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Text Education: How North Carolina Teens Used a Sexual Health Text Information Line

Jessica Fitts Willoughby and Kennon Jackson Jr., “‘Can You Get Pregnant When U R in The Pool?’: Young People’s Information Seeking from A Sexual Health Text Line,” Sex Education: Sexuality, Society and Learning(May 2012).

Researchers analyzed over 1,300 text messages sent to a North Carolina sexual health text messaging service, to identify the types of questions sent by clients. The BrdsNBz text message service was launched by the Adolescent Pregnancy Prevention Campaign of North Carolina (APPCNC), to provide answers to teens’ questions about sexuality. Trained employees of APPCNC monitor incoming text messages, identify questions, and provide medically-accurate responses within 24 hours (typical response time is 4 hours or less). According to the authors, “Although there is some research regarding young people’s questions in new media environments, it is unclear what adolescents ask a text service when they can anonymously ask any sexual health questions and expect to receive a personal response from a trained health educator.”[1] The analysis covered questions sent during the time period between February 2009 and March 2011.

Key Findings:

  • Over 80% of senders’ questions were about sexual health topics such as STDs
  • Only about 4% of senders’ questions were about dating and relationships
  • Fully one-third of all senders’ questions were about sexual intercourse or other sexual behaviors (e.g. “Does sex hurt?” “How does sex work?” or “What is anal sex?”)
  • Pregnancy-related questions were most often (60% of the time) about whether pregnancy was possible under certain conditions
  • Most questions about sexual health were information-seeking, rather than permission-seeking or support-seeking

The findings illustrate the range and frequency of questions about sexuality received over a two-year period by a sexual health information texting ‘warmline’ in North Carolina. The authors acknowledge significant limitations to their study design while noting that the BrdsNBz service largely fulfills its mandate to provide medically-accurate sexual health information in a timely, personalized, confidential forum.

As more youth-serving agencies explore the medium of text messaging to communicate with adolescents about health, risk-reduction, and other issues related to sexuality, they will find the results of this study useful for planning their own texting services. For example, using the findings of this study, other agencies can more effectively plan professional training for employees or youth leaders who might be tasked with responding to sexual health questions sent by text: if this study is an accurate predictor of use patterns for such a service, then training should focus on responses to information-seeking questions rather than questions seeking advice, permission, or support. The article includes several sample questions which could be used as case studies for training text message responders.

The authors note several limitations affecting their ability to analyze the data that serve as the basis for the article:

“First, because the service is anonymous, no demographic information on users was available, so we do not know the extent to which adults rather than young people are sending questions, nor gender or race [nor is it] possible to determine the number of unique users who have accessed the service….In addition, it is not clear what young people are doing with the information they receive.”[2]

Until such texting services can identify client characteristics (and behavioral outcomes) in greater detail without compromising anonymity, much will remain unknown about the actual return-on-investment to youth-serving agencies when they commit resources to developing text warmlines along the model of BrdsNBz.

[1]Willoughby JF, Jackson K (2012). “‘Can you get pregnant when u r in the pool?’: Young people’s information seeking from a sexual health text line.” Sex Education: Sexuality, Society and Learning, 13(1): 96-106.