Abstract
Adolescents from rural, resource poor regions of the United States have disproportionately higher rates of drug and alcohol misuse, which may lead to increased sexual risk behaviors. Adolescents living in both urban and rural areas are major users of smartphones as a source for health information. Yet, the quality and accuracy of some Internet sites tend to be unreliable. The purpose of this study was to explore the perceptions and attitudes of adolescents from a rural region in the southeastern United States regarding health and social concerns to inform the development of a risk reduction application for smartphone use. This study used a qualitative descriptive design guided by the Theory of Triadic Influence. The research team was composed of community partners, faculty, and students from a mid-Atlantic university. Forty-nine adolescents (18 boys and 31 girls) participated in one of five mixed-gender focus groups; they were predominantly Black and Latino, with a mean age of 13.8. Content and thematic analysis led to three interrelated themes: Family as Nexus, Unlevel Playing Field, and Threats to Safety and Security. Structural (racism and bullying) and proximal (neighborhood, family and peers) determinants of health were congruent with other recent reports. Snapchat and Instagram were the most popular social media platforms used. Using a contextual approach, we analyzed the daily experiences of ethnic minority adolescents to inform the development of a risk reduction mobile health application. Community-academic partnerships with engaged youth can assist in smartphone application development and beta testing.
Highlights
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The Theory of Triadic Influence illustrated contexts of adolescent decision-making.
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Adolescents made decisions in the contexts of racism, poverty, and violence.
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Contextual elements provided a holistic approach to mobile health applications.
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References
Andrade, E. L., Evans, W. D., Barrett, N. C., Cleary, S. D., Edberg, M. C., Alvayero, R. D., Kierstead, E. C., & Beltran, A. (2018). Development of the place-based Adelante social marketing campaign for prevention of substance use, sexual risk and violence among Latino immigrant youth. Health Education Research, 33(2), 125–144. https://doi.org/10.1093/her/cyx076.
Ardichvili, A., Maurer, M., Li, W., Wentling, T., & Stuedemann, R. (2006). Cultural influences on knowledge sharing through online communities of practice. Journal of Knowledge Management, 10(1), 94–107. https://doi.org/10.1108/13673270610650139.
Banks, D. E., Winningham, R. D., Wu, W., & Zapolski, R. C. B. (2019). Examination of the indirect effect of alcohol expectancies on ethnic identity and adolescent drinking outcomes. American Journal of Orthopsychiatry, 89(5), 600–608. https://doi.org/10.1037/ort0000390.
Bernard, H. R., Wutich, A., & Ryan, G. W. (2017). Analyzing qualitative data. (2nd Ed.). Thousand Oaks, CA: SAGE Publications, Inc.
BroadbandNow. (2019). Internet access in North Carolina, 2014–2019. https://broadbandnow.com/North-Carolina.
Bucholtz, M. In L. Monaghan, J. E. Goodman, J. M. Robinson, (eds) (2012). Word up: Social meanings of slang in California youth culture. A cultural approach to interpersonal communication: Essential readings. (pp. 274–297). Oxford, UK: John Wiley & Sons, Inc.
Buhi, E. R., Daley, E. M., Oberne, A., Smith, S. A., Schneider, T., & Fuhrmann, H. J. (2010). Quality and accuracy of sexual health information web sites visited by young people. Journal of Adolescent Health, 47, 206–208. https://doi.org/10.1016/j.jadohealth.2010.01.002.
Centers for Disease Control and Prevention (2019). Sexually Transmitted Disease Surveillance 2018. https://doi.org/10.15620/cdc.79370.
Coley, R. L., Sims, J., Dearing, E., & Spielvogel, B. (2018). Locating economic risks for adolescent mental and behavioral health: Poverty and affluence in families, neighborhoods, and schools. Child Development, 89(2), 360–369. https://doi.org/10.1111/cdev.12771.
Crosby, R. A., Kegler, M. C. & DiClemente, R. J. (2002). Understanding and applying theory in health promotion practice and research. In R. J. DiClemente, R. A. Crosby, & M. C. Kegler (Eds), Emerging theories in health promotion practice and research: Strategies for improving public health (pp. 1–15). Jossey-Bass. https://iums.ac.ir/files/hshe-soh/files/EMERGING_THEORIES(1).pdf.
DeSmet, A., Shegog, R., Van Ryckeghem, D., Crombez, G., & De Bourdeaudhuij, I. (2015). A systematic review and meta-analysis of interventions for sexual health promotion involving serious digital games. Games for Health Journal: Research, Development, and Clinical Application, 4(2), 78–90. https://doi.org/10.1089/g4h.2014.0110.
Dunbar, A. S., Leerkes, E. M., Coard, S. I., Supple, A. J., & Calkins, S. (2017). An integrative conceptual model of parental racial/ethnic and emotion socialization and links to children’s social-emotional development among African American families. Child Development Perspectives, 11(1), 16–22. https://doi.org/10.1111/cdep.12218.
