the school community and will likely have substantial interest in participating in this study. Furthermore, it is generally difficult to begin research studies within public school districts, particularly when the subject of the research is on sensitive issues such as those relating to sexuality, or when a strong rationale for the research has not yet been developed.
For these reasons, the opportunity to begin this study at a school with whom the principal investigator is already familiar has established relationships with some of the community members is expected to be an opportunity that will allow the researchers to create a basis for further examination of this topic in the future.
MEASUREMENT METHODS
The data collection instruments consist of a student survey, a parent survey and semi- structured focus group discussion questions for both the parent and the student focus groups.
The survey items and the focus group questions were developed from previous studies that have attempted to investigate issues similar to the research questions this study intends to address. The researchers have added a few original items to these instruments as well. Both
22 researchers have received training on conducting research with human subjects and are certified to do so. A timeline (Table 1) for the project’s activities, including IRB submission, survey administration and the focus group meetings, is included below.
Project Activity (2008-2009) Sep Oct Nov Dec Jan Feb Mar Apr May Jun Project Development X X IRB Submission X X (X) Recruitment (upon IRB approval) (X) X X Data Collection (survey and focus groups) X X Development of Computer Files/Data X X X Entry Data Analysis (X) X X Report Writing X X Dissemination of Findings X
TABLE 1. PROJECT TIMELINE
The survey items used to collect demographic data are taken from the principal investigator’s (Nathalie Bartle’s) earlier work on the Man2Man program and the Adolescent
Male Project.21 For the Man2Man program, Bartle et al21 developed a questionnaire to assess the reproductive and sexual health needs of young males in Philadelphia. Some of the survey items used to evaluate attitude and behavior are also taken from Bartle’s work on the
Man2Man program as well as from her work on her book published in 1998, Venus in Blue
Jeans: Why Mothers and Daughters Need to Talk About Sex. In order to collect data for the writing of this book, Dr. Bartle interviewed mothers and daughters on issues related to communication, relationships, sexuality and sexual activity. Both survey items and focus group questions have been taken from the questions used by Dr. Bartle to collect data during these interviews.
Additional survey items are from the CDC’s Assessment Instrument for Measuring
Student Outcomes Grades 7-12, Booklet 6 (1992);22 Basen-Engquist et al (1999);23 the First
(YISS-1) and Second (YISS-2) Youth Internet Safety Surveys, conducted in 2000 and 2005,24 respectively; the Girl Scout Research Institute (2002);25 or are based on research by Cohall et al (2007)13 and the PEW Internet and American Life Project (2007).7 Survey items taken
23 directly from previous research are from instruments that have already been validated and used among teens or parents in the United States. There are a few items on the surveys that have been developed by the researchers specifically for use in this study, which have not yet been validated. Most of these items ask about the frequency of certain online activities (i.e., visiting chat rooms or logging on to a MySpace account). Additional focus group questions will be based on the First (YISS-1) and Second (YISS-2) Youth Internet Safety Surveys;24 the Girl
Scout Research Institute (2002);25 Cohall et al (2007);13 the PEW Internet and American Life
Project (2007)7; and Kanuga and Rosenfeld (2004).5
The surveys will be given to participants in paper form. Participants will be asked to record their answers on the survey and hand it back in to the researchers when they are finished. In order to maximize the response rate among parents, surveys will be emailed as well since parents may have difficulty getting to the school during the school day. Study variables relate to knowledge, attitude, beliefs and behaviors regarding sexuality, Internet use and parent-teen communication. These are reflected in the survey items.
The focus groups will be audio recorded and transcripts will then be developed. The transcripts will be used to identify themes and patterns that are salient in the discussions with teens and parents.
Because the researchers will ask participants to complete the anonymous survey themselves, a number of problematic issues may arise. Low response rates may introduce bias as parents who do complete the survey or allow their child to complete the survey may be those who are more involved in the lives of their teenagers. Literacy requirements are not expected to be a barrier for this sample population. However, for parents who take the survey at home, the chance to ask the researchers about an item that is unclear will not be easily available and participants may skip such questions. In addition, because the survey and template for the focus group discussions contain new items that have not been piloted with a different group previously, they may include some questions that lack clarity to participants, which may impact the instruments’ reliability. Furthermore, the validity of these new items
24 has not yet been established. In order to minimize such biases, the researchers have asked others in the field who work with adolescents to review and edit these new items.
PROPOSED ANALYSIS PLAN
The survey responses from the first part of this study will be compared to each other to shed light on some of the major thematic differences between teens’ and parents’ thoughts regarding parent-teen communication and teens’ knowledge, attitudes and behavior that relate to sexuality. A number of variables such as attitudes and beliefs about sex or sexuality, parent-teen communication, teen’s connections with other individuals and institutions in the community, online behaviors and knowledge, and skill-level regarding various online activities will be examined for patterns in their relationships with each other and their relationship to sexual activity and safe sex practices. Data from the surveys will be entered as numeric response codes so that means with respect to the study variables can be calculated and so that the researchers may look for associations between the different study variables.
Focus group discussions are intended to supplement these data by allowing the researchers to tap into group norms and to gain an understanding in narrative form of the complexities of the issues addressed by this study. The discussions will most likely provide more information than the surveys with regard to the ways that the five C’s of the Youth
Development Model are impacted by adolescent Internet use and use of the Internet to explore sexual issues. Content analysis of the data from the surveys and focus group discussions will identify important themes for adolescents, important themes for parents and connections between these themes. These themes will then be categorized and the researchers will identify patterns in the themes within and between categories. Data entry will be based on three to four letter codes for each theme and category.
The table (Table 2) below describes the proposed analysis plan for each specific aim of this study.
