Adolescents, Technology and Reducing Risk for HIV, STDs and Pregnancy Suggested Citation Kachur, R., Mesnick, J., Liddon, N., Kapsimalis, C., Habel, M., David-Ferdon, C., Brown, K., Gloppen, K., Tevendale, H., Gelaude, D.J., Romero, L., Seitz, H., Heldman, A. B., Schindelar, J. (2013). Adolescents, Technology and Reducing Risk for HIV, STDs and Pregnancy. Atlanta, GA: Centers for Disease Control and Prevention. Design and Layout - Mark Conner contents Executive Summary . 7 I. Introduction . 8 II. Adolescence . 10 A. Demographics. 11 B. Adolescent Development . 13 i. Cognitive Development. 13 ii. Identity Development. 13 iii. Behavioral Development . 14 iv. Social and Environmental Factors and Adolescent Development . 15 III. Adolescents and Reproductive and Sexual Health . 17 A. Sexual Behavior . 17 B. Adolescent Pregnancy and Births. 20 C. HIV/AIDS . 20 D. Sexually Transmitted Diseases . 21 E. Summary . 22 contents IV. Technology: How It’s Used by Adolescents . 22 A. Internet . 23 i. Social Networking Sites (SNS) . 25 ii. User-Generated Content (UGC) . 30 iii. Video Sharing . 31 iv. Blogs. 31 v. Instant Messaging . 32 B. Mobile Devices . 33 i. Text Messaging . 37 ii. Mobile Software Applications . 37 iii. Future of Mobile Technology . 38 C. Video Games . 38 i. Virtual Worlds . 41 D. Risks and Dangers. 42 i. Internet and Sexual Risk . 43 ii. Mobile Devices and Sexual Risk . 46 E. Summary . 49 V. Technology: A Tool to Improve Adolescent Sexual Health. 49 A. Examples of Multimedia Campaigns. 49 B. Example of Online Intervention . 52 C. Example of Blogs . 53 D. Example of Social Networking Site . 53 E. Example of Computerized Intervention . 54 F. Examples of Mobile Efforts. 56 i. Mobile Efforts to Reach Teens. 56 ii. Mobile Efforts for Clinical Services . 57 G. Examples of Games Targeting Sexual Health . 58 H. Examples of Websites that Address Technological Risks . 59 I. Summary . 59 VI. Conclusion . 60 References . 61 Adolescents, Technology and Reducing Risk for HIV, STDs and Pregnancy 6 Adolescents, Technology and Reducing Risk for HIV, STDs and Pregnancy 7 Executive Summary Digital technology, including the internet, mobile phones, and gaming, increasingly influences the lives of adolescents. Ninety-three percent of youth, aged 12–17 years, are online, 75% have a mobile phone (Lenhart et al., 2010a), and 97% play video games (Lenhart et al., 2008). These technologies allow youth to engage in age–old behaviors such as chatting, flirting, and dating in novel ways. They also provide youth with anonymous avenues for seeking health information in general and sexual health, in particular. While technology has changed the development. Targeting youth way in which teens interact and who are using emerging digital access information, they remain technology is important for ensuring a vulnerable population when it sexual health equity for adolescents. comes to sexual risk. The burden of sexually transmitted diseases (STDs) This white paper is intended for among people aged 15–24 years practitioners and others who work accounts for nearly half of all STDs with adolescents and provides reported in the U.S. (Weinstock et an overview about the ways in al., 2004). The U.S. pregnancy rate which digital technology can be among youth aged 12–19 years is used to improve the sexual health one of the highest in the developed of adolescents. We begin with world (National Campaign to Prevent a brief summary of adolescent Teen and Unplanned Pregnancy, characteristics, including their 2010). Adolescents are also especially demography, development, and vulnerable to sexual risk because sexual behavior. We then provide they are undergoing rapid cognitive, a basic overview of the new behavioral, emotional, and social digital technologies and media Adolescents, Technology and Reducing Risk for HIV, STDs and Pregnancy 8 that youth are using such as social networking sites (SNS), video sharing, blogs, instant messaging, mobile technology, and virtual worlds. We examine technology’s potential for use in sexual health promotion, as well as the risks associated with misuse of digital technology. Finally, we present examples of innovative adolescent sexual health interventions that have used digital technology to improve their reach and effectiveness. We expect that this document will serve as a resource for improving for entertainment, and to look for adolescent sexual health and will information (Foehr, 2006). Each of offer new tools to reach youth. these reasons offers an opportunity for outreach, education, and I. Introduction intervention to promote sexual health. Adolescents today are adopting new digital technologies almost as However, for adults who are involved quickly as they are being introduced. in programs to improve the health of