Dusseldorp, E., Velderman, M. K., Paulussen, T. W. G. M., Junger, M., van Nieuwenhuijzen, M., & Reijneveld, S. A. (2014). Targets for primary prevention: cultural, social and intrapersonal factors associated with co-occurring health-related behaviours. Psychology & Health, 29(5), 598–611. https://doi.org/10.1080/08870446.2013.879137.
Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling and purposive sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1–4. https://doi.org/10.11648/j.ajtas.20160501.11.
Fiellin, L. E., Hieftje, K. D., Pendergrass, T. M., Kyriakides, T. C., Duncan, L. R., Dziura, J. D., Sawyer, B. G., Mayes, L., Crusto, C. A., Forsyth, B., & Fiellin, D. A. (2017). Video game intervention for sexual risk reduction in minority adolescents: randomized controlled trial. Journal of Medical Internet Research, 19(9), e314 https://doi.org/10.2196/jmir.8148.
Flay, B. R., & Petraitis, J. (1994). The theory of triadic influence: a new theory of health behaviors with implications for preventative interventions. Advances in Medical Sociology, 4, 19–44.
Flay, B. R., Snyder, F., & Petraitis, J. (2009). The theory of triadic influence. In R. J. DiClemente, R.A. Crosby, & M.C. Kegler (eds), Emerging theories in health promotion practice and research (pp. 451–510). New York, NY: Jossey-Bass.
Fox, A. M., Himmelstein, G., Khalid, H., & Howell, E. A. (2019). Funding for abstinence-only education and adolescent pregnancy prevention: does state ideology affect outcomes? American Journal of Public Health, 109(3), 497–504. https://doi.org/10.2105/AJPH.2018.304896.
Freeman, J. L., Caldwell, P. H. Y., Bennett, P. A., & Scott, K. M. (2018). How adolescents search for and appraise online health information: A systematic review. The Journal of Pediatrics, 195, 244–255. https://doi.org/10.1016/j.jpeds.2017.11.031.
Future of Sex Education Initiative (2020). National sexuality education standards: Core content and skills, K-12. https://advocatesforyouth.org/wp-content/uploads/2020/03/NSES-2020-web.pdf.
Gilliam, M., Jagoda, P., Jones, I. B., Rowley, J., & Hill, B. (2018). Embedded game design as a method for addressing social determinants of health. American Journal of Sexuality Education, 13(3), 378–398. https://doi.org/10.1080/15546128.2018.1445572.
Green, E. R., Hamarman, A. M., & McKee, R. W. (2015). Online sexuality education pedagogy: Translating five in-person teaching methods to online learning environments. Sex Education, 15(1), 19–30. https://doi.org/10.1080/14681811.2014.942033.
Guttmacher Institute. (2017). American adolescents’ sources of sexual health information. https://www.guttmacher.org/fact-sheet/facts-american-teens-sources-information-about-sex.
Han, J. H., Kim, S. A., Kim, S., & Park, J. Y. (2019). Factors influencing disordered eating behavior based on the theory of triadic influence. Perspectives in Psychiatric Care, 55(3), 366–371. https://doi.org/10.1111/ppc.12308.
Hsu, C. L., & Lin, J. C. C. (2008). Acceptance of blog usage: The roles of technology acceptance, social influence, and knowledge sharing motivation. Information & Management, 45(1), 65–74. https://doi.org/10.1016/j.im.2007.11.001.
Israel, B. A., Eng, E., Schulz, A. J., & Parker, E. A. (2013). Methods for community-based participatory research for health. (2nd Ed.). San Francisco, CA: John Wiley & Sons, Inc.
Jiang, G., Sun, F., & Marsiglia, F. F. (2016). Rural-urban disparities in adolescent risky behaviors: a family social capital perspective. Journal of Community Psychology, 44(8), 1027–1039. https://doi.org/10.1002/jcop.21825.
Kalke, K. M., Ginossar, R., Ali Shah, S. F., & West, A. J. (2018). Sex ed to go: a content analysis of comprehensive sexual education apps. Health Education & Behavior, 45(4), 581–590. https://doi.org/10.1177/1090198117749259.
Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen, B., Lowry, R., Chyen, D., Whittle, L., Thornton, J., Lim, C., Bradford, D., Yamakawa, Y., Leon, M., Brener, N., & Ethier, K. A. (2018). Youth risk behavior surveillance United States—2017. MMWR Surveillance Summaries, 67(8), 1–114. https://doi.org/10.15585/mmwr.ss6708a1.
Kovar, C. L. (2018). Reproductive coercion: baby, if you love me. Maternal Child Nursing, 43(4), 213–217. https://doi.org/10.1097/NMC.0000000000000435.
