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Motivations, Associations, and Consequences: A Content Analysis of Adolescents’ Displayed Alcohol References on Myspace
Abstracts / 44 (2009) S14–S47
S20
Table 1 Eating behavior and menstrual health in female college athletes survey results.
Swimming Gymnastics Rowing
Dance
Track/ Cross Country
Lacrosse
Rugby
Soccer
Recreational Sport Sedentary
n
103
24
51
24
31
37
34
35
342
90
p
Age at Survey BMI EDE-Q Global Score NEQ Score FAST Total Score % 6 or fewer menses last year
20.3 (1.4) 22.6 (2.4) 1.7 (1.3) 12.2 (4.6) 71.1 (13.9) 22.3
21.0 (1.3) 22.9 (1.8) 2.4 (1.4) 13.7 (5.0) 79.3 (17.8) 32
20.3 (1.4) 23.4 (2.3) 1.8 (1.3) 12.6 (5.4) 71.8 (14.2) 7.7
20.4 (1.1) 20.9 (1.8) 2.2 (1.5) 13.1 (5.1) 75.2 (15.0) 8.3
20.3 (1.9) 22.1 (3.7) 1.6 (1.4) 12.8 (3.8) 69.6 (17.4) 6.2
20.6 (1.0) 22.7 (2.4) 1.5 (1.3) 13.2 (4.4) 66.5 (15.8) 0
20.6 (1.3) 26.2 (5.0) 1.3 (1.1) 13.1 (7.1) 64.7 (12.5) 13.5
21.1 (1.3) 22.4 (1.9) 1.7 (1.5) 14.5 (5.1) 67.5 (14.0) 5.7
21.1 (1.7) 22.6 (3.2) 1.9 (1.3) 13.1 (5.1) 62.9 (12.9) 3.2
20.7 (1.6) 22.3 (4.5) 1.3 (1.1) 13.9 (4.9) 57.7 (13.1) 5.9
0.009 0.002 0.000 0.379 0.000 0.000
Methods: Students were recruited via a popular online social networking site. All data were collected online through a comprehensive survey which included the Eating Disorder ExamQuestionnaire (EDE-Q), the Night Eating Questionnaire (NEQ), and the Female Athlete Screening Tool (FAST). Results: A total of 978 females responded to the survey; this included 544 competitive athletes (56.4%), 344 recreational athletes (35.2%) and 90 sedentary controls (9.2%). Gymnasts had the highest EDEQ and FAST scores with rugby players and sedentary controls displaying some of the lower scores; no differences between groups were demonstrated on the NEQ. 15.3% of competitive athletes reported weigh-ins with their team, and 22.6% had been told by a coach to lose weight. Recreational athletes scored comparably to many competitive sports on validated measures (Table 1). Conclusion: Weight-related pressures, disordered eating, and amenorrhea are common in many competitive female sports as well as in recreational athletics. Advocacy for improved education of athletes and coaches, particularly in gymnastics and swimming, may help reduce risk.
SESSION I (WEDNESDAY): INTERNET AND ELECTRONIC APPROACHES TO RESEARCH 16. THE STRENGTHS AND LIMITATIONS OF THE INTERNET AS A HEALTH INFORMATION RESOURCE FOR ADOLESCENTS Billie Kell, BSc, and Hons, PGCE, RHV, RN, PGDip. Dept. Health and Human Sciences, Univ. of Hertfordshire School of Nursing and Midwifery, Hertfordshire, England Purpose: To identify the strengths and limitations of the internet as a health information resource for adolescents. Methods: A review of the literature using over 15 databases (e.g., BioMed, PubMed, PsychInfo) was undertaken to identify relevant articles. The search terms used were: teen, adolescent, youth, young people, young person, internet, www, web, online, electronic, health information, health advice, and health resource. Using these terms, the literature that explored adolescence and internet use in relation to health were identified. Each article title and abstract was read and the full article accessed if deemed relevant. The author then screened each article for inclusion by coloring extracted relevant data under the following categories: credibility of the information, skills required to access information, the prevalence of topics for which health information is sought, and the methods of utilization of the internet, numbers accessing health information and where this ranked, and the strengths and weaknesses of this medium. This review focuses upon the latter.