25 Specific Aim Analysis Plan There are 13 items on the student survey related to Aim 1: Evaluate teens’ knowledge level, attitudes knowledge level and each item has 4 answer and beliefs about sex and sexuality. choices: (aj) I know, (bj) I think I know, (cj) I am pretty sure I don’t know, and (dj) I am sure I don’t know; or, for true/false questions, (ak) I am sure it’s true, (bk) I think it’s true, (ck) I think it’s false, or (dk) I’m sure it’s false. The answer choices will be scored as 0 points for (dj), 1 for (cj), 2 for (bj), and 3 for (aj); or, for true false questions, 0 points for wrong answers when responded to with either (ak) or (dk), 3 points for correct answers using one of these responses, 1 point for incorrect answers when responded to with either (bk) or (ck), and 2 points for correct answers using one of these responses. The mean score for all students will be calculated as well as the mean for frequent, moderate and infrequent Internet users. A Chi-square analysis will be used to determine if knowledge level differs depending on frequency of Internet use. When significant differences are found, odds ratios will be calculated. Covariate adjustment will be done in the case that more than one exposure is suspected to influence an outcome. (Chi-square analysis will also be used to determine if there are differences in the frequency of Internet use and other variables such as race/ethnicity, number of family members, parents rules about sites their teens can visit or time their teens can spend online, and possibly other variables if an association is suspected). Teens will rate the people with whom they are most Aim 2: Learn how teens are communicating and likely to talk about sex, to whom or where they learning about sexuality, including how they are would go if they had a question about sexual health communicating with or learning from their on a score ranging from 1 (most likely) to 9 (least parents, other adults, peers, the media and the likely), and their comfort level with talking to their Internet. parents about sex. The scores for each person (i.e., a parent, a friend etc.) or resource (i.e., magazines, a book, the Internet etc.) will be averaged for all students as well as for frequent, moderate and infrequent Internet users. When significant differences are found, odds ratios will be calculated. Covariate adjustment will be done in the case that more than one exposure is suspected to influence an outcome. This will all be supplemented with data from the analysis of themes from focus group discussions. Parents will be asked about the people with whom Aim 3: Examine what parents think their their teens are most likely to talk about sex (i.e., me, teenagers’ knowledge level, attitudes and beliefs a friend etc.), to whom or where their teens would about sexuality are and identify thematic go if they had a question about sexual health (i.e.,
TABLE 2. SPECIFIC AIMS AND PROPOSED ANALYSIS PLAN
25 26 differences between what parents think and what me, a friend, the Internet etc.), their comfort level teens are reporting. with talking to their teens about sex, and what they think their teens know or believe about sex and sexuality. The number of parents who say their teen would talk to them about sex, their friends about sex etc. will be averaged for each person/resource. Chi-square analyses will be used to see if there is a significant difference between teens versus parents’ comfort levels with talking to their parents/child about sex. The same will be done for teens’ reported knowledge levels and beliefs about sexuality and what parents report about their teens’ knowledge levels and beliefs. Chi-square analyses will also be used to see if there are significant differences in these outcomes based on frequency of Internet use among teens. When significant differences are found, odds ratios will be calculated. Covariate adjustment will be done in the case that more than one exposure is suspected to influence an outcome. This will all be supplemented with data from the analysis of themes from focus group discussions.
Aim 4: Examine how parents feel they are Focus group discussions are meant to address this communicating with their teens about sex and aim. Themes from the student focus groups will be sexuality, determine what parents think teens identified and compared each other and to themes learn about sexuality from the Internet and from the parent focus groups. identify thematic differences between parents’ opinions and teens’ opinions.
Aim 5: Identify possible ways that parents today Focus group discussions are meant to address this can begin to become more active and supportive aim. Themes from the student focus groups will be in their teens’ online lives and sexual identified and compared each other and to themes development, as well as possible ways that from the parent focus groups. parents and other adults can use the Internet to enhance the sexual development of adolescents.
TABLE 2. SPECIFIC AIMS AND PROPOSED ANALYSIS PLAN (CONTINUED)
As a pilot study, this project will clearly have a number of methodological weaknesses. As a pilot study, this project will clearly have a number of methodological weaknesses. These These may include a limited study population, the inability or failure to use well-validated may include a limited study population, the inability or failure to use well-validated measurements and instruments, or biases on the part of the researchers when analyzing the measurements and instruments, or biases on the part of the researchers when analyzing the data. Furthermore, this study relies on self-report and because teens and parents may not data. Furthermore, this study relies on self-report and because teens and parents may not always tell the truth or have a clear answer, the data itself may not be entirely reliable. always tell the truth or have a clear answer, the data itself may not be entirely reliable.
2627 Nonetheless, it is expected that the results of this study will prove useful in developing more refined instruments for further studies as well as better direction for guiding future research on the subject of the Internet and adolescent sexual health and development.
V. HUMAN SUBJECTS CONSIDERATIONS
Due to the sensitive nature of the material in the surveys, it is possible that study participants may experience some discomfort. Subjects, therefore, will be informed that they are able to stop the survey or decide not to participate at any time. Additionally, subjects will be informed that their answers are confidential and will only be seen by authorized individuals such as the institutional review boards or the researchers conducting the study.
Confidentiality will be ensured in this project through the use of self-administered surveys, which will not ask participants to record their names or any identifying information.
Additionally, the investigator will at no point verbally ask for information that would expose the study participant’s identity. All surveys will be kept in a locked file cabinet at Drexel
University for one year after the completion of the study, at which point they will be destroyed.
Focus group discussions may also provoke feelings of discomfort. Focus group participants will not be required to speak at any point and may decide not to participate at any time. Information from focus group meetings will also be kept confidential. The audio records of these discussions will only be heard by authorized individuals such as the institutional review boards or the researchers conducting the study. Transcripts developed from the audio records will only be seen by authorized individuals as well. The audio records and transcripts will also be kept in a locked file cabinet at Drexel University for one year after the completion of the study, at which point they will be destroyed.
Participants will be informed that they may skip any survey questions, refrain from any focus group discussion questions, or discontinue participation at any time. Contact information will be available to participants so that they may reach the investigators during or after the study, in the case that participants encounter any problems attributable to the
28 project. If problems do arise as a result of this study, the principal investigator will be available upon request to discuss with the participant. The principal investigator will also be able to discuss any issues that develop between family members as a result of this study and will provide families with guidance and counseling if necessary.
This project has been through full review by the institutional review board at Drexel
University and was approved in January of 2009.
