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Youth definitions of_healthy_sexuality -kimmel
1. Youth Definitions of Healthy Sexuality: Implications for Technology Use Sex::Tech April 1, 2011 Allison Kimmel, MPH Candidate Terrance Campbell, MISM, MA Ed, PhD Candidate Daniel J. Kruger, PhD March 31, 2011 Allison Kimmel, MPH Candidate; Terrance Campbell, MISM, MA Ed, PhD Candidate; Daniel J. Kruger, PhD The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department
2. Overview Genesee County Healthy Sexuality Project Method Used Results Youth definitions of healthy sexuality Youth technology preferences Discussion Current Projects March 31, 2011 Allison Kimmel, MPH Candidate; Terrance Campbell, MISM, MA Ed, PhD Candidate; Dan Kruger, PhD The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department Allison Kimmel, MPH Candidate; Terrance Campbell, MISM, MA Ed, PhD Candidate; Daniel J. Kruger, PhD The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department Dan Kruger, PhD, Terrance Campbell, MISM, MA Ed, PhD Candidate, Allison Kimmel, MPH Candidate The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department
3. Genesee County Healthy Sexuality Project Why Genesee County? Highest HIV rates in Michigan 437 per 100,000 African-American males 167 per 100,000 African-American females Flint designated as “high prevalence area” by state of Michigan Number of STIs in youth continue to rise1 Collaborative Partners YOUR Center Genesee County Health Department Prevention Research Center of Michigan Goals Develop coalition to increase awareness of healthy sexuality Develop an asset map focused on STI and teen pregnancy rates Identify strategies to fill gaps in existing efforts Conduct events & activities highlighting issues around healthy sexuality Why text messaging and email? Part of existing social network Social and technical capital as protective factors Economic landscape 1Michigan Department of Community Health. (2010, April). The state of adolescent sexual health in Michigan. Retrieved on February 28, 2011 from http://www.michigan.gov/documents/mde/WhitePaper2010_319339_7.pdf Allison Kimmel, MPH Candidate; Terrance Campbell, MISM, MA Ed, PhD Candidate; Dan Kruger, PhD The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department Allison Kimmel, MPH Candidate; Terrance Campbell, MISM, MA Ed, PhD Candidate; Daniel J. Kruger, PhD The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department Dan Kruger, PhD, Terrance Campbell, MISM, MA Ed, PhD Candidate, Allison Kimmel, MPH Candidate The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department
4. Methods and Results Methods 6 Focus groups 92 participants (total) Age 14 – 24 16 LGBT participants (self-reported) 80% African American 20% White or Hispanic/Latino Results Youth definitions of healthy sexuality are embedded in youth preferences of technology as tools to promote healthy sexuality. Allison Kimmel, MPH Candidate; Terrance Campbell, MISM, MA Ed, PhD Candidate; Dan Kruger, PhD The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department Allison Kimmel, MPH Candidate; Terrance Campbell, MISM, MA Ed, PhD Candidate; Daniel J. Kruger, PhD The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department Dan Kruger, PhD, Terrance Campbell, MISM, MA Ed, PhD Candidate, Allison Kimmel, MPH Candidate The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department
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7. “Because that’s not really an option about our safe, well it is, but a lot of people don’t talk about [abstinence]. You say use safe sex, you don’t say its ok to not have sex, if you decide that.”Allison Kimmel, MPH Candidate; Terrance Campbell, MISM, MA Ed, PhD Candidate; Dan Kruger, PhD The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department Allison Kimmel, MPH Candidate; Terrance Campbell, MISM, MA Ed, PhD Candidate; Daniel J. Kruger, PhD The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department Dan Kruger, PhD, Terrance Campbell, MISM, MA Ed, PhD Candidate, Allison Kimmel, MPH Candidate The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department
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9. “It’s not my responsibility to tell you…I’m not gonna hold your hand. Is you wearing a condom, booboo? It’s your responsibility because you your own person.”