Results: Thirty papers were retrieved that included aspects of the strengths and limitations of using the internet to access health information. The data extracted were read and placed into nine emergent themes. Five themes reflected the strengths of the internet as a health information resource for adolescents: increased access to health information; increased user involvement; interactivity; tailoring of information; and anonymity/confidentiality. Four themes reflected the limitations of the internet: concerns regarding access to the internet; literacy – computer, language, and health, information overload, and quality/trust. These findings were then considered in relation to the implications for health professionals, integrating any recommendations made to address limitations. Conclusions: Health professionals play a significant role in providing health information to adolescents. However, in order to be effective health communicators, providers need to ensure that they and their adolescent patients are familiar with the strengths and limitations of the internet as a medium for delivering health information. For adolescents, the internet is an integral part of their world, making e-Healthcare not only a reasonable extension of technology but an expectation. There is an ongoing need for much more focused research that explores with adolescents the strengths and limitations of the internet for accessing health information. In addition, it will be important to explore and evaluate how healthcare professionals can best make use of the internet in order to optimize adolescent health care. Sources of Support: None.
17. MOTIVATIONS, ASSOCIATIONS, AND CONSEQUENCES: A CONTENT ANALYSIS OF ADOLESCENTS’ DISPLAYED ALCOHOL REFERENCES ON MYSPACE Megan A. Moreno, MD, MSEd, MPH1, Leslie R. Briner, BA2, Amanda Williams, MSW, CDP2, Leslie Walker, MD2, and Dimitri A. Christakis, MD, MPH3. 1University of Wisconsin, Madison, WI; 2 University of Washington, Seattle, WA; 3Seattle Children’s Research Institute, Seattle, WA Purpose: The social learning model argues that individuals learn by direct experience as well as modeled behavior. Individuals are more likely to engage in modeled behaviors if they are linked to desirable motivations, associations, and consequences. A new venue in which adolescents may experience modeled behavior is via social networking websites (SNS) where many adolescents display alcohol use references. The purpose of this study is to conduct a theoretically-based content analysis to assess teens’ displayed
Abstracts / 44 (2009) S14–S47
motivations, associations, and consequences regarding alcohol use on MySpace profiles. Methods: We randomly selected 400 publicly accessible MySpace web profiles from self-reported 17 to 20-year-olds. We evaluated each profile once between January and June 2008 for displayed alcohol references. Content analysis was conducted on the 225 profiles that displayed textual or pictorial alcohol references. Content was evaluated by two independent coders for (1) references to explicit alcohol use or intoxication, (2) motivations, associations and consequences of alcohol use, and (3) references that met the CRAFFT problem drinking clinical criteria. Interrater reliability on collected data was 0.78; coder agreement for content analysis was 0.88. Results: Of 400 profiles, 225 profiles (56%) contained a total of 341 references to alcohol. Profile owners who displayed alcohol references were predominantly male (54.2%) and White (70.7%). The most frequent category of textual reference was explicit use (30.5%) and intoxication (27.2%). The majority of pictorial references were photographs depicting alcohol use (93.6%). The most commonly displayed motivation for alcohol use was peer pressure (7.5%), the most commonly displayed association with alcohol use was drinking games (6.6%), and the most commonly displayed consequence was negative physical consequences such as hangovers (3.3%). Approximately 5% of references met CRAFFT problem drinking criteria. Conclusion: Explicit alcohol use is frequently referenced on adolescents’ MySpace profiles via text and photographs. Though the validity of references is unknown, the high proportion of photograph references suggest that these references may be real, or perceived as real. Motivations, associations, and consequences for alcohol use displayed on MySpace profiles appear consistent with previous studies of adolescent alcohol use. A small percentage of references met clinical criteria for problem drinking. Further research is needed to determine the validity and potency of these displayed SNS alcohol references. Sources of Support: Funded by a grant from the Social Venture Partners Foundation.
