Elsevier

Journal of Applied Developmental Psychology

Volume 25, Issue 6, November–December 2004, Pages 685-698
Journal of Applied Developmental Psychology

The search for peer advice in cyberspace: An examination of online teen bulletin boards about health and sexuality

https://doi.org/10.1016/j.appdev.2004.09.002Get rights and content

Abstract

The physical, emotional, and psychological changes that occur in adolescence prompt youths to have serious questions about their bodies, relationships, and health that are often personal, sensitive, or embarrassing. Past research has shown that adolescents are often reluctant to consult physicians, peers, and others for personal health questions due to concerns about confidentiality. One new venue for health information is the Internet, which is a promising resource due to its accessibility, interactivity, and anonymity. This study is a snapshot investigation of a popular health support website, which utilized a peer-generated bulletin board format to facilitate the discussion of adolescent health and social issues. Analyses of two health bulletin boards—one on teen issues and one on sexual health—were conducted on the questions and replies found on 273 topics of mainly anonymous adolescents collected over a 2-month period. Results revealed that the questions most frequently posted and viewed reflected interests and concerns about their changing physical, emotional, and social selves: Romantic relationships were the most frequent topic on the teen issues bulletin board; sexual health was the most frequent topic on the sexuality bulletin board. The bulletin boards proved to be a valuable forum of personal opinions, actionable suggestions, concrete information, and emotional support and allowed teens to candidly discuss sensitive topics, such as sexuality and interpersonal relations.

Introduction

Adolescence is a time of many physical, cognitive, and social changes that can prompt numerous health, sexuality, and relationship-based questions among youth (e.g., Joffe et al., 1988, Klein & Wilson, 2002, Malus et al., 1987). The avenues for finding answers to these questions, however, may be limited because teens often lack knowledge about available medical resources (Dubow, Lovko, & Kausch, 1990) and are often reluctant to reveal personal problems to others (e.g., Ackard & Neumark-Sztainer, 2001, Cheng et al., 1993). Fortunately, the Internet has provided easy access to a low-cost means of both receiving and providing health information. Moreover, it provides a level of confidentiality that could particularly appeal to teens, especially for embarrassing or controversial inquiries. This study investigated the content of two “Teen Issues” bulletin boards found on a popular health support website. The objective was to learn more about the types of health, sexuality, and relationship questions that youths choose to ask their peers online, and the types of advice and support that they receive. A secondary objective was to assess teen interest in different health, sexual, and relationship topics as indicated by the number of times that each topic was clicked on and read.

Although most studies on health- and sex-related informational help-seeking behaviors have been conducted on adults (Boldero & Fallon, 1995), some data are available about teens. When asked what issues they found most distressing, most teens mentioned interpersonal relationships, weight, depression, suicidal thoughts, confusion about the future, and health problems (Boldero & Fallon, 1995, Dubow et al., 1990, Puskar et al., 1999, Borzekowski & Rickert, 2002). Older children and teens mentioned wanting to discuss topics, such as physical fitness, stress, nutrition, STDs, alcohol, good eating behaviors, and contraception with their physicians (Ackard & Neumark-Sztainer, 2001, Joffe et al., 1988, Klein & Wilson, 2002, Malus et al., 1987). However, teens often hesitate to request personal health information from their physicians (Ackard & Neumark-Sztainer, 2001, Cheng et al., 1993), and there is evidence that most adolescents do not receive all of the health advice from their health care practitioners that they desire (Boldero & Fallon, 1995, Klein & Wilson, 2002, Malus et al., 1987). Moreover, they report struggling with their lack of knowledge about sexual health and healthy sexual relationships (Andrew et al., 2003, Banister & Schreiber, 2001).

Confidentiality seems to be of particular concern when talking to others about health (Dunham et al., 1998, Ginsburg et al., 1997). One study found that 82% of youths felt that the protection of confidentiality was very important when seeking health information (Rideout, 2002). A survey of 1295 high school students revealed that 58% had health concerns that they wanted to keep from their parents, and 69% had health concerns that they did not want to disclose to friends (Cheng et al., 1993). Adolescents in general were particularly uncomfortable discussing private health issues, such as sexuality and contraception, and younger adolescents in grades 5 through 9 were more embarrassed, afraid, or uncomfortable discussing certain health issues (e.g., menstruation, pregnancy) than were their older peers in grades 10 through 12 (Ackard & Neumark-Sztainer, 2001).

In fact, teenagers often express a fear of discussing sex with a physician because of embarrassment and the potential disclosure of information to parents (Hassan & Creatsas, 2000). Adding to such discomfort, many physicians feel ill equipped to counsel adolescents, and parents often feel inadequate as resources, due to a lack of information, distress in broaching matters of a sexual nature, and confusion about their own sexual attitudes and feelings (Hassan & Creatsas, 2000). It seems that teens want to receive counseling from adults, adults want to be effective resources to teens, but such information exchanges rarely occur (Somers & Paulson, 2000).