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11. “…once you know someone you are suppose to have that trust and if you have been together for so long you are suppose to be allowed to ask questions as far as your sexuality so you need to know what your partners have, what you have and you both need to get it together and go and get checked out”.Allison Kimmel, MPH Candidate; Terrance Campbell, MISM, MA Ed, PhD Candidate; Dan Kruger, PhD The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department Allison Kimmel, MPH Candidate; Terrance Campbell, MISM, MA Ed, PhD Candidate; Daniel J. Kruger, PhD The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department Dan Kruger, PhD, Terrance Campbell, MISM, MA Ed, PhD Candidate, Allison Kimmel, MPH Candidate The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department
12. Results: Youth Preferences for Technology Use Personal Responsibility “Your own self probably or something like that, your own computers and stuff like that to know all this information, get your information and stuff about this that is going on, I don’t know.” “You gotta know for yourself. I gotta have proof. I just can’t go off hearsay.” Trust and Privacy “Because the nurses don’t know you personally as well [as the teachers], they may not talk about you because they don’t see you on a day to day basis. And since they are certified they cannot talk about you, they have to keep it private.” ”It would be cool if [texting nurses] could be 24/7 help. If you seriously have questions about something that you have a way to find out what you want to know.” “I: [Would you like] sexual health information via text messaging or email? R: I wouldn’t. I don’t want to talk to no phone or text…I want to see them in person.” Allison Kimmel, MPH Candidate; Terrance Campbell, MISM, MA Ed, PhD Candidate; Dan Kruger, PhD The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department Allison Kimmel, MPH Candidate; Terrance Campbell, MISM, MA Ed, PhD Candidate; Daniel J. Kruger, PhD The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department Dan Kruger, PhD, Terrance Campbell, MISM, MA Ed, PhD Candidate, Allison Kimmel, MPH Candidate The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department
13. Results: Youth Preferences for Technology Use cont’d Other preferences Directionality of communication Partner notification “Probably the worst idea ever...I would be so mad… I would be so upset.” Information source “That is where we hear about everything happening and phones text messaging. When Michael Jackson got, died. How did you find out?” Need for variety of sources “There is not a certain way or a certain thing that you can say, this is what you need to do to be aware. It just depends on your background. She might be fortunate to be able to go on the Internet or be able to read a book.” Allison Kimmel, MPH Candidate; Terrance Campbell, MISM, MA Ed, PhD Candidate; Dan Kruger, PhD The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department Allison Kimmel, MPH Candidate; Terrance Campbell, MISM, MA Ed, PhD Candidate; Daniel J. Kruger, PhD The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department Dan Kruger, PhD, Terrance Campbell, MISM, MA Ed, PhD Candidate, Allison Kimmel, MPH Candidate The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department
19. Very specific group and cityAllison Kimmel, MPH Candidate; Terrance Campbell, MISM, MA Ed, PhD Candidate; Dan Kruger, PhD The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department Allison Kimmel, MPH Candidate; Terrance Campbell, MISM, MA Ed, PhD Candidate; Daniel J. Kruger, PhD The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department Dan Kruger, PhD, Terrance Campbell, MISM, MA Ed, PhD Candidate, Allison Kimmel, MPH Candidate The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department
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23. Wellness AIDS Service, Planned Parenthood, and Raise It Up Allison Kimmel, MPH Candidate; Terrance Campbell, MISM, MA Ed, PhD Candidate; Dan Kruger, PhD The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department Allison Kimmel, MPH Candidate; Terrance Campbell, MISM, MA Ed, PhD Candidate; Daniel J. Kruger, PhD The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department Dan Kruger, PhD, Terrance Campbell, MISM, MA Ed, PhD Candidate, Allison Kimmel, MPH Candidate The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department
31. YOUR Center StaffAllison Kimmel, MPH Candidate; Terrance Campbell, MISM, MA Ed, PhD Candidate; Dan Kruger, PhD The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department Allison Kimmel, MPH Candidate; Terrance Campbell, MISM, MA Ed, PhD Candidate; Daniel J. Kruger, PhD The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department Dan Kruger, PhD, Terrance Campbell, MISM, MA Ed, PhD Candidate, Allison Kimmel, MPH Candidate The Prevention Research Center of Michigan, YOUR Center, and Genesee County Health Department
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Editor's Notes
Introduce myselfExplain that this is a Community-Based Participatory Research study, which means that academic researchers partner with community organizations, such as YOUR Center, at all stages of the study, including questionnaire development, data analysis, and dissemination, like this presentationExplain that this is a qualitative study, in which we attempted to understand youth experiences and definitions of healthy sexualityThis is a presentation that we will be giving next week at the Sex::Tech conference, a conference for academics, community workers, youth, and activists that focuses on youth, sexuality, and technology or new media.