VI. RESULTS AND ANALYSIS
STUDY PARTICIPANTS
Recruitment for participants was conducted primarily through the Head of the Upper
School and parents, as per the requirements of the institutional review board at Drexel
University. Throughout February and March (2009), the Head of the Upper School sent “email blasts” to the parents, which described the study and the details of being a participant. A parent meeting was held at the beginning of April (2009) to discuss the consent/permission form and answer parents’ questions. Parent surveys were given out at this time. The researchers set a due date in the middle of April for parents’ permission/consent forms and surveys. Once the researchers received parental permission for the participation of students, the Head of the Upper School asked willing students to complete the student surveys. A total of 12 parents and eight students completed surveys. Focus groups were then held in the beginning of May. Due to the small number of participants, only one parent group and two student groups (one with boys and one with girls) were held. Four parents participated in the parent focus group, three girls participated in the girls’ student focus group, and six boys participated in the boys’ student focus group.
ANALYSIS METHODS
The data from the parent surveys and the student surveys were analyzed with SPSS
(version 16). Due to the small number of participants, it was not possible to follow the approach outlined in the proposed analysis plan for the survey data. However, correlations
29 were calculated in some cases for the student surveys. In most cases, the Spearman rank correlation (Spearman’s rho) was used. The Spearman rank correlation test was used because it does make and assumptions about the distribution of data, and in this case, most study variables were not normally distributed. However, the distribution of scores on the knowledge and attitude scales from the teen surveys followed a somewhat normal distribution (mean ≈ median). Therefore, the Spearman rank correlation test and the Pearson r correlation were calculated to determine the strength of the association between sexual knowledge and attitudes regarding sexuality and risky sexual behavior. Descriptive statistics only were obtained for the rest of the data.
PARENT SURVEY
A total of 12 were recruited to complete the parent survey. All parent participants were female (mothers), ranging from 43-61 years of age (Figure 7). The mean age was 50 ± 5.6 years.
FIGURE 7. AGE OF PARENT
Most described themselves as White/Caucasian, with the exception of one mother who described herself as Asian/Pacific-Islander, and one mother who described herself as African-
American/White (Figure 8). All parents had three children or fewer. Seven mothers were parents of girls and eight were parents of boys. Eight mothers lived in households with their
30 child’s or children’s father present, two lived in households with a stepfather present, and two were single mothers.
FIGURE 8. RACE/ETHNICITY OF PARENT
Varying levels of comfort when talking with their teens about sexual issues were reported. On average, parents claimed to be “somewhat comfortable” with having these discussions with their adolescents (Figure 9).
FIGURE 9. HOW COMFORTABLE ARE YOU WITH TALKING TO YOUR TEENAGER(S) ABOUT SEX?
Most (almost 60%) parents reported that they were unsure who their teens went to or what sources they referred to in order to find information about sex (Figure 10).
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FIGURE 10. TO WHOM OR WHERE DOES YOUR TEEN GO TO OBTAIN INFORMATION ABOUT SEX?
All parents reported having Internet access at home and using the Internet at least 4 to 5 times per week, with most reporting daily use. Eleven parents reported that they did not know how often, if ever, their teens used the Internet to look up information related to sex or sexuality and sexual health (Figure 11), and ten reported that they have never personally gone online to find any kind of health related information.
FIGURE 11. HOW OFTEN DOES YOUR TEEN LOOK UP INFORMATION ABOUT SEX WHILE ONLINE?
While most parents claimed that they were “fairly aware” of what their teenager(s) are doing on the Internet (Figure 12), parents did not report knowing what their teens specific activities were while online. Parents thought that their teens checked email and visited social
32 networking sites fairly often, however, they reported not knowing who their teens talk to online, via what method (chat rooms, AIM etc.), and if or how their teen looks up information about sex while online (Figure 13 and Figure 14).
FIGURE 12. HOW TUNED IN ARE YOU TO WHAT YOUR TEEN IS DOING ONLINE?
FIGURE 13. HOW OFTEN DOES YOUR TEEN USE THE INTERNET TO TALK TO A BOYFRIEND, GIRLFRIEND OR ROMANTIC INTEREST?
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FIGURE 14. HOW OFTEN DOES YOUR TEEN VISIT SOCIAL NETWORKING SITES WHILE ONLINE?
STUDENT SURVEY
The data from the parent surveys was analyzed with SPSS (version 16). Four boys and four girls completed the survey for teens, ranging from 15 to 18 years of age (Figure 15). The mean age was 16.5 ± 0.9 years. Most teens described themselves as Caucasian (5), and others described themselves as Black/African-American, Hispanic/Latino (1), and Middle Eastern (1)
(Figure 16). All teens lived with both their mothers and their fathers.
FIGURE 15. AGE OF TEEN
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FIGURE 16. RACE/ETHNICITY OF TEEN
All teens reported using the Internet at least once daily and having Internet access at home.
On average, teens reported being “somewhat comfortable” with talking to adults about sex in general as well as pregnancy and STD/HIV prevention (Figure 17). On the other hand, they reported being uncomfortable with talking to adults about their sexual behaviors (Figure 18).
FIGURE 17. COMFORTABLE ARE YOU TALKING WITH AN ADULT ABOUT SEX IN GENERAL?
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FIGURE 18. COMFORTABLE ARE YOU TALKING WITH AN ADULT ABOUT YOUR SEXUAL BEHAVIORS?
When asked who they most often talk to about sex, teens reported friends and mothers most often, followed by fathers and doctors or nurses, then siblings and teachers or a school counselor, and finally, by a religious leader least often. However, when asked who they would go to if they had a question about sex, the majority of teens reported that they would go to the Internet (Figure 19) or a friend, many reported that they would go to a book, magazine, or a doctor or nurse, and a few reported that they would go to a parent (Figure
20), teacher or counselor, sibling, or may refer to a movie.
Figure 19. I would refer to the Internet if I had a question about sex.
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Statistics Knowledge
total Attitude total FIGURE N20. I WOULDValid ASK A PARENT8 IF I HAD A QUESTION8 ABOUT SEX. Missing 0 0
Teens’ knowledge withMean regard to sexual29.38 health information52.62 was, on average, fairly Median 30.00 51.50 high (mean = 29 out of 32; median = 30 out of 32) on the instrument developed by the CDC Mode 30 48 (Figure 21).