18. REAL USE OR ‘‘REAL COOL’’: ADOLESCENTS SPEAK OUT ABOUT DISPLAYED ALCOHOL REFERENCES ON MYSPACE Megan A. Moreno, MD, MSEd, MPH1, Leslie R. Briner, BA2, Amanda Williams, MSW, CDP2, Leslie Walker, MD2, and Dimitri A. Christakis, MD, MPH3. 1University of Wisconsin, Madison, WI; 2 University of Washington, Seattle, WA; 3Seattle Children’s Hospital Research Institute, Seattle, WA Purpose: Exposure to substance use in media is linked to substance use in adolescents. Social networking websites (SNS) are an important media venue in which teens are frequently exposed to alcohol references on other teens’ web profiles. These references may influence teens, particularly when displayed by other adolescents. This study conducted focus groups to determine teens’ views on adolescents’ display of alcohol use on SNS. Methods: A convenience sample of adolescents between 11 and 18 years of age were recruited from youth recreation centers and clinics between June and August 2008. Three trained facilitators asked subjects for their views and interpretations of displayed alcohol references on SNS. All tape-recorded data was fully transcribed, transcripts were coded by three reviewers then discussed to determine consensus on themes. Results: A total of 32 adolescents participated in eight focus groups. Adolescents reported that they most commonly interpreted
S21
displayed alcohol references on SNS as representing real use, particularly when references were photographic displays of alcohol use, or if youth viewing the references were younger teens. Adolescents also recognized that references to alcohol use on SNS may be fabricated and represent efforts by other teens to ‘‘look cool.’’ Perceived benefits to displaying alcohol references on SNS included ‘‘looking cool’’, ‘‘getting noticed’’, providing ‘‘proof you are cool’’, and the ability to ‘‘broadcast’’ your social activities to a wide audience; these were considered to be benefits regardless of whether the displays represented real use. Perceived risks to displaying alcohol references on SNS included worries about getting into trouble (legal, school, employer, or parental), being ‘‘hazed,’’ or being ‘‘blackmailed’’ using the displayed information. Conclusion: Though adolescents recognize the risks involved in displaying underage alcohol use on publicly accessible web profiles, many persist in doing so. Regardless of whether displayed references to alcohol use by adolescents on SNS represent actual use, adolescents often interpret these references as representing actual use and perceive social value in their display. Given the popularity of SNS and the high prevalence of alcohol references displayed on SNS, these references have the potential to influence adolescents’ views of alcohol use as a normative behavior. Sources of Support: Funded by a grant from the University of Washington Alcohol and Drug Abuse Institute.
19. ‘‘OOPS, I DID IT AGAIN’’: A CONTENT ANALYSIS OF ADOLESCENTS’ DISPLAYED SEXUAL REFERENCES ON MYSPACE Megan A. Moreno, MD, MSEd, MPH1, Libby Brockman, BS2, and Dimitri A. Christakis, MD, MPH3. 1University of Wisconsin-Madison, Madison, WI; 2University of Washington, Seattle, WA; 3Seattle Children’s Hospital Research Institute, Seattle, WA Purpose: Media depictions of sex influence adolescent sexual behavior. Social networking websites (SNS) are an increasingly important media venue for teens. Many adolescents display sexual references on their personal MySpace web profiles. Sexual references on SNS may influence adolescent sexual behavior, particularly when sexual references are displayed by other teens. These online references may provide insight into adolescents’ self-reported sexual attitudes and experiences, as well as show gender differences in how sex is displayed on web profiles. The purpose of this study is to conduct a content analysis of displayed sexual references on adolescents’ MySpace web profiles. Methods: A random sample of 500 self-reported 18-year-old adolescents’ publicly accessible MySpace web profiles were evaluated once for sexual references between October and December 2007. A content analysis was conducted between on the 122 profiles that displayed textual or pictorial sexual references. Content was evaluated for references to risky sex, safe sex, and further descriptive content categories by two independent coders. Content analysis categories were compared by gender using X2 test. Interrater reliability on collected data was 0.74; coder agreement for the content analysis was 0.8. Results: Of 500 evaluated profiles, 122 profiles (24.4%) contained a total of 225 sexual references. Profile owners who displayed sexual references were predominantly male (59%) and White (62%). We found 18 references to risky sex (8%) and 2 references to safe sex (< 1%). The most common descriptive categories included references to sexual behaviors (38.7%), revealing photographs (26%), and intimate personal descriptions (21%). There were no gender differences in category distribution, with the exception that females
S20
Table 1 Eating behavior and menstrual health in female college athletes survey results.