A little background on Genesee County:Genesee County is:47% male53% female53% African-American or black41% White<1% American Indian<1% Asian10-14 year olds are 8% of the population15-19 year olds are 7% of the population20-24 year olds are 7% of the populationGenesee County Why Genesee County? African Americans in the U.S., Michigan, and Genesee County are significantly and disparately affected by the HIV/AIDS epidemic. Nationally, African Americans are approximately 12% of the U. S. population, but account for 50% of the new AIDS cases (reported in the country in 2002 (Kochanek & Smith, 2004). In Michigan, African Americans comprise 14% of the Michigan’s population, but account for 58% of new AIDS cases In 2000, African American males HIV/AIDS rate: 437 per 100,000 In 2000, African American females HIV/AIDS rate: 167 per 100,000 Genesee County and Flint, the largest city in Genesee County, are both designated as “high prevalence area” by the State of MichiganAlthough there are several social services agencies and programs within Genesee County that offer sex and sexuality education, the number of sexually transmitted diseases in youth continues to rise.2. Collaborative PartnersYOUR Center is a faith-based service organization that has provided a comprehensive array of STI education, prevention and care services since 1996. YOUR Center is a partner organization in the Prevention Research Center of Michigan (PRC), a decade long University/community partnership funded by the CDC. YOUR Center, which works primarily in the faith-based and African-American community, is dedicated to providing culturally appropriate intervention strategies to increase effectiveness. It was also a participant organization in Project EXPORT, a campus/community partnership established by the University of Michigan-Flint to reduce health disparities including STIs. In 1996, collaborating with Faith Access to Community and Economic Development, YOUR Center began to provide limited STI education to churches and other faith institutions.The Genesee County Health Department works to improve the quality of life in Genesee County by preventing disease, promoting health, and protecting the public from environmental hazards to health. The Prevention Research Center of Michigan, which operates out of the U of M School of Public Health, is currently distinguished by the degree to which it adopts CBPR principles and practices, and the extensive involvement and power of Community Based Organization partners. Most other PRCs focus on specific health conditions, such as diabetes, and there has been considerable discussion in the PRC partnership of moving in this direction. Recently, a consensus has developed that the demonstration program proposed for the next phase of the PRC should focus on STI incidence reduction. 3. GoalsThe Genesee County Health Department received a grant from the Ruth Mott Foundation that funded a Healthy Sexuality Coalition and Conference Project (HSCCP) in 2006-2007. The HSCCP achieved the following goals: 1.Developed a coalition of community partners around the topic of healthy sexuality to increase awareness, interaction and cooperation among coalition partners that are working to address the high rates of STIs and unintended teen pregnancy in Genesee County; 2.Completed an asset map of current contacts, programs and activities conducted by coalition partners that are addressing the high rates of STIs and unintended teen pregnancy in Genesee County; 3. Brainstormed through three sub- committees (Technology, Clinical and Education) possible actions that might be developed into future programming to fill gaps in activities to address the high rates of STIs and unintended teen pregnancy; 4. Conducted an all day conference during Public Health Week to highlight and bring attention to the issues around healthy sexuality.This presentation focuses on the second stage of the Healthy Sexuality Coalition and Conference Project, the Genesee County Healthy Sexuality Project, which examines youth experiences with and definitions of healthy sexuality. One area examined was the idea of using technology as a tool for sexual health promotion. Why text messaging and email?A number of emerging technologies were identified during the first stage. One example was a text-messaging project initiated in 2006 in San Francisco to address an increase in gonorrhea rates among African-American teens that some Genesee County Healthy Sexuality Coalition members thought might work well in Flint. We included some questions around technology to assist in determining if some of the emerging practices identified may be projects we want to consider for Genesee County.YOUR Center staff identified that youth were already using technology such as texting and email – so this technology was already part of the existing social networkSocial capital, or social support received through your social network, and technical capital, or social networks created through technology, have been identified The current economic landscape of Genesee County. Genesee County was experiencing its own recession before the national recession. This led to a decrease of school extracurriculars, after school programming or hang out spots, and sexual and reproductive health classes in the schools.