Krueger, R. A. & Casey, M. A. (2015). Focus groups, A practical guide for applied research. (5th Ed.). Thousand Oaks, CA: SAGE Publications, Inc.
L’Engle, K. L., Mangone, E. R., Parcesepe, A. M., Agarwal, S., & Ippoliti, N. B. (2016). Mobile phone interventions for adolescent sexual and reproductive health: a systematic review. Pediatrics, 138(3), e20160884 https://doi.org/10.1542/peds.2016-0884.
Letourneau, N. L., Duffett-Leger, L., Levac, L., Watson, B., & Young-Morris, C. (2013). Socioeconomic status and child development: A meta-analysis. Journal of Emotional and Behavioral Disorders, 21(3), 211–224. https://doi.org/10.1177/1063426611421007.
Leventhal, T., Dupéré, V., & A.E. Shuey (2015). Children in Neighborhoods. In R. M. Lerner, M. H. Bornstein, & T. Leventhal (eds), Handbook of Child Psychology and Developmental Science (pp. 493–533). Hoboken, NJ: John Wiley & Sons, Inc.
Lewis, L., Somers, J. M., Guy, R., Watchirs-Smith, L., & Skinner, S. R. (2018). ‘I see it everywhere’: young Australians unintended exposure to sexual content online. Sexual Health, 15(4), 335–341. https://doi.org/10.1071/SH17132.
Lippke, S., Nigg, C. R., & Maddock, J. E. (2012). Health-promoting and health-risk behaviors: theory-driven analyses of multiple health behavior change in three international samples. International Journal of Behavioral Medicine, 19(1), 1–13. https://doi.org/10.1007/s12529-010-9135-4.
Lopez, C. E., & Tucker, C. S. (2019). The effects of player type on performance: a gamification case study. Computers in Human Behavior, 91, 333–345. https://doi.org/10.1016/j.chb.2018.10.005.
Lugo-Gil, J., Lee, A., Vohra, D., Harding, J., Ochoa, L., & Goesling, B. (2018). Updated findings from the HHS teen pregnancy preven/tion evidence review: August 2015 through October 2016. https://tppevidencereview.aspe.hhs.gov/pdfs/Summary_of_findings_2016-2017.pdf.
McLellan, A. T. (2017). Substance misuse and substance use disorders: Why do they matter in healthcare? Transactions of the American Clinical and Climatological Association, 128, 112–130.
Militello, L. K., Kelly, S. A., & Melnyk, B. M. (2012). Systematic review of text-messaging interventions to promote healthy behaviors in pediatric and adolescent populations: Implications for clinical practice and research. Worldviews on Evidence-Based Nursing, 9(2), 66–77. https://doi.org/10.1111/j.1741-6787.2011.00239.x.
Morse, J. (2015). Critical analysis of strategies for determining rigor in qualitative inquiry. Qualitative Health Research, 25(9), 1212–1222. https://doi.org/10.1177/1049732315588501.
Nasim, A., Fernandez, A., Townsend, T., Corona, R., & Belgrave, F. (2011). Cultural protective factors for community risks and substance use among rural African American adolescents. Journal of Ethnicity in Substance Abuse, 10(4), 316–336. https://doi.org/10.1080/15332640.2011.623510.
National Institute on Drug Abuse. (2003). Preventing drug use among children and adolescents: A research-based guide for parents, educators, and community leaders (2nd ed.). USDHHS. https://www.drugabuse.gov/sites/default/files/preventingdruguse_2.pdf.
North Carolina Center for After School Programs. (2017). Roadmap of need 2018. https://www.ncforum.org/wp-content/uploads/2018/05/2018_RoadmapOfNeed.pdf.
North Carolina HIV/STD/Hepatitis Surveillance Unit. (2019). 2018 North Carolina HIV/STD/Hepatitis Surveillance Report. NCDHHS, Division of Public Health, Communicable Disease Branch. https://epi.dph.ncdhhs.gov/cd/stds/figures/std18rpt_02102020.pdf.
North Carolina State Center for Health Statistics. (2018). Social Determinants of Health by Regions. http://nc.maps.arcgis.com/apps/MapSeries/index.html?appid=def612b7025b44eaa1e0d7af43f4702b.
Rideout, V. J. & Robb, M. B. (2019). The Common Sense census: Media use by tweens and teens, 2019. Common Sense Media. https://www.commonsensemedia.org/sites/default/files/uploads/research/2019-census-8-to-18-full-report-updated.pdf.
Runions, K., Shapka, J. D., Dooley, J., & Modecki, K. (2013). Cyber-aggression and victimization and social information processing: Integrating the medium and the message. Psychology of Violence, 3(1), 9–26. https://doi.org/10.1037/a0030511.