Swimming Gymnastics Rowing
Dance
Track/ Cross Country
Lacrosse
Rugby
Soccer
Recreational Sport Sedentary
n
103
24
51
24
31
37
34
35
342
90
p
Age at Survey BMI EDE-Q Global Score NEQ Score FAST Total Score % 6 or fewer menses last year
20.3 (1.4) 22.6 (2.4) 1.7 (1.3) 12.2 (4.6) 71.1 (13.9) 22.3
21.0 (1.3) 22.9 (1.8) 2.4 (1.4) 13.7 (5.0) 79.3 (17.8) 32
20.3 (1.4) 23.4 (2.3) 1.8 (1.3) 12.6 (5.4) 71.8 (14.2) 7.7
20.4 (1.1) 20.9 (1.8) 2.2 (1.5) 13.1 (5.1) 75.2 (15.0) 8.3
20.3 (1.9) 22.1 (3.7) 1.6 (1.4) 12.8 (3.8) 69.6 (17.4) 6.2
20.6 (1.0) 22.7 (2.4) 1.5 (1.3) 13.2 (4.4) 66.5 (15.8) 0
20.6 (1.3) 26.2 (5.0) 1.3 (1.1) 13.1 (7.1) 64.7 (12.5) 13.5
21.1 (1.3) 22.4 (1.9) 1.7 (1.5) 14.5 (5.1) 67.5 (14.0) 5.7
21.1 (1.7) 22.6 (3.2) 1.9 (1.3) 13.1 (5.1) 62.9 (12.9) 3.2
20.7 (1.6) 22.3 (4.5) 1.3 (1.1) 13.9 (4.9) 57.7 (13.1) 5.9
0.009 0.002 0.000 0.379 0.000 0.000
Methods: Students were recruited via a popular online social networking site. All data were collected online through a comprehensive survey which included the Eating Disorder ExamQuestionnaire (EDE-Q), the Night Eating Questionnaire (NEQ), and the Female Athlete Screening Tool (FAST). Results: A total of 978 females responded to the survey; this included 544 competitive athletes (56.4%), 344 recreational athletes (35.2%) and 90 sedentary controls (9.2%). Gymnasts had the highest EDEQ and FAST scores with rugby players and sedentary controls displaying some of the lower scores; no differences between groups were demonstrated on the NEQ. 15.3% of competitive athletes reported weigh-ins with their team, and 22.6% had been told by a coach to lose weight. Recreational athletes scored comparably to many competitive sports on validated measures (Table 1). Conclusion: Weight-related pressures, disordered eating, and amenorrhea are common in many competitive female sports as well as in recreational athletics. Advocacy for improved education of athletes and coaches, particularly in gymnastics and swimming, may help reduce risk.
SESSION I (WEDNESDAY): INTERNET AND ELECTRONIC APPROACHES TO RESEARCH 16. THE STRENGTHS AND LIMITATIONS OF THE INTERNET AS A HEALTH INFORMATION RESOURCE FOR ADOLESCENTS Billie Kell, BSc, and Hons, PGCE, RHV, RN, PGDip. Dept. Health and Human Sciences, Univ. of Hertfordshire School of Nursing and Midwifery, Hertfordshire, England Purpose: To identify the strengths and limitations of the internet as a health information resource for adolescents. Methods: A review of the literature using over 15 databases (e.g., BioMed, PubMed, PsychInfo) was undertaken to identify relevant articles. The search terms used were: teen, adolescent, youth, young people, young person, internet, www, web, online, electronic, health information, health advice, and health resource. Using these terms, the literature that explored adolescence and internet use in relation to health were identified. Each article title and abstract was read and the full article accessed if deemed relevant. The author then screened each article for inclusion by coloring extracted relevant data under the following categories: credibility of the information, skills required to access information, the prevalence of topics for which health information is sought, and the methods of utilization of the internet, numbers accessing health information and where this ranked, and the strengths and weaknesses of this medium. This review focuses upon the latter.
