E-mail intervention decreases online health risk references among adolescents

Moreno MA, VanderStoep A, Parks MR, Zimmerman FJ, Kurth A, Christakis DA. Reducing at-risk adolescents’ display of risk behavior on a social networking web site: A randomized controlled pilot intervention trial. Arch Pediatr Adolesc Med 2009;163:35-41.

Question 

Among at-risk adolescents who display references to sex and substance abuse on internet social networking sites (SNSs), will an online intervention reduce these references?

Design 

Randomized controlled intervention trial.

Setting 

www.MySpace.com

Participants 

A total of 190 self-described 18- to 20-year-olds with public MySpace profiles who met predefined criteria for being at-risk.

Intervention 

Single e-mail from self-identified physician.

Outcomes 

Web profiles were evaluated for references to sex and substance use and for security settings before and 3 months after the intervention.

Main Results 

Of 190 subjects, 58.4% were male. At baseline, 54.2% of subjects referenced sex and 85.3% referenced substance use on their social networking site profiles. The proportion of profiles in which references decreased to 0 was 13.7% in the intervention group versus 5.3% in the control group for sex (P < .05, number needed to treat = 12) and 26.0% versus 22% for substance use (P < .61). The proportion of profiles set to “private” at follow-up was 10.5% in the intervention group and 7.4% in the control group (P < .45). The proportion of profiles in which any of these 3 protective changes were made was 42.1% in the intervention group and 29.5% in the control group (P < .07).

Conclusions 

A brief e-mail intervention shows promise in reducing sexual references in the online SNS profiles of at-risk adolescents.

Commentary 

Although media exposure has long been investigated as a health influence, interactive media present opportunities to measure and intervene on risk behaviors. Internet SNSs have become an increasingly important venue for identity exploration and self-presentation among youth. This study investigated effects of online warning from a physician on public displays of sex or substance use among high-risk 18- to 20-year-olds. Of 1340 profiles, 109 displayed ≥3 references to sex or substances, including ≥1 reference each to tobacco and alcohol use. Half were randomly selected to receive a single cautionary e-mail from a physician. After 3 months, compared with control subjects, adjusted odds of having removed all references to risk behaviors in the e-mail group were 4.2 times higher for sex and 1.9 times higher for either removing risk references or making the profile private. For youth, individualized concerned communication from an online health authority appears to encourage reduction in online displays of health risks.