FIGURE 21: TOTAL SCORES ON THE KNOWLEDGE SCALE (PERCENTAGES)
On the attitude scale from this same instrument (Figure 22), this group of teens scored noticeable lower (mean = 53 out of 65; median 52 out of 65). Teens seemed to score lowest on their attitudes about abstinence and highest on their attitudes about condom use.
Attitudes regarding threat (of unwanted pregnancy, STDs, or HIV) and peer pressure were in between. Knowledge level seemed to be higher among girls than boys and, and surprisingly,
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seemed to be higher among younger teens. When examined by grade level rather than age, however, the latter trend was not observable. Attitudes were also higher for girls than boys, particularly with respect to beliefs about abstinence. Attitudes regarding peer pressure, however, were very similar for boys and girls.
FIGURE 22: TOTAL SCORES ON THE ATTITUDE SCALE (PERCENTAGES)
Most teens reported checking their email almost daily and logging on to social networking sites between 2 to 5 times per week. Additionally, half of teens reported using the Internet to look up information about sex and one quarter reported doing this once a week or more (Figure 23).
FIGURE 23. HOW OFTEN DO YOU USE THE INTERNET TO LOOK UP INFORMATION ABOUT SEX?
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While teens reported that they unintentionally came across pornography infrequently, they reported intentionally seeking out pornographic material more often than accidental exposure
(Figure 24).
FIGURE 24. HOW OFTEN DO YOU SEARCH FOR PORNOGRAPHY WHILE ONLINE?
In both cases (intentional and unintentional exposure), this was more frequent among boys:
Spearman’s rho (intentional exposure and male gender) = 0.53, significance (2-tailed) = 0.18;
Spearman’s rho (unintentional exposure and male gender) = 0.54, significance (2-tailed) =
0.17. Girls, on the other hand, were more frequent users of the Internet for the purposes of finding information about sex and sexual health. Interestingly, a correlation between attitudes and the frequency of searching for pornography while on the Internet was observable, with attitudes declining as the frequency of searching explicit materials increased: Spearman’s rho (searching pornography and attitude) = r – 0.3, significance (2- tailed) = 0.5. A slight positive relationship between knowledge and the frequency of looking up information about sex while online was also observable. It is important to note, however, that none of the above relationships were significant, which is likely due to the small sample size obtained in this study. The tables of correlation coefficients are located in Appendix C.
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PARENT FOCUS GROUP
Four mothers participated in the parent focus group. The most salient themes identified from the focus group discussion with parents were the potential damage of posting information about a person online, teens telling parents “I already know,” easy access and quantity over quality, girl’s vulnerability, protective values taught at school and at home, and
“what should parents do – not what they shouldn’t do?” For example, parents were afraid that their child or their child’s friend might post inappropriate information about them online that college admissions committees or future employers might see. Parents also reported that it was difficult to talk to their teens about sex because teens either became defensive or told their parents that they “already know about that.” Because the Internet makes meeting and communicating with people so easy, and because a great deal of information is readily available online, parents reported feeling that the emphasis for teens is on the number of relationships they have with others rather than the qualities of those relationships. This sentiment was related to parents’ fear regarding the vulnerability of young girls as a result of the “sexualizing of everything” that has become common in today’s culture. According to parents, this has led to a different set of expectations for girls, especially in terms of their relationships with boys.
Finally, parents felt that the values young people learn at home and at school can protect them from being easily influenced and may help them make good decisions about sex and their health in general. The central issue that concerned parents was the lack of information and support available that helped them in guiding their teens today. Plenty of information, according to the mothers, is available on what one should avoid saying to an adolescent. However, the fact that parents are behind the curve in terms of their understanding of today’s digital world has made them feel as though they are very much in need guidance on how they can become more proactive in the lives of their teenagers.
Parents expressed a desire for more information and guidance regarding how to communicate with their teens about sex and how to make sure that teens’ experiences with the Internet were positive rather harmful to themselves or other teens in the community.
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GIRLS FOCUS GROUP
A total of three girls participated in the girls’ focus group. The most common themes identified from the meeting with the girls were double standards, values learned at school and at home, and knowing yourself. Girls referred to a number of different double standards that they felt conveyed mixed messages to them about sex and sexuality. The first was that although in the Internet and media, information and attitudes about sex are conveyed constantly, sex is treated as a very secret, private “thing that we’re always trying to hide.”
The second double standard girls pointed out related to oral sex being “all about guys,” so that boys almost expect oral sex from girls while girls are expected to want boys to fulfill their emotional needs instead. The third double standard the girls described was about the messages conveyed to young girls in the media and on the Internet about sexuality. Girls felt that many of these messages encouraged girls in younger grades (pre-teen girls) to dress and act sexy at an inappropriate age, when they were “too young to know” what this behavior really meant. Girls felt these messages did not affect boys’ behaviors in the same way, although it may influence a boy’s expectation that through a webcam, a girl would “show him her boobs… or something.”
The girls seemed to consider the values that they had learned at home and at their school as protective. They referred to themselves as a “good group of girls” who worked very hard at school and had parents who were very involved in their lives. The group stated that they had friends at schools where the culture seemed to value socializing over academics, and even though they sometimes felt overwhelmed by the workload, they were glad that they were “finding a balance.” Parents also played a role in this and the girls said they were glad their parents acted like responsible adults instead of “trying to be cool.” In addition, mothers’ thoughts and opinions about sexuality influenced girls’ beliefs, and girls tended to express opinions similar to those of their mothers’.
A final theme that was very common in the discussion with the girls was knowing oneself. The girls made many references to the importance of “knowing my limits,” “knowing where I stand and where my friends stand,” and “finding where you’re comfortable.”
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Although these statements generally related to alcohol and substance use, the girls attempted to articulate their feelings about knowing themselves within the context of their relationships with boys and other individuals as well. One girl commented that fighting with people over the Internet was “just not reflective of who I am,” and another, disapproving of the upward trend in casual sex today expressed her disappointment by saying, “Before, sex had more to do with love – now it’s just like you’re with a guy, so why not?.... Now it’s just the act.”