Results: Thirty papers were retrieved that included aspects of the strengths and limitations of using the internet to access health information. The data extracted were read and placed into nine emergent themes. Five themes reflected the strengths of the internet as a health information resource for adolescents: increased access to health information; increased user involvement; interactivity; tailoring of information; and anonymity/confidentiality. Four themes reflected the limitations of the internet: concerns regarding access to the internet; literacy – computer, language, and health, information overload, and quality/trust. These findings were then considered in relation to the implications for health professionals, integrating any recommendations made to address limitations. Conclusions: Health professionals play a significant role in providing health information to adolescents. However, in order to be effective health communicators, providers need to ensure that they and their adolescent patients are familiar with the strengths and limitations of the internet as a medium for delivering health information. For adolescents, the internet is an integral part of their world, making e-Healthcare not only a reasonable extension of technology but an expectation. There is an ongoing need for much more focused research that explores with adolescents the strengths and limitations of the internet for accessing health information. In addition, it will be important to explore and evaluate how healthcare professionals can best make use of the internet in order to optimize adolescent health care. Sources of Support: None.
17. MOTIVATIONS, ASSOCIATIONS, AND CONSEQUENCES: A CONTENT ANALYSIS OF ADOLESCENTS’ DISPLAYED ALCOHOL REFERENCES ON MYSPACE Megan A. Moreno, MD, MSEd, MPH1, Leslie R. Briner, BA2, Amanda Williams, MSW, CDP2, Leslie Walker, MD2, and Dimitri A. Christakis, MD, MPH3. 1University of Wisconsin, Madison, WI; 2 University of Washington, Seattle, WA; 3Seattle Children’s Research Institute, Seattle, WA Purpose: The social learning model argues that individuals learn by direct experience as well as modeled behavior. Individuals are more likely to engage in modeled behaviors if they are linked to desirable motivations, associations, and consequences. A new venue in which adolescents may experience modeled behavior is via social networking websites (SNS) where many adolescents display alcohol use references. The purpose of this study is to conduct a theoretically-based content analysis to assess teens’ displayed
Abstracts / 44 (2009) S14–S47
motivations, associations, and consequences regarding alcohol use on MySpace profiles. Methods: We randomly selected 400 publicly accessible MySpace web profiles from self-reported 17 to 20-year-olds. We evaluated each profile once between January and June 2008 for displayed alcohol references. Content analysis was conducted on the 225 profiles that displayed textual or pictorial alcohol references. Content was evaluated by two independent coders for (1) references to explicit alcohol use or intoxication, (2) motivations, associations and consequences of alcohol use, and (3) references that met the CRAFFT problem drinking clinical criteria. Interrater reliability on collected data was 0.78; coder agreement for content analysis was 0.88. Results: Of 400 profiles, 225 profiles (56%) contained a total of 341 references to alcohol. Profile owners who displayed alcohol references were predominantly male (54.2%) and White (70.7%). The most frequent category of textual reference was explicit use (30.5%) and intoxication (27.2%). The majority of pictorial references were photographs depicting alcohol use (93.6%). The most commonly displayed motivation for alcohol use was peer pressure (7.5%), the most commonly displayed association with alcohol use was drinking games (6.6%), and the most commonly displayed consequence was negative physical consequences such as hangovers (3.3%). Approximately 5% of references met CRAFFT problem drinking criteria. Conclusion: Explicit alcohol use is frequently referenced on adolescents’ MySpace profiles via text and photographs. Though the validity of references is unknown, the high proportion of photograph references suggest that these references may be real, or perceived as real. Motivations, associations, and consequences for alcohol use displayed on MySpace profiles appear consistent with previous studies of adolescent alcohol use. A small percentage of references met clinical criteria for problem drinking. Further research is needed to determine the validity and potency of these displayed SNS alcohol references. Sources of Support: Funded by a grant from the Social Venture Partners Foundation.