Consequently, most adolescents prefer to consult friends and peers on sexual topics (Andrew et al., 2003, Di Iorio et al., 1999), although there are private health issues that many teens wish to keep from even from their friends (Cheng et al., 1993).

Given that teens' concerns about confidentiality seem to be a major barrier to seeking information and help directly from others, teenagers might be better served by the anonymity of the Internet, which would allow them to explore sensitive topics online that they may not want to reveal to parents, physicians, school officials, or acquaintances (McKenna & Bargh, 1998, McKenna & Bargh, 2000, Rideout, 2002). Health information on the Web can be found on Internet web pages, bulletin boards, newsgroups, listservs, and chatrooms (Hsiung, 2000, Sharp, 2000). One study revealed that 18% of online youth looked for sensitive information on the Web, and for teenage boys aged 15–17, the percentage increased to 25% (Lenhard, Rainie, & Lewis, 2001). While these percentages are not huge, they provide ample evidence that the Internet is already being utilized by a fair number of adolescents on issues about health and sexuality. One study in New York City found that across all socioeconomic and ethnic groups, adolescents considered having health information available over the Internet worthwhile (Borzekowski & Rickert, 2002). There is utility in learning more about this phenomenon, which is sure to increase.

Although online health support has potential drawbacks, such as limited access for noncomputer-using populations, potentially inaccurate information, and abusive language or content (a.k.a. “flaming”; Finn & Lavitt, 1994, McKenna & Bargh, 2000, Winzelberg, 1997), on the whole, many find it to be beneficial. For example, 48% of adults that used the Internet for health information said that it improved the way they took care of themselves, and 92% said that the health information found on their last online search was useful (Fox & Rainie, 2000). A survey of adult users of a mental health discussion board in Norway revealed that 75% felt that it was easier to discuss personal problems online than face to face, and the majority reported that they would not have participated without the option of using a pseudonym (Kummervold et al., 2002).

Searching for online health advice from peers has other benefits as well. On the Web, advice is available 24 hours a day (Fox & Rainie, 2000). Unlike face-to-face support groups, online support groups also provide access to information for a potentially large number of participants worldwide (Finn, 1999, White & Dorman, 2001). Gender differences are also minimized; one study of a bulletin board group on depression found a lack of gender differences in the frequency and content of postings, although women tend to have higher rates of depression (e.g., Immerman & Mackey, 2003) and use more medical and psychological help services than do men (Mechanic, 1976, Salem et al., 1997). Furthermore, those who are shy about revealing themselves, but still desire information, can view other people's messages without active participation (King & Moreggi, 1998, Winzelberg, 1997).

A few studies have been conducted on online health information support groups (e.g., Braithwaite et al., 1999, Finn, 1999, Finn & Lavitt, 1994, Greer, 2000), but these studies did not focus on teens. One of the few studies on analyzed questions on reproduction asked by teens in an online format (Flower-Coulson, Kushner, & Bankowski, 2000). In this study, however, responses to teen questions were provided by medical health professionals, rather than by other teens. There appear to be no studies of teen health boards that have analyzed content of both teen questions and responses.

Our study was a qualitative examination of peer health advice bulletin boards for teens; one bulletin board was intended for general teen issues, the other for sexual health. Unlike listservs and chatrooms, bulletin boards have the benefit of having topics organized into readily accessible “threads” (posts by multiple people on the same topic; Hsiung, 2000). We explored both the types of questions posted and the types of responses given on two teen health bulletin boards. We also investigated the types of questions eliciting the most responses as well as views or “hits.” This information is intended to show the types of health, sexual, and social issues that teens ask questions about online, how they respond to their peers' questions, and how much they access this information.

Section snippets

Bulletin board downloading

We explored the content found on a popular public website that houses over 120 health-related bulletin boards, including issues such as diabetes, autism, and HIV. Two boards on this site are specifically for teens and were used for this study: a general teen issues board and a teen sexual health board. While teens are not prevented from posting questions on any of the adult health boards, the teen boards are specifically created for young people's concerns. Although the questions posted on

Results

During the course of this study, 452 different screen names were used to post questions and/or responses on the boards. Of the 452 posters, 181 posted questions, and 393 posted responses, for a total of 273 questions and 1752 replies. Of those who posted questions, each poster contributed an average of 1.5 questions (SD = 1.1). Of those that posted responses, an average of 4.5 responses were provided (SD = 11.6). As shown by the large standard deviations, bulletin board users varied greatly in

Discussion

In general, adolescents tended to use the health bulletin boards most frequently to ask questions related to romantic relationships (teen issues board) and sexual health (teen sexual health board). In addition, the sexual health board was more popular than the teen issues board. This focus on sexuality mirrors the findings in teen chat (Subrahmanyam & Greenfield, 2004). Teenage interest in such topics is not surprising, given that adolescence is a period of physical and sexual maturation. Such

Acknowledgements

This research is funded by HopeLab, Palo Alto, CA, and a grant from NSF to establish the Children's Digital Media Center. The authors would like to extend thanks to Ivan Beale, Pam Kato, and John Pinto for helpful comments on earlier versions of this paper.

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