This presentation will focus on the data obtained from the six focus groups implemented in stage 2 of the GCHSP. The focus groups had 92 total participants, ages 14-24, with 16 self-reported LGBT participants. About 80% of the participants were African-American, and the remaining 20% were White or Hispanic/Latino. Focus group participants were organized into six sessions with up to 10 individuals by type and age. Focus groups were held specifically for straight men, straight women, Men who have Sex with Men (MSMs), and lesbian or gay women. Groups were segmented into school age (14-18) and post-secondary school age 18-24 sessions; 18 year olds who are still in High School will be encouraged to attend the younger group, those no longer in High School were encouraged to attend the older group. There were two LGBTQ groups that were mixed.A peer moderator, usually a YOUR Center staff member, conducted each of the focus groups. The peer moderators underwent a standardized training by GCHD and YOUR Center staff to ensuring greater consistency in which questions are asked and the manner in which they are asked. Focus group participants were recruited from outreach activities; i.e. church recruitment, collaborative organizations with youth programming, and youth lead social marketing campaign) conducted by YOUR Center, the Genesee County Health Department, and Genesee County Healthy Sexuality Coalition Member Organizations. At the focus group, prior to beginning data collection, each participant was asked to read and sign an informed consent form. Upon completion, participants completed a brief, anonymous demographic survey. At the conclusion of each focus group, participant received a small honorarium ($20 gift card) in appreciation of their participation. Each focus group was recorded by a note taker and audio-recorded for verification of the notes staff from the Health Department and PRC interns took notes. Focus groups were transcribed verbatim and the data was analyzed by researchers at UMSPH with Nvivo software, a qualitative data analysis software. 1) organizing the responses in the discussion group notes into a series of in vivo restatements (data chunks), 2) double checking the restatements, 3) coding the restatements into categories, 4) combining coded restatements across discussion groups and participants to form one consolidated document per case study, and 5) reviewing the consolidated document to identify themes to be included in written discussion group results.We reviewed this data to help to modify the curriculum and intervention components to address developmental, cognitive, social, and environmental barriers that contribute to young African Americans’ HIV risk. A list of themes was developed based on: 1) issues of interest to GCHD, YOUR Center, UM-SPH and 2) patterns and topics that reoccurred throughout the focus groups. This project and its activities was submitted for review by the University of Michigan’s Institutional Review Board-Health Sciences.
So let’s take a look at youth definitions of healthy sexuality.Youth reported several dimensions of healthy sexuality.Personal Power and CommunicationPersonal power: Some young people expressed view that healthy sexuality was tied with up with their ability to demand respect, be themselves, communicate openly and make well-reasoned choices. Personal respect related to being selective about potential partners. Quote 1Open communication involved being truthful with partners, and discussing personal desires and limits with partners. But communication also meant using their power to ask health care providers such, as doctors, for information and putting the information to use. Quote 2Morality:For some youth, values related to abstinence predominated in their definitions of healthy sexuality.Abstinence was characterized as a virtue for individuals, and as a community-wide strategy for reducing HIV/STI rates and unintended pregnancies. Quote 3While some young people advocated the view that abstinence promotion could be a valuable part of sex education, and one even felt that abstinence was not promoted enough (quote on slide). Yet, participants strongly felt that abstinence should not be the only content covered, and wanted options presented. Quote 4Further, youth expressed that safer sex is heterosexual sex: same sex sexuality was absent from the conversation or viewed with negativity.