Rodriguez, K. L., Schwartz, J. L., Lahman, M. K. E., & Geist, M. R. (2011). Culturally responsive focus groups: reframing the research experience to focus on participants. International Journal of Qualitative Methods, 10(4), 400–417. https://doi.org/10.1177/160940691101000407.
Sandelowski, M. (2010). What’s in a name? Qualitative description revisited. Research in Nursing & Health, 33, 77–84. https://doi.org/10.1002/nur.20362.
Sandelowski, M. (1995). Sample size in qualitative research. Research in Nursing & Health, 18, 179–183.
Santelli, J. S., Kantor, L. M., Grilo, S. A., Speizer, I. S., Lindberg, L. D., Heitel, J., Schalet, A. T., Lyon, M. E., Mason-Jones, A. J., McGovern, T., Heck, C. J., Rogers, J., & Ott, M. A. (2017). Abstinence only-until-marriage: an updated review of US policies and programs and their impact. Journal of Adolescent Health, 61(3), 273–280. https://doi.org/10.1016/j.jadohealth.2017.05.031.
Sexual Health Initiative for Teens. (2018). North Carolina. http://www.shiftnc.org/data/map/northcarolina.
Sexuality Information and Education Council of the United States. (2018). State profiles: North Carolina FY18 state profile 2018. https://siecus.org/state_profile/north-carolina-fy18-state-profile.
Snyder, F. J. (2014). Socio-emotional and character development: a theoretical orientation. Journal of Character Education, 10(2), 107–127.
Stevens, R., Gilliard-Matthews, S., Dunaev, J., Todhunter-Reid, A., Brawner, B., & Stewart, J. (2017). Social media use and sexual risk reduction behavior among minority youth: Seeking safe sex information. Nursing Research, 66(5), 368–377. https://doi.org/10.1097/NNR.0000000000000237.
Stewart, B. (2011). Personality and play styles: A unified model. Gamasutra. https://www.gamasutra.com/view/feature/134842/personality_and_play_styles_a_.php.
Trent, M., Dooley, D. G., & Dougé, J., AAP Section on Adolescent Health, Council on Community Pediatrics, & Committee on Adolescence. (2019). Pediatrics, 144(2): e20191765. https://doi.org/10.1542/peds.2019-1765.
Viner, R. M., Ozer, E. M., Denny, S., Marmot, M., Resnick, M., Fatusi, A., & Currie, C. (2012). Adolescence and the social determinants of health. The Lancet, 379, 1641–1652. https://doi.org/10.1016/S0140-6736(12)60149-4.
Vyas, A. M., Landry, M., Schnider, M., Rojas, A., & Wood, S. F. (2012). Public health interventions: reaching Latino adolescents via short message service and social media. Journal of Medical Internet Research, 14(4), e99. https://doi.org/10.2196/jmir.2178.
Waasdorp, T. E., & Bradshaw, C. P. (2015). The overlap between cyberbullying and traditional bullying. Journal of Adolescent Health, 56(5), 483–488. https://doi.org/10.1016/j.jadohealth.2014.12.002.
Widman, L., Golin, C. E., Kamke, K., Burnette, J. L., & Prinstein, M. J. (2018). Sexual assertiveness skills and sexual decision making in adolescent girls: randomized controlled trial of an online program. American Journal of Public Health, 108(1), 96–102. https://doi.org/10.2105/AJPH.2017.304106.
Zapolski, T. C. B., Beutlich, M. R., Fisher, S., & Barnes-Najor, J. (2019). Collective ethnic-racial identity and health outcomes among African American youth: examination of promotive and protective effects. Cultural Diversity and Ethnic Minority Psychology, 25(3), 388–396. https://doi.org/10.1037/cdp0000258.
Zhao, Y., Kim, H., & Peltzer, J. (2017). Relationships among substance use, multiple sexual partners, and condomless sex: Differences between male and female U.S. high school adolescents. The Journal of School Nursing, 33(2), 154–166. https://doi.org/10.1177/1059840516635712.
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The authors wish to thank all community leaders and participants in this study.
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This study was funded by the ECU Office of Research, Economic Development, and Engagement.
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K.L.L. and S.M.B. designed and implemented the study, analyzed and interpreted the data, and led the writing of the paper. L.B.S., D.F.E., J.E.C. and J.G.P. collaborated with the study design, data analyses, and writing of the paper. J.E.C., R.L.L. and T.B.N. collaborated in the writing and editing of the final manuscript.
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Larson, K.L., Ballard, S.M., Ellis, D.F. et al. A Contextual Approach to Inform a Mobile Health Application for Adolescent Health. J Child Fam Stud 29, 3420–3432 (2020). https://doi.org/10.1007/s10826-020-01826-x
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DOI: https://doi.org/10.1007/s10826-020-01826-x