Outreach through social media can encourage condom use in young adults, study shows

Sexually transmitted infection (STI) prevention messages delivered by Facebook can be effective in promoting condom use among young adults in the short term, a new study has found. Few students and young adults receive comprehensive sexuality education or guidance on HIV and other STI risks. Social media may provide a viable alternative to promote safe sex using online networks of friends, the study published in the November issue of the American Journal of Preventive Medicine reports.

"The use of social media to influence sexual risk behavior in the short term is novel. It is a first step in considering how to reach the overwhelming numbers of youth online, and how to maximize approaches to technology-based interventions," says lead investigator Sheana S. Bull, PhD, MPH, of the Department of Community and Behavioral Health at the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus, Aurora, CO.

Researchers initially recruited in community settings and through postings on popular blogs and websites, as well as advertisements in college and local papers in US cities with higher than average rates for STI and HIV. Recruitment focused on African-American and Latino youth given the disparity of infections between these groups and other . Each recruit was given an incentive to recruit three friends to participate, and each new recruit was also incentivized to recruit three friends, for five recruitment waves.

Participants and those they recruited were randomly assigned as a network to either an intervention group or a control group. The signed up to "Like" and receive news from Just/Us, a Facebook community developed to promote sexual health. Each week a new topic such as communicating about , skills building for condom negotiation and use, and how to access STI testing was discussed on the site, with updates each day from youth facilitators in the form of video links, quizzes, blogs, and threaded discussions. The control page was called "18-24 News," and shared news that happened during the hours of 6 pm to midnight on the 24 hour clock that was of interest to 18-24 year olds.

Demographic information and baseline information on at last sexual encounter and the proportion of sex acts protected by condom use in the last 60 days were collected at the start of the study. 636 people were enrolled in the 18-24 News intervention and 942 in the Just/Us intervention. Surveyed two months after the intervention, 68% of the Just/Us group reported using a condom during the last sex act, versus 56% of the controls, and the proportion of sex acts protected by condom use in the last 60 days was 63% for the Just/Us group versus 57% for controls. The effects decreased over time and a survey six months after the intervention found no difference between the two groups. There was no evidence that any demographic characteristics influenced response to the intervention.

"The effect size from the short-term outcomes match or exceed those observed in other Internet interventions, suggesting Facebook for sexual health interventions is at least equally effective as other technology-based mechanisms, and these effects match those observed for more traditional HIV prevention programs delivered in real-world settings," Dr. Bull observes.

Results also show success in recruitment of youth of color and youth living in geographic regions with high STI and HIV prevalence, and success in reaching large numbers of people with STI- and HIV-related content through Facebook. There is little evidence that youth actively seek out and engage with organizations on Facebook. Thus approaches like that of Just/Us to push messages out offer one way to get messages in front of a large number of youth.

Dr. Bull notes that the study relied on self-reporting, and condom use may have been over-reported. Another concern is that the number of active participants declined over time, as did the treatment effect. "Although this type of attrition has been documented in other online STI-related research, it underscores the need to redouble efforts to attract and engage higher-risk youth in prevention efforts using social media. Future work should explore approaches to keep audiences engaged in social media content related to sexual health," she concludes.

In a commentary accompanying the article, Nathan K. Cobb, MD, from the Schroeder Institute for Tobacco Research and Policy Studies at the American Legacy Foundation, Washington, DC, says, "For health behavior change intervention designers, Facebook offers something unprecedented – direct access to an individual's social network, in real time, and without the need for tedious network enumeration by participants. However, such approaches require multidisciplinary teams that include specialists, marketers, and software developers as equal partners in design and intervention development. Building such teams will undoubtedly require changes to traditional funding and development models, but the potential is too large to be ignored or minimized."

More information: "Social Media-Delivered Sexual Health Intervention: A Cluster Randomized Controlled Trial," by Sheana S. Bull, PhD, MPH, Deborah Levine, MA, Sandra R. Black, DVM, Sarah J. Schmiege, PhD, John Santelli, MD, MPH (DOI: 10.1016/j.amepre.2012.07.022). It appears in the American Journal of Preventive Medicine, Volume 43, Issue 5 (November 2012)

"Health Behavior Interventions in the Age of Facebook," by Nathan K. Cobb, MD and Amanda L. Graham, PhD (DOI: 10.1016/j.amepre.2012.08.001). It appears in the American Journal of Preventive Medicine, Volume 43, Issue 5 (November 2012)

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