Teens Talk Health: An Interactive Website to Promote Healthy Relationships and Prevent STIs

Introduction: Young people account for roughly half of unintended pregnancies and contracted sexually transmitted infections (STIs) in the United States each year. Equation of condom use with lack of intimacy and trust, involvement in a physically or emotionally abusive relationship, and substance use are modifiable risk factors for inconsistent condom use. Roughly half of individuals who experience sexual assault or rape are estimated to be younger than 18 at the time of first victimization. Substance use and failure to establish and communicate about sexual boundaries in situations where sexual behavior can occur are modifiable risk factors for sexual assault. Highly interactive, moderated websites are an ideal setting to foster health protective attitudes, intentions, and behaviors among teens.  

Methods: Sexually active teens aged 14-18 years (n=147) participated a feasibility and pilot study of TeensTalkHealth, a highly interactive web-based intervention to prevent and reduce sexual risk-taking and related risk behaviors. Intervention participants (n=92) logged onto the website with non-identifying usernames and passwords and were asked to complete a total of 60 activities (e.g., watching video vignettes, reading teen-friendly articles, posting to message boards) across a 4-month intervention period. All participants were asked to complete 7 monthly surveys.

Results: Intervention teens submitted 2,292 comments on message boards over the 4-month period. Satisfaction indices were high for comfort, perceived privacy, website accessibility and ease of use, and perceived credibility of health educators. Preliminary growth curve analyses of pilot data, utilizing an intent-to-treat approach, suggest that the TeensTalkHealthintervention did not impact number of unprotected sex acts or sex in the context of substance use over time. However, the number of tasks that intervention participants completed appeared to impact sex in the context of alcohol use. Sex in the context of alcohol use generally increased over time. However, intervention participants who completed a greater number of tasks had smaller increases or decreases in this risk behavior over time. Additional analyses demonstrated that pilot participants reported a greater number of unprotected sex acts at baseline if they used hormonal or IUD contraception, were involved in a monogamous relationship, or had less desire to use condoms. These factors were not associated with changes in unprotected sex acts over time, suggesting that condom use patterns were typically ‘set’ at study entry. While participants who reported a high level of relationship quality also reported fewer unprotected sex acts at baseline, high relationship quality at baseline was associated with increasing numbers of unprotected sex acts over time.

Conclusions: Teens feel comfortable discussing sexual health through private, moderated websites. An intervention may have the greatest impact on patterns of condom use if the intervention is delivered prior to teens’ first sexual experiences, when teens may be more receptive to sustained use of condoms. Other sexual risk-taking behaviors, such as sex in the context of substance use, may be influenced after teens have become sexually experienced.