3. Personal responsibility and self-sufficiency: Young people clearly understood the gravity of HIV, and therefore expressed concern about the possibility that people might unknowingly transmit the disease. This concern manifested as judgment of people who might be spreading HIV /STIs, with the occasional statement that people should be warned about others. There was a link made between responsibility and personal character. Quote 1Responsibility was a sign of self-respect. Young people clearly defined sexual activity as belonging in adulthood. With sexual activity, then, came the task of being responsible like an adult should. This included using condoms, communicating, being tested for HIV/STIs and recognizing that there is no one to blame but oneself for the consequences of sexual activity. Part of this recognition of self-sufficiency involved seeing that the greatest consequences of safe sex were experienced by oneself. Quote 2Youth also expressed that some people just didn’t care about the risk of STIs/HIV. Quote 34. Trust: Trust was a central theme in young people’s discussions of healthy sexuality. For the most part, trust in a partner was held up as an ideal, but there were a number of doubts about whether they could truly trust other people.Quote 4Some young people expressed doubts that a partner would remain monogamous, even in marriage.Even with new partners, young people felt that there may be dishonesty when a potential partner was asked about their sexual history. Monogamy was linked to trust in partners, and participants felt that when trust was there, other forms of healthy sexuality became possible, such as open communication, self-expression, intimacy, honesty and collaboratively ensuring each other’s health by getting tested together.Quote 5Because of the prevalence of STIs in Flint, young people expressed fear of STI/HIV vulnerability and a general mistrust of the population of Flint, “Feels like we can’t help it because it is here and is going to be here because it is like people are so like you can’t trust anybody these days”. Additionally, a few mentioned that with the small size of their community, it was especially risky to have sex with others in Flint, “People are not being responsible here…Everybody know everybody, everybody done did everybody…”. -
As we look at youth preferences for technology use, we see that their definitions of healthy sexuality are mirrored, or embedded in their preferences – with personal responsibility and trust.Personal responsibility: Youth preferences for the use of technology corresponded to their definitions of healthy sexuality as involving personal responsibility. Youth expressed a need to know for oneself – that it was their responsibility to find the information. For example, an individual has to take it upon himself to go on the computer and get information or to send a text message to get information. Quotes 1 & 2Trust and privacy:For youth, preferences around technology use were tied to trusting the source of the information and knowing that their privacy would be protected. Teachers were seen as judgmental, whereas health professionals, such as nurses were considered trusted and credible sources, because of their specialized knowledge. Quotes 3 & 4Privacy was also linked to trust. Youth expressed concern that their information exchanged over text messages would be accessed or changed by someone else. While some youth preferred to know the source, such as nurses, providing them with information over text or email, others did not. This concern was expressed to the extent that some participants preferred to receive information from an anonymous source. Quote 5
Other preferences youth expressed for technology as a possible healthy sexuality promotion tool included directionality of communitication, partner notification, technology as a source of information, and the need for a variety of sources.Directionality of communication: Youth preferences for technology use, as described, were related to the direction of communication. While communication with doctors, nurses, and partners were valued, it was clear that youth preferred to initiate communication – i.e. text a question into a hotline – rather than be contacted personally. However, if general health information was being communicated via text messaging or email, youth would accept that information. Partner notification: Text messaging and email as a form of partner notification of exposure to a sexually transmitted infection was not preferred.Quote 1Information source: Texting was identified as a good way to spread information and method already being used. Quote 2Need for a variety of sources as not everyone has access to the same sources. Quote 3
In summary, we found the following as potential concerns.Privacy – that no one would read or change their text messagesTrust – that the information source providing accurate information and wouldn’t discuss their business with other people.Directionality – youth preferred to initiate the conversationPartner notification – technology was not favored as a partner notification toolNeed for a variety of information sources – so that each person could have the informationEven with these concerns, some youth expressed that they would favor using technology, such as text messaging as a tool for sexual health promotion.
NLM = National Library of MedicineAnd another round of focus groups were held that focus specifically on technology use. Those results are forthcoming.
