1. advocate facilitate evaluate educate research Fearless Flyers – Social media approaches for connecting youth to sexual and reproductive health services Andrew Woodruff, MPH Healthy Teen Network Conference October 13, 2011 Pittsburgh, PA

2. advocate facilitate evaluate educate research Teensource.org is an online resource, developed by the California Family Health Council, to improve the health and well being of young people in CA by providing non judgemental, accurate and reliable sexual and reproductive health information and appropriate links to care. HookUp is a statewide text-message-based sexual health information and clinic referral service for California youth

3. advocate facilitate evaluate educate research CFHC carries out its mission by coordinating and supporting the delivery of health services in community-based organizations throughout California. The organization directs funding for providers of family health services, performs advanced research in reproductive health care and contraception, conducts education, training and community outreach efforts, and tests, implements and monitors effective programs.

4. advocate facilitate evaluate educate research We will cover a lot! – What is Teensource.org? – What is HookUp? – How does Teensource and HookUp use social media to engage teens? – Lessons learned/successes and challenges – Activity and discussion

5. advocate facilitate evaluate educate research Teens are online and on their phones 93% of teens are online. 70% go online daily. 73% use social networking sites. 75% of 12 – 17 year-olds own a cell phone. 1 in 3 teens sends 100 or more texts a day Pew Research Center, 2009, 2010 Kaiser Family Foundation, 2009

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7. Links to care made prominent

8. advocate facilitate evaluate educate research What is Teensource? STD/STI information: prevention, testing, treatment Birth Control information: methods, access Comprehensive teen friendly CA clinic search Know your Rights: legal information about teens rights to privately access sexual and reproductive health care in California Teen generated content and blogs

9. advocate facilitate evaluate educate research Teensource.org Clinic Finder

10. advocate facilitate evaluate educate research Teensource.org Birth Control

11. advocate facilitate evaluate educate research Teensource.org STD Homepage

12. advocate facilitate evaluate educate research Teensource.org Stats Teensource launched in 2001 Since embedding Google Analytics in 2008: 1,974,050 Unique users 399,010 STD page views – 181,878 STD unique views – Non curable- 48,744 views – Curable- 42,554 views

13. advocate facilitate evaluate educate research Teensource averages ~1400 hits a day

14. advocate facilitate evaluate educate research Many users find Teensource through Google

15. advocate facilitate evaluate educate research Direct search visitors stay longer 85% accessed via search engines – Curable STDs – STD symptoms – Herpes Average time: 2.19 minutes

16. advocate facilitate evaluate educate research hookup background In April 2009, the California Family Health Council (CFHC) and ISIS launched the Hookup, a statewide text-message-based sexual health information and clinic referral service for California youth The program is the first statewide service of its kind, and builds on the success of ISIS SexINFO program in San Francisco Funding through the Centers for Disease Control and Prevention Attempt to leverage 300+ California Title X clinics who offer free or low-cost sexual health services via the Family PACT program

17. advocate facilitate evaluate educate research hookup development Our goal is to provide California youth ages 13-24 with: - Relevant and accurate sexual health information - A convenient, confidential resource for accessing free or low-cost services at local clinics Key considerations - Statewide audience and field partners - Limited funding and staff time - User experience - Conducted usability testing with target audience - Industry rules & regulations - Opt-out option, Mandatory user language, Introductory and off-message texts

18. advocate facilitate evaluate educate research hookup system design Weekly sexual health text messages on wide variety of topics Shared short-code key word driven – To opt-in, subscribers text the word HOOKUP' to the short code 61827 Each message contains: – A prompt to text the word CLINIC plus a zip code to get up to four local referrals (Title X Clinics, School Based Health Centers, STD Clinics) – A link to CFHCs sexual health website: www.teensource.orgwww.teensource.org Operates as a referral service with information related to each weekly message Clinic locator also includes map/directions and clinic websites when available Subscribers can opt-out at any time by texting STOP

19. advocate facilitate evaluate educate research hookup text development 160 characters for sender identification, health education message, zip-code prompt, website link and legal jargon Decision not to use text-speak (eg. OMG, LOL), only common abbreviations to save space Messages were developed by health educators based on issues identified in youth focus groups in high schools and teen clinics; Reviewed by clinical and health department staff Sample topics: - STD Screening & Prevention - Contraceptive Options - Communication Skills - Substance Abuse - Parental Involvement - Consent & Confidentiality

20. advocate facilitate evaluate educate research hookup text examples Many STDs dont have symptoms. If ur having sex, get tested to know. Txt CLINIC +ur zipcode 4 clinics. www.teensource.org Scared to talk to ur parents about sex? It might not be so bad. Some ideas on how to start at www.teensource.org Condom broke? EC can prevent pregnancy if used w/in 5 days - ASAP is best. Txt CLINIC + ur zipcode 4 clinics. www.teensource.org

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22. hookup marketing Marketing is a necessity for building & maintaining a user-base System purposefully designed to self-market (ie. weekly messages) Developed guidelines for Marketing the Hookup on the Cheap - Promotion via local health departments and youth-serving organizations, press releases to local newspapers, posting on social media sites - Created print-ready Hookup materials, housed on a public access site Removable stickers Temporary tattoos Palm cards