BOYS FOCUS GROUP
A total of six boys participated in the boys’ focus group. Among the boys, the strongest themes were the popularity of viewing pornography (pornography use), equality between girls and boys (no double standard), the stress felt “when parents don’t trust you.”
The boys seemed almost relieved to talk about pornography with their peers. All expressed agreement with one participant who stated, “Pornography! It’s extremely widely used among boys – I’m sure almost every guy in the Upper School uses it.” While boys recognized that pornography may portray a misleading depiction of sexuality, boys focused primarily on the physical aspects of the actors’ bodies, noting that most people are not as muscular and many women from the videos/pictures have breast implants. They felt as though this creates self-esteem issues for both boys and girls. However, most boys did not comment on the sexual behaviors or the attitudes about sex and sexuality conveyed in pornography, with the exception of one participant, who stated, “Imagine if aliens came in and saw this… It’s the same way for kids who see this the first time. It’s this idealized view of what sex should be and it never really measures up to that. It’s good for both of them, but they are faking it… It ruins, or at least alters, your first experience.” Although this participant may have had more insight into the negative effect of pornography on perceptions about sexuality, the other boys tended to focus on the potential for pornography to lower one’s self-esteem about his or her body.
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In contradiction to what girls had said, boys claimed that they felt that no double standards existed between boys and girls regarding sexual relationships. Most agreed with one participant who stated, “You can’t generalize. There are different women and different men
It’s even,” and another who responded, “Yeah, and whoever’s hormones – that is the person who will get things.” On the other hand, boys did feel that girls are dressing “sexier” today, and felt that this “changes the idea of what is supposed to be sexy and it’s bad for their mentalities.”
Finally, boys, similar to girls, claimed that the values that they learned at school and home had taught them to be “reasonable” and to make good decisions. However, boys were frustrated by their parents’ worries about their online activities and felt that they were based on “what’s in the media,” which, according to boys, is not reality. Boys felt that this mistrust caused them stress and was unnecessary, as their online behaviors were generally safe and did not cause harm to other teens in the community.
VII. DISCUSSION
Between August of 2008 and May of 2009, a pilot project to study the impact of the
Internet upon adolescent health and sexuality was launched. Project development was completed by November of 2008, at which point the proposal to conduct the research was submitted to Drexel University’s IRB for full review. The project was approved in December
(2008), arrangements for the recruitment of subjects continued throughout January (2009), and the researchers began recruiting subjects in February (2009). Recruitment proved to be the greatest challenge the study presented, as the researchers were required to obtain parental consent as well as parental permission before data collection could begin. Due to the busy schedules of most parents, scheduling meetings to explain the permission/consent process that all participants could attend was difficult to arrange. The Head of the Upper
School assisted the researchers in connecting with parents who were very involved in the school community, which helped the researchers in overcoming this barrier. Collecting the forms from parents was also difficult due to the time and effort associated with bringing the
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forms to the researchers that this process imposed upon parents. The researchers agreed to accept electronic copies (scanned to a computer and sent via email) to ease this burden. The process of obtaining consent and permission from parents continued throughout February and
March and data collection began at the beginning of April (2009). Data entry and analysis began once the first surveys were collected in April and continued through the beginning of
May (2009). Data collection was officially completed by the end of the first week in May.
THE GAP IN COMMUNICATION BETWEEN PARENTS AND TEENS
The results of this study indicate that teens are more avid users of the Internet than parents, and significantly, rely on the Internet for information about health and sexuality much more so than parents. Also of interest in this study was that while parents have a great deal of trust in their teens, they are still not entirely “in tune” with teens’ online activities.
While parents were able to accurately estimate teens’ knowledge levels regarding sexuality and sexual health, they were much less aware of their teens’ sexual attitudes and behaviors.
This is not surprising given the difficulty teens usually have in discussing sexual activity or their thoughts about becoming sexually active with parents.
Teens in this study not only had high levels of sexual health knowledge, but also said that they were able to distinguish inaccurate from accurate online information through a variety of methods. Teens said that they validate online information by checking with other sources online to see if the information is repeated elsewhere. However, it should be noted that even when information is repeated in several sources online, there is no guarantee that this is accurate information and not a common or popular myth. In addition, while teens often claim to know a great deal about sex, or frequently tell their parents, “I already know about that,” teens’ knowledge, in reality, is often much patchier than it appears from the outset.
The knowledge scale used in this study was not as thorough as the original instrument from the CDC, so it is difficult to know whether or not these teens were lacking in their knowledge regarding specific sexual issues. Parents, therefore, should not be discouraged when their teens claim that they already know what their parents have to tell them as even repeated
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information may fill in teens’ gaps in sexual knowledge or correct any misinformation that their teens may have.
THE INTERNET AND EXPLICIT MATERIAL
A valid fear that is occasionally mentioned in the existing literature on this topic is the influence or effect that viewing pornography may have on teens’ perceptions of and attitudes toward sexuality. A number of researchers have noted that because the Internet provides easy access to a large quantity of pornographic content, it can be expected that teens’ exposure to such explicit material would be higher than in the past. The literature on this issue cites a range of negative consequences associated with long-term or frequent exposure to pornography. Mesch29 has summarized this body of research and assigns the negative effects to three general categories: “First, it leads to more liberal sexual attitudes and greater belief that peers’ are sexually active, which increases the likelihood of first intercourse at an early age; second, adolescents exposed to sexual behaviors outside cultural norms may develop a distorted view of sex as unrelated to love affection and intimacy, and a desire for emotionally uncommitted sexual involvement; and third, youth exposed to pornography may develop attitudes supportive of ‘rape myth,’ which ascribe responsibility for sexual assault to the female victim.”29
It is worth noting that while exposure may encourage the development of such attitudes among youth, establishing a true causal linkage in this case is a difficult task and may lead to unsound conclusions. This epidemiologic reality led Mesch to believe that a reverse relationship may exist.29 Social bonding theory posits that ties between members of a society to each other and to social institutions tend to assist individuals in refraining from deviant behavior. Weak social bonds or the absence of these bonds distinguishes deviants from non- deviants. For example, studies have found a link between low social bonding in youth and risk-taking behavior such as drunk driving, academic dishonesty and illicit sex.29 Mesch cites two recent studies of particular interest: the first reported a positive relationship between engagement in illicit sexual behaviors (such as pornography use and indecent exposure) and
45
delinquent acts; and the second reported that online seekers of X-rated materials were more likely to experience lower levels of emotional bonding with their parents.29 In response to these findings, Mesch conducted a study and found that “weak ties to mainstream social institutions were characteristic of adolescent frequent users of the Internet for pornography in comparison to the group of adolescents who used the Internet for information, communication and entertainment” and that “X-rated material consumers proved to be a distinct subgroup at risk of deviant behavior.”29
The issues introduced by Mesch and by the existing literature raise the question: Does viewing online pornography influence the development of attitudes that encourage sexual risk-taking among teens, or is seeking out pornography online a symptom of deviance that may indicate that teens are already involved in sexual, and other, risk-taking behaviors?