These technologies, such as the adolescents, it is often difficult to stay internet, social networking sites, and abreast of every new and emerging mobile phones are considered by technology; understand all the ways adolescents to be an integral and adolescents use these technologies; essential part of their lives (Consumer and make sense of how to adopt new Electronics Association, 2008). technologies for our efforts. It is our The vast majority of adolescents collective challenge (and perhaps are online regularly (Lenhart et duty) to learn and understand these al., 2010a), have mobile phones popular technologies as well as to (Lenhart, et al., 2010a), and play creatively use them to educate, video games (Lenhart et al., 2008). empower, and motivate adolescents Adolescents use technology for many to adopt healthier behaviors. reasons— to communicate with one another, as a form of self-expression, Adolescents, Technology and Reducing Risk for HIV, STDs and Pregnancy 9 This document was developed in become outdated. We hope that recognition of the need for a basic by summarizing the interaction summary of how U.S. adolescents between adolescents, technology, currently use the various technologies. and sexual health and by providing We realize, however, that technology examples of current efforts, we add evolves much faster than the a valuable, foundational piece to development of a document and the toolbox for adolescent sexual recognize that some sections of health promotion activities. this white paper could quickly Adolescents, Technology and Reducing Risk for HIV, STDs and Pregnancy 10 We begin this document by Prevention (DSTDP), Division of HIV/ presenting a definition of adolescence AIDS Prevention (DHAP), Division of including age ranges and a brief Adolescent and School Health (DASH), overview of adolescent development. Division of Reproductive Health The next section describes various (DRH), Division of Violence Prevention aspects of adolescent sexual health (DVP) and the Office of the Associate including sexual initiation, sexual Director for Communication (OADC), behaviors and rates of disease. The formerly the National Center of Health document continues by providing Marketing (NCHM). Although our a broad overview of the various division-specific missions are different, technologies currently popular with we all share a common population— youth, how they are using them, adolescents—and a common and ways that technology can be objective—to improve their overall used for sexual health and STD/ health, safety, and sexual well-being. HIV prevention efforts. We use the terms “new media,” Web 2.0, II. Adolescence and technology to refer to current Definition of adolescence. popular technologies such as social Adolescence is a unique and networking sites (e.g., Facebook), pivotal developmental period microblogging (e.g., Twitter), online marked by physical maturation, video sites (e.g., YouTube), online psychological and social changes, games, and mobile phones and increased independence, and the mobile phone-related activities (e.g., experimentation with or establishment texting). This section also touches of new behaviors. The course of upon how technology creates adolescent development is influenced sexual risk for adolescents. The final by the adolescents as well as the section presents examples of current people and world that surround them technology-based sexual health (Bronfenbrenner, 1979). In this white programmatic efforts that could paper, we define youth as ages 8–19 inform the development of future years, comprised of the preteenage health promotion activities. Five ages of 8–12 years, frequently referred divisions and one center from across to as “tweens,” and “teens” ages the Centers for Disease Control and 13–19 years. We use the terms “youth” Prevention (CDC) came together to and “adolescents” interchangeably create this document: Division of STD throughout this document. Adolescents, Technology and Reducing Risk for HIV, STDs and Pregnancy 11 A. Demographics is expected to continue to grow In 2012, adolescents aged 8–19 through 2050 (U.S. Census Bureau, years, who were born during 2004). According to the 2010 Census, 1993–2004, are popularly known there are approximately 41 million as Generation Y or the Millennial youth, ages 10–19, currently living Generation, which includes cohorts in the U.S. (Howden & Meyer, 2011). born between the early 1980s The adolescent population is more to early 2000s. The Millennial racially/ethnically diverse than the Generation is noted for being the first overall population. In 2010, about “connected” generation; influenced 24% of youth ages 14–17 belonged by communication technologies to racial and ethnic minorities (U.S. such as email, cell phones, instant