23. advocate facilitate evaluate educate research hookup evaluation – metrics As of May 2011, 5668 unduplicated users subscribed to the Hookup service - Of those, 2231 have opted-out (ie. 3290 current subscribers) 2378 clinic requests received for 429 zip codes in 39 counties CA counties with highest # of clinic requests include Alameda, Los Angeles, Orange, Riverside, San Bernardino and San Diego

24. advocate facilitate evaluate educate research hookup evaluation – text survey In January 2011, a program evaluation survey was sent in place of a weekly message to approx. 3,000 Hookup subscribers Four survey questions: demographics (age and gender, zip code), Hookup promotion points and any knowledge or behavior changes associated with Hookup subscription User participation was voluntary; incentive offered for completion Response rates ranged from 27% (Q1) to 16% (Q4) 33% of responses received within 10 minutes; 98% responded within 24 hours

25. advocate facilitate evaluate educate research hookup evaluation – text survey PurposeText Introduction No tip this week. Your turn to help the Hookup! 4 questions coming your way. Answer all and you can win prizes. Age, Gender 1st a little about u. Text back GUY or GIRL then ur age. Like GIRL 16 or 'GUY 20'. Zip Code We want to know if were reaching youth all over CA. Text back ZIP then ur zipcode to tell us where ur at! Like ZIP 94117. Promotion Point Howd u get hooked up with the Hookup? A friend tell u? Teacher? Saw a poster? Text back HOOKED and ur reason, like HOOKED my bff. Associated KAB Change How has the Hookup changed u? Text back CHANGE then ur change or something new, like CHANGE STD test last week. ConclusionThx 4 helping us make Hookup better 4u! Stay tuned 2 learn if u won our raffle 2 win $50 Target card. Back 2 ur regular tips next week! Survey Questions:

26. advocate facilitate evaluate educate research hookup evaluation – text survey 80% female, 20% male 87% in target population - 5% Under 15 - 47% 15 to 17 - 22% 18 to 19 - 14% 20 to 24 Broad geographic range within California - 57% southern, 33% northern, 10% central Demographics

27. advocate facilitate evaluate educate research hookup evaluation – text survey

28. advocate facilitate evaluate educate research hookup evaluation – text survey Knowledge, Attitude, & Behavior Change Sexual Behaviors208 (44%) not having sex and how to check condoms and when you do have sex be real careful Information / Awareness141 (30%)more 411 on how to love n take care of myself Unknown58 (12%)it hasn't really changed me I just like getting the tips Resources28 (6%) i got addresses to clinics near me where i was able to pick up Plan B emergency contraceptive yesterday Other17 (4%)drug test last week Social Behaviors15 (3%) found a fun way to discuss STDs and safe sex with friends Attitudes6 (1%)changed the way I look at sex

29. advocate facilitate evaluate educate research hookup looking forward Complete analysis of program evaluation data Increase opportunities for youth involvement - Encourage youth to develop messages, ie. text ur own tips competition - Use teensource.org to assess what other topics youth want to hear about Expand geographic reach of clinics in referral system Partner with youth-serving CBOs outside of the health field Expand marketing strategy to better incorporate new media

30. advocate facilitate evaluate educate research hookup conclusions Since launch, the Hookup has effectively provided low-cost sexual health information to many users and resulted in a high proportion of clinic referrals across California Evaluation is necessary to ensure we reach our target audience The programmatic platform can be translated for adoption by other organizations considering implementing text-based projects Hookup is an excellent model of a low-cost program using health communication and mobile technology to facilitate youth access to sexual health information and services

31. advocate facilitate evaluate educate research How does Teensource and HookUp engage teens? Peer educator developed tips Advertising budget = increased #s Partnerships with youth serving organizations and delegate agencies Youth led social media strategies and internship program Different interns engage different audiences

32. advocate facilitate evaluate educate research Teensource.org uses Facebook

33. advocate facilitate evaluate educate research Teensource.org uses Twitter

34. advocate facilitate evaluate educate research Teensource blogs about pop culture

35. advocate facilitate evaluate educate research Teensource has partnerships with youth serving organizations LA Youth – Youth led journalism and blogging Venice Arts – Picturing Health Project ISIS - Hookup CA STD Control Branch – Condom Access Project

36. advocate facilitate evaluate educate research There is still a lot to do Working with SBHCs Peer Advocate groups Condom Access Project youth engagement Increased interactivity on social media threads Improved leverage of social media platforms http://www.facebook.com/teensource http://twitter.com/teensource http://paper.li

37. advocate facilitate evaluate educate research Working with teens on social media is rewarding Successes Reaching target population Increased interaction with each intern Productive partnerships Challenges Large state w/ diverse audience Inconsistent activity Revolving interns and training time Varied skill sets and quality of work

38. advocate facilitate evaluate educate research Group activity – Lets share! Groups of 3-6 people who you dont work with 5-8 minutes per person to share: 1)A challenge faced in engaging youth using social media 1)Best practices approaches for solving that problem 2)Future ideas for improving reach online and in social media Share with larger group questions and lessons learned

39. advocate facilitate evaluate educate research Thank you! Contact: Andrew Woodruff, MPH Woodruffa@cfhc.org 510.486.0412 And thanks to: CFHC Staff Design Action ISIS, Inc. CA STD Control Branch