Regardless of the way this relationship works, it is still important to note that many adolescents, similar to those in this study, view online pornography, which tends to distort their perceptions of sexuality and negatively affects their attitudes regarding the emotional aspects of sex and committed sexual involvement.
DOUBLE STANDARDS
Related to the issue of distorted views of sex and sexual activity is the double standard that both girls and parents in this study referred to regarding expectations around sexual activity. While boys felt that the expectations to engage in sexual activities were similar between boys and girls, girls and parents consistently expressed frustration over the normalization of casual sex, the pressure around oral sex (performed by females on males), and the diminished role of romance in relationships. Girls’ and parents’ views that intimacy has become disassociated from sexual activity and that there is too much of a focus on
“servicing guys” has been echoed on numerous occasions in recent years. Ariel Levy describes the extent to which “raunch culture” – a growing phenomenon marked by intense efforts to correlate the showcasing of female sexuality with the empowerment of women – has pervaded, and changed, our society: “Only thirty years ago, our mothers were ‘burning their
46
bras’ and picketing Playboy, and suddenly we (are) getting implants and wearing the bunny logo as supposed symbols of our liberation … How (has) the culture shifted so drastically in such a short period of time?30
If this culture is capable of pulling in so many young women today, it would be unwise to assume that the values it attempts to transmit are not also capable of influencing teenage girls. And indeed, as Levy has found in her research, they have. Levy interviewed a large number of teens in Connecticut, New York and California who told her about “hooking up,” oral sex, dressing provocatively, and relationships – and often made reference to values they had learned from today’s highly sexualized culture: “What all of these adolescent incidents have in common are, of course, exhibitionism and oral sex – oral sex for boys that is … Part of the reason they are so indiscriminate in their choice of partners is that the quality of these sexual encounters in terms of feeling or meaning isn’t really the point – Jessica described sexual activity as something they engaged in primarily for bragging rites.”30 Adding her own spin to Jessica’s narrative, Levy comments, “These are not stories about girls getting what they want sexually, they are stories about girls gaining acclaim socially, for which their sexuality is a tool.”30
Although Levy’s argument might seem to blame too harshly girls for their desire for social acceptance, and the frustration and distress that comes with it, such an interpretation would be flawed. The reason that teen girls are engaging in this sort of behavior is because these are the norms conveyed from television, the media and the Internet.30 Of significant concern is the fact that this socialization process tends to perpetuate itself. As Levy notes,
“While it would be ‘weird’ for a teen girl to pursue sexual gratification, it is crucial that she seem sexy … That’s where the Internet really comes in handy – it allows young women to act out in front of the maximum number of eyes.”30 Thus, because girls tend to define themselves at least partially within the context of their relationships with others,31 the Internet is an ideal place to construct their self-definition. And because the Internet and media are flooded with references to raunch culture norms, these outlets can have a major influence in the socialization process of adolescent girls.
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The relevance of this topic is a consequence of the effects of the double standard noted by girls and parents in terms of young girls’ sexual and reproductive health. The overwhelming consensus of research studies on adolescent sexual desire point toward the reality that girls focus more on what is expected of them than what they expect or what they desire.30 For youth who are negotiating adolescence and their developing sexualities in today’s society, girls will likely have a much harder time than boys in defining their sexual selves, as “there is now a rigidly specific message girls are supposed to convey before they even grasp its meaning.”30
To write Dilemmas of Desire: Teenage Girls talk about Sexuality, Deborah Tolman investigated girls’ experiences of “wanting,” in contrast to their sexual experiences, which is a conversation that usually turns into a discussion about “being wanted.”31 In her research,
Tolman’s findings first note “how confusing it is (for girls) to develop a sexual identity that leaves their sexuality out.”30 By avoiding acknowledging their own sexual desires, Tolman argues, girls put themselves at risk for adverse outcomes: “When a girl does not know what her own feelings are, when she disconnects the apprehending psychic part of herself from what is happening in her own body, she then becomes especially vulnerable to the power of others’ feelings.”31 This gets to the heart of the problem formulated by girls and parents in this study. Messages conveyed by the Internet and the media – sources that have significant roles in socializing and conveying norms to teens – are imbued with “raunch culture” values, which, when adopted and internalized, make girls more vulnerable and put them at risk for poor sexual and psychological health outcomes. And, getting back to one parent’s fear that we have “returned to the pre-feminist days,” this problem asks us to challenge the validity of equating “raunchy” with “liberated” and raises the question: “How is imitating a stripper or a porn star – a woman whose job is to imitate arousal in the first place – going to render women sexually liberated?”30 If we are able to critically analyze the cultural trends of today in light of this question, we will be able to more effectively address the double standard that exists between male and female sexuality. For example, the “baseline expectation that women will be constantly exploding in little blasts of exhibitionism” that runs throughout our culture is
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clearly one-sided, and overt licentiousness and oral sex are, in all likelihood, not truly symbolic of women’s empowerment or liberation. It is important that youth are educated about this. This may be particularly important for boys so that they develop a critical eye regarding such sexual double standards, as they may, similar to those in this study, may be less aware or may avoid acknowledging their existence.
