Using Media and Technology to Improve Sexual Health Outcomes for Youth

1. Using Media and Technology to Improve Sexual Health Outcomes for Youth Alwyn Cohall, M.D. Professor of Clinical Public Health and Pediatrics, Mailman School of Public Health, Morgan Stanley Children’s Hospital of New York Presbyterian Hospital, Director, Harlem Health Promotion Center and Project STAY

2. Sexual Health Information • “Young people are sexually active…but sexually illiterate” • Faye Wattleton, former head of PPFA • In NYC, 25% of youth screened by our Mobile Health Team in schools, juvenile justice programs and youth agencies were involved in 1 or more unintended pregnancies, yet less than half had ever heard of Emergency Contraception

3. Typical scenario • Rakheem is 18, and presents to a primary care clinic for a college physical • Waits , 45 minutes to an hour before being seen • Health provider reviews college form, asks a few questions about allergies, past hx of medical problems etc. • Conducts brief physical, places a PPD test, orders a blood count, cholesterol level and urinalysis, and gives him a follow-up appointment to return in 48 hours to get his PPD test read, obtain his lab results and to complete his college form • Rakheem misplaces his slip, and misses his appointment. When he calls to re-schedule, he is told that the next available slot is in 2 weeks. • He eventually returns, waits another 45 minutes to be seen, collects his paper work and sends the form off to school

4. What’s wrong with this picture? • Got basic services rendered… • But multiple opportunities missed for health education, targeted screening and intervention

5. Current state of affairs • Clinicians often inadequately trained to care for adolescents • Have limited time • Youth reluctant to bring up sensitive issues without being asked • Believe that providers have “X-ray vision” and blood tests check for “everything” • Opportunities are missed

6. Can media and technology make a difference?

7. Potential roles for media and technology Taking advantage of “dead” time to begin educational process: • Rakheem comes into a primary care clinic, and while waiting to see a provider, participates in a workshop discussion delivered by public health students • Using Power-Point slides in the waiting room, the students review various sexual health topics, such as anatomy STIs, HIV, contraception and male responsibility

8. Potential roles for media and technology Improving assessment of assets and risks: • ACASI (audio-assisted computer self interview) • Youth prefer being queried by a computer and may be more likely to reveal sensitive information • Screen: • 5 LTSP (all females), 3 in last 6 months, 1 current partner • Hx unprotected sex with new female partner (female) 48 hrs ago

9. Potential roles for media and technology • Provider reviews risk-assessment • Verifies information • Conducts physical exam • Places PPD, orders standard tests, but in addition, orders a urine screen for Chlamydia and Gonorrhea and blood tests for syphilis and HIV

10. Potential roles for media and technology Providing health information: • While waiting for results of rapid HIV test, Rakheem is invited to view a video on the computer which shows young people in relationships dealing with the consequences of unprotected intercourse • In addition to demonstrating the need for linkages to care, it encourages youth to use Emergency Contraception to prevent unintended pregnancies

11. Potential roles for media and technology • 30 minutes later, provider returns, HIV test is negative • Encourages him to contact his girlfriend (also 18) and discuss the need for EC. Given website (www.ec123.org) for more information. • Appointment made for follow-up in 48 hours to check PPD and complete college forms

12. Potential Roles for Media and Technology @the clinic 4 a chkup. 'Member when we messed up on Sat? We don't hv 2 w8t 2 see if u get ur period. chk out www.ec123.org 2 get info abt Plan B. Hit me back!

13. Potential roles for media and technology • Girlfriend logs onto www.ec123.org and learns more about emergency contraception • She goes to her local pharmacy and obtains product and takes them immediately

14. Potential roles for media and technology Appointment reminder system: • 48 hours later, Rakheem gets a text message from the clinic reminding him of his appointment

15. Potential roles for media and technology • When he returns, in addition to getting his form completed, he learns that his urine test for Chlamydia was Positive • Provider gives him basic information about Chlamydia, along with a sample of antibiotics for himself and his current partner

16. Potential roles for media and technology • Additionally, she advises him to contact his previous partners • Rakheem wants to do the right thing, but is somewhat embarrassed and concerned about their reactions • He is advised to consider using an anonymous service called InSpot which will alert them to the need for testing and will also provide listings of clinics in their communities

17. Potential roles for media and technology Provision of continued information after the clinic visit has ended: • He is also encouraged to visit the web to get more information about Chlamydia • Rakheem views the websites but still has questions about Chlamydia

18. Potential roles for media and technology • Using a secure email system (www. RelayHealth.com), he emails his concerns to his provider…

19. Potential roles for media and technology • …and receives a detailed response later that day which reassures him • “Thanks for your note, many young men (and young women) with Chlamydia have no symptoms. The treatment is very effective and your chances of being a father (in the future!) should be good. Just remember to use a condom every time to prevent additional infections”

20. Potential roles for media and technology • His current girlfriend makes an appointment to the clinic after taking EC and Zithromax • Her examination is normal and she elects to start OCP

21. Potential roles for media and technology Medication reminder system: • She receives an automated text message from the clinic every evening at 8pm to remind her to take the pills REMEMBER!

22. Potential roles for media and technology • As a result of their experiences, Rakheem and his girlfriend text friends to check out the website links, as well as to make appointments at the clinic for services

23. Standard Physical done College form completed Enhanced Physical done College form completed Risk-assessment conducted Additional screening tests ordered A potentially serious STI is identified and treatment provided (for index patient and partner/s) Potential pregnancy averted Multiple opportunities for health education utilized Additional youth engaged in care Comparative Approaches

24. Potential roles for media and technology Pipe-dream? • All the elements in this altered scenario are available • But, need to connect the dots… • Several of our clinics at Columbia and NYP use Powerpoint presentations and health education videos in the waiting room • ACASI – used in research settings, can be used clinically as well • Media can be used to initiate and reinforce health information • Secure email • Text-message applications for health promotion

25. Conclusion • Multiple applications for media and technology • Has potential for improving access to health information, facilitating access to care, strengthening client-provider interactions, and enhancing adherence to medication • It’s time that we examine every possible resource to provide youth with support

26. Contact Information • Alwyn T. Cohall, MD • atc1@columbia.edu • www.ec123.org