18. REAL USE OR ‘‘REAL COOL’’: ADOLESCENTS SPEAK OUT ABOUT DISPLAYED ALCOHOL REFERENCES ON MYSPACE Megan A. Moreno, MD, MSEd, MPH1, Leslie R. Briner, BA2, Amanda Williams, MSW, CDP2, Leslie Walker, MD2, and Dimitri A. Christakis, MD, MPH3. 1University of Wisconsin, Madison, WI; 2 University of Washington, Seattle, WA; 3Seattle Children’s Hospital Research Institute, Seattle, WA Purpose: Exposure to substance use in media is linked to substance use in adolescents. Social networking websites (SNS) are an important media venue in which teens are frequently exposed to alcohol references on other teens’ web profiles. These references may influence teens, particularly when displayed by other adolescents. This study conducted focus groups to determine teens’ views on adolescents’ display of alcohol use on SNS. Methods: A convenience sample of adolescents between 11 and 18 years of age were recruited from youth recreation centers and clinics between June and August 2008. Three trained facilitators asked subjects for their views and interpretations of displayed alcohol references on SNS. All tape-recorded data was fully transcribed, transcripts were coded by three reviewers then discussed to determine consensus on themes. Results: A total of 32 adolescents participated in eight focus groups. Adolescents reported that they most commonly interpreted
S21
displayed alcohol references on SNS as representing real use, particularly when references were photographic displays of alcohol use, or if youth viewing the references were younger teens. Adolescents also recognized that references to alcohol use on SNS may be fabricated and represent efforts by other teens to ‘‘look cool.’’ Perceived benefits to displaying alcohol references on SNS included ‘‘looking cool’’, ‘‘getting noticed’’, providing ‘‘proof you are cool’’, and the ability to ‘‘broadcast’’ your social activities to a wide audience; these were considered to be benefits regardless of whether the displays represented real use. Perceived risks to displaying alcohol references on SNS included worries about getting into trouble (legal, school, employer, or parental), being ‘‘hazed,’’ or being ‘‘blackmailed’’ using the displayed information. Conclusion: Though adolescents recognize the risks involved in displaying underage alcohol use on publicly accessible web profiles, many persist in doing so. Regardless of whether displayed references to alcohol use by adolescents on SNS represent actual use, adolescents often interpret these references as representing actual use and perceive social value in their display. Given the popularity of SNS and the high prevalence of alcohol references displayed on SNS, these references have the potential to influence adolescents’ views of alcohol use as a normative behavior. Sources of Support: Funded by a grant from the University of Washington Alcohol and Drug Abuse Institute.
19. ‘‘OOPS, I DID IT AGAIN’’: A CONTENT ANALYSIS OF ADOLESCENTS’ DISPLAYED SEXUAL REFERENCES ON MYSPACE Megan A. Moreno, MD, MSEd, MPH1, Libby Brockman, BS2, and Dimitri A. Christakis, MD, MPH3. 1University of Wisconsin-Madison, Madison, WI; 2University of Washington, Seattle, WA; 3Seattle Children’s Hospital Research Institute, Seattle, WA Purpose: Media depictions of sex influence adolescent sexual behavior. Social networking websites (SNS) are an increasingly important media venue for teens. Many adolescents display sexual references on their personal MySpace web profiles. Sexual references on SNS may influence adolescent sexual behavior, particularly when sexual references are displayed by other teens. These online references may provide insight into adolescents’ self-reported sexual attitudes and experiences, as well as show gender differences in how sex is displayed on web profiles. The purpose of this study is to conduct a content analysis of displayed sexual references on adolescents’ MySpace web profiles. Methods: A random sample of 500 self-reported 18-year-old adolescents’ publicly accessible MySpace web profiles were evaluated once for sexual references between October and December 2007. A content analysis was conducted between on the 122 profiles that displayed textual or pictorial sexual references. Content was evaluated for references to risky sex, safe sex, and further descriptive content categories by two independent coders. Content analysis categories were compared by gender using X2 test. Interrater reliability on collected data was 0.74; coder agreement for the content analysis was 0.8. Results: Of 500 evaluated profiles, 122 profiles (24.4%) contained a total of 225 sexual references. Profile owners who displayed sexual references were predominantly male (59%) and White (62%). We found 18 references to risky sex (8%) and 2 references to safe sex (< 1%). The most common descriptive categories included references to sexual behaviors (38.7%), revealing photographs (26%), and intimate personal descriptions (21%). There were no gender differences in category distribution, with the exception that females