LIMITATIONS
The limitations of the results from this study are largely due to its sampling methods.
First, the sample population was mostly well-educated, higher-income individuals. It has been well-established that Internet access and use increase with education and income, although this trend is declining rapidly. In addition, mothers only participated in the surveys and in the parent focus group, and more boys participated in the student focus groups than girls. It is possible that fathers would have had different perspectives on the issues addressed in this study than mothers. Likewise, the presence of more girls in the girls’ focus group may have resulted greater differences of opinion on the issues discussed. The small number of participants in this study also made it difficult to draw conclusions based on the data that were collected.
Another possible limitation was the time that it took to obtain permission, consent and assent from parents and students for participation in this study. It is likely that this compromised the number of participants recruited for the surveys and focus groups. In the future, the consent process may need to be revised if this research study continues.
Despite these limitations, the researchers believe that the issues addressed by this study are becoming increasingly important to adolescent health and sexuality and that these results shed light on the need to address this matter.
VIII. RECOMMENDATIONS
In terms of the parental guidance that the results of this study can offer, perhaps one of the most important recommendations is to be aware. Parents were unaware of their teens’
49
online behaviors, and although the nature of online pornography and its prevalence on the
Internet are cause for concern, parents did not feel that this was very much of an issue. Being aware means knowing about the different forms of media on the Internet as well as how teens are interacting with it.32 In addition, though parents may feel the need to restrict their teens’ access to the Internet to prevent them from viewing explicit material, it is important to remember that restricting access in this way can inhibit teens’ learning about other important sexual issues that are too sensitive to discuss with a parent.
It is also recommended that researchers in the fields of public health as well as those in psychology, media and education begin to look into the issues of Internet pornography and the double standards between men and women that it may reinforce. In particular, qualitative research that investigates not only how pornography impacts sexual practices, but that also examines how pornography influences identity formation and the roles men and women adopt within the context of their sexual relationships is becoming an important area for further study.
Finally, it is recommended that those in the field of health policy and health education work toward changing national policy with respect to sexuality education. Currently, comprehensive sexuality education is lacking. Sexuality education that includes coverage of abstinence as well as contraception, relationships and the new role that the Internet and related technologies have assumed in the lives of teenagers today would help many teens in protecting their sexual health and their reproductive health in the future. Students at Friends
Select School expressed the need for gender-specific sexuality education when appropriate and discussion-based rather than didactic learning. This may also be a consideration when developing and improving current sexuality education.
IX. CONCLUSION
Despite its limitations, this study was an important first step in determining what role the Internet has in adolescent health and sexuality. This is a cutting edge issue that addresses
50
the needs of teens – a population of individuals who tend to be at risk for negative health outcomes without the guidance of capable and caring adults. This study represents a launching point for further research in this area as well as initial guidance for parents, health educators and policymakers in how they may better serve teens in the digital age in which they are growing up today.
51
X. APPENDICES
52
APPENDIX A
53
APPENDIX B !
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'$5.8"$*&$79".$ .3.-"$&4$35.+$)2$ .3.-"$&4$35.+$)2$ :*&3$35.+$)2$ 35.+$)2$+""*.6"-$ +""*.6"-(#$&*17*"$ +""*.6"-(#$&*17*"$ +""*.6"-$7#$9&7*6$ 9&"#$&*17*" ./+787+7"#$.-"$ ./+787+7"#$.-"$ &*17*"$ $ "#N%&!K90/,--?!5(4!@(!)(*!800-!,3(*+!+50!0880=+!+50!:1+0/10+!5,7!5,@!(1!)(*/!+001,20/;! ! '+$5.#$5.9$.$0+78"$"44"/+$ ! '+$ 5.#$ *&+$ 5.9$ .*$ "44"/+$ ! '+$ 5.#$ 5.9$ .$ *"6.+78"$ &*"$3.2$&-$+5"$&+5"-$ "44"/+ ! ! ' ' ' -;B6J'G.1'H2/G'M1D;N'-;53'53'4;2'26C'.F'4;2'31/H2GO' 86 Focus Group With Teens A. INTRODUCTION Hello, my name is (investigator’s name). I’m a (investigator’s title) and I’m here today to talk with you about some issues of concern to teens. Thanks for coming. Your presence and participation is important. B. PURPOSE What we are doing here today is called a sharing group. It’s a discussion to find out your opinions – like a survey – but with broad, general questions. Our discussion is going to last about an hour and half. Focus groups are different from workshops or classes. Once we get started, I am going to ask you questions and you are going to share your thoughts and opinions. You will do most of the talking. I will be doing a lot of listening. Remember we want to learn from you. We are not going to necessarily 'teach' you anything today. I am interested in all of your ideas, comments and suggestions. Each of you is will be very important to our study. We need to hear all of your opinions. All of your comments – both positive and negative – are welcome. Please speak up – even if you disagree with someone else here. It’s important that I hear what each of you thinks. There are no right or wrong answers. C. PROCEDURE We will be audio taping our discussion. Everything you say is important to us and we want to make sure we don’t miss any comments. Later, we’ll go through all of your comments and use them to prepare a report on our discussion. However, all of your comments are confidential and will be used only for research purposes. Nothing you say will be connected with your name or other identifying information. Since we will be talking about adolescent sexuality and behaviors and how you and your parents communicate about these issues, parts of this discussion may feel a bit sensitive to you. If any question makes you uncomfortable, feel free not to answer it. I want this to be a group discussion so you don’t need to wait for me to call on you. Please speak one at a time so the recorder can pick everything up everything you’re saying. We have many topics to discuss so I may change the subject or move ahead. Please stop me if you want to add anything. 87 1. What does it feel like to be a teenager today? • What are the biggest issues facing teens today? • What would you do about these issues? • If there was one thing that you could tell adults about being a teen, what would it be? 2. How do teens learn about sex today? • Who do you talk to about sex? • What subjects related to sex would you talk about with your mother? Your Father? Who brings things up? How do you feel when you talk about sex with your mom or dad? • Can teens learn about sex from the media? TV? Computers/Internet? How? • When are these good/helpful for learning about sex? When are they bad/not helpful? 3. Does anyone give you advice on how to use the Internet? • What Internet advice do you get from your parents? Is it pertinent and valuable? • What worries parents most about what teens do online? • Are these worries reasonable? Or are there other things they should be more concerned about? 4. Do teens use the Internet to find out about issues that relate to their health? • When would you go to the Internet to find out about health issues? • When would you go to your parents or your doctor? • Is the Internet a good place for finding out about sexual health? 88 5. Some people think that all the sexual material that teens are exposed to in the media and on the Internet encourages teens to be sexually active or to dress and act sexy. What do you think about this? (Ex: Anything from the oral sex scene in the first episode of the new 90210 to all the pornography and pornography ads on the Internet.) • What do teens think about pornography when they intentionally view it or get pop-up ads of it online? 6. What or who influences your thoughts and decisions about whether to be sexually active? 7. Do teens argue or fight with each other or spread rumors about each other online? • Do teens sometimes act differently online? Would they act differently if they were speaking face-to-face? • Do teens sometimes pretend to be someone or something they’re not online? Why? 89 Focus Group With Parents A. INTRODUCTION Hello, my name is (investigator’s name). I’m a (investigator’s title) and I’m here today to talk with you about some issues of concern to teens. Thanks for coming. Your presence and participation is important. B. PURPOSE What we are doing here today is called a sharing group. It’s a discussion to find out your opinions – like a survey – but with broad, general questions. Our discussion is going to last about an hour and half. Focus groups are different from workshops or classes. Once we get started, I am going to ask you questions and you are going to share your thoughts and opinions. You will do most of the talking. I will be doing a lot of listening. Remember we want to learn from you. We are not going to necessarily 'teach' you anything today. I am interested in all of your ideas, comments and suggestions. Each of you is will be very important to our study. We need to hear all of your opinions. All of your comments – both positive and negative – are welcome. Please speak up – even if you disagree with someone else here. It’s important that I hear what each of you thinks. There are no right or wrong answers. C. PROCEDURE We will be audio taping our discussion. Everything you say is important to us and we want to make sure we don’t miss any comments. Later, we’ll go through all of your comments and use them to prepare a report on our discussion. However, all of your comments are confidential and will be used only for research purposes. Nothing you say will be connected with your name. Since we will be talking about adolescent sexuality and behaviors and how you and your child communicate about these issues, parts of this discussion may feel a bit sensitive to you. If any question makes you uncomfortable, feel free not to answer it. I want this to be a group discussion so you don’t need to wait for me to call on you. Please speak one at a time so the recorder can pick everything up everything you’re saying. We have many topics to discuss so I may change the subject or move ahead. Please stop me if you want to add anything. 90 1. What does it feel like to be a parent today? • What are the biggest issues facing parents of teenagers today? • Are you afraid that you may not know ‘what’s going on’ with (your) teenagers today? • Does technology and the Internet complicate matters? Or make things easier? • Do you worry about what teens are doing online? Why? 2. Where do you get advice or information on how to keep teens safe online? • Is this pertinent? Is it helpful? • What do you wish you could find out from others about how they are dealing with keeping their teens safe while online? 3. How do you think that easy access to so much information and so many people on the Internet is affecting teens? • How do you think that the many mediums for communication that teens are using online might affect their development? • How do you think that exposure to pornography, unintentional or intentional, might affect the development of adolescents? • How do you think that being sexually harassed by others while online might affect their development? (Ex: Harassment could be anything from someone asking a teen questions about his or her body to someone sending him/her naked pictures.) • How do you think that communicating with boyfriends/girlfriends/romantic partners online might affect their development? Their capacities in relationships? • How do you think that bullying or being bullied by someone else online might affect their development? (Bullying might be anything from spreading rumors about someone to being very mean or threatening someone online.) 91 4. “Some people define ‘youth development’ as the growing capacity of a young person to understand and act upon their environment. Others describe it as groups like family and the community coming together to provide active support for the growing capacity of young people.” • If the Internet is to enhance adolescent development what protective factors do you think need to be in place? (Ex: Parental guidance, time limits, filters, education/literacy classes that help teens analyze and understand the Internet.) • What opportunities should be available? (Ex: Services/programs that help teens improve technologic skills, services that link families to community resources, more websites like girlsinc.org that are alternatives to other forms of online entertainment.) • What role should parents have in this? 5. “Some people think that the growing amount of sexual material teens are exposed to in the media and on the Internet encourages teens to be sexually active or to dress and act sexy.” (Ex: Anything from the oral sex scene in the first episode of the new 90210 to all the pornography and pornography ads on the Internet.) • What do you think about this? • How can parents today help teens put sex and sexuality in perspective? 6. How does the emerging sexuality of a teenager make parents feel? • Do parents feel comfortable talking to their teens about sex? Do teens seem comfortable when talking to their parents about sex? • Who or what do parents think influences a teenager’s thoughts and decisions about whether to be sexually active? • What teens see today in the media and on the Internet ignores a lot of the realities of sex – pregnancy, STDs and emotional injury. How do parents think they can encourage teens to make good decisions about sex in light of these influences? 92 APPENDIX C Mean Median Mode Missing Knowledge Scale: Total Scores (out of 32) 29.4 30.0 30 0 Attitude Scale: Total Scores (out of 65) 52.6 51.5 48 0 Gender and Searching Gender and Using the Pornography on the Internet to Find Internet Information about Sex Spearman’s rho: 0.5 Spearman’s rho: -0.2 Significance (2-tailed): 0.2 Significance (2-tailed): 0.6 Searching Pornography Looking up Information and Attitude about Sex and Knowledge Spearman’s rho: -0.3 Spearman’s rho: 0.1 Significance (2-tailed): 0.5 Significance (2-tailed): 0.8 Knowledge and Attitude Pearson correlation: 0.46 Significance (2-tailed0: 0.26 93 XI. REFERENCES (1) U.S. Department of Commerce, National Telecommunications and Information Administration. (2008) Networked Nation: Broadband in America 2007, January 2008. 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