October 2008

YouTube, Facebook, MySpace, Blogs,
and More: Innovative Ways Local Health
Departments are Reaching Adolescents

Introduction                                                          popular that 55 percent of all online adolescents aged 12 to 17
                                                                      use these types of sites. The average SNS allows users to post
American adolescents are online in huge, growing numbers.             photos and announcements, add friends, comment on other
About 93 percent of today’s adolescents between the ages of 12        users’ profiles, and communicate via private messages.
and 17 are online, up from 87 percent in 2004 and 73 percent
in 2000.1, 2 Eighty-nine percent of teens that are online use the     Profiles on SNSs are generally created by the user through
Internet at least once a week, with 61 percent using the Internet     answering a questionnaire, which typically gathers information
daily. Internet-use patterns are similar for boys and girls. Among    about user demographics (such as age, gender, and location)
teens ages 15–17, 94 percent of boys and 95 percent of girls          and personal interests (such as favorite movies, television shows,
have gone online.3 Recent research has found that the Internet        and books). Most questionnaires also include an “about me”
is becoming an important tool for Americans making health             section where users can write a brief statement to help define
decisions. A 2002 Kaiser Family Foundation report found that 76       themselves to other users. Users can personalize their online
percent of American adolescents have used the Internet to look        space by including photos or multimedia content, such as
up health information.3                                               videos (from sites like YouTube) and music files.6 The ability of
                                                                      SNSs to allow users to personalize their profiles, connect and
Given the importance and popularity of the Internet in                communicate with friends, and share multimedia help explain
youth culture, local health departments (LHD) have many               their popularity among adolescents.
opportunities to reach adolescents in new ways by using
Internet technology. This issue brief discusses the rising use of
the Internet among adolescents; describes the Web sites that              Using an SNS profile is a unique mechanism of
adolescents visit; and profiles initiatives that LHDs can and have
                                                                          communication because, unlike with a flyer, brochure,
used to educate and empower adolescents to make informed
                                                                          TV ad, etc., LHD staff or volunteers can manage the
and responsible choices about their health and well-being. This
                                                                          profile so that users can ask questions, post comments,
issue brief examines social networking sites, health information/
education sites, and user-generated content sites.                        and engage in an active dialogue through a blog or
                                                                          message board.

Social Networking Sites (SNSs)
The field of social networking has grown in recent years to           SNSs allow their users to communicate easily with one another.
include Social Networking Sites (SNSs) designed specifically          These sites create networks linking users with common
for individuals within a certain age group, for people living in a    characteristics (such as school, geographic area, or mutual
defined region, or for users to share information about travel,       friends) on the site. On SNSs such as Facebook and MySpace,
music, or common interests. SNSs, including MySpace (www.             users typically connect to others by inviting people to be their, Facebook (, and Xanga                  friends. Users identify fellow users by searching by name or
(, allow users to create private or semi-private        within networks organized by various categories such as high
profiles online not only to make connections to others but also       school or college attended, regional location, or favorite music
to articulate and visualize their social networks.4 These sites are   artist. As malls and other traditional sites for adolescents to
extremely popular and have garnered much attention in the             gather become more restrictive in allowing young people to
press. MySpace, one of the most popular SNS, had more than            congregate, SNSs provide a platform for youth to chat, plan
117,000 unique visitors in June, 2008, just under the 132,000         activities, and engage in typical adolescent behaviors without
visitors to Facebook during that same time period.5 SNSs are so       interference.7 To communicate with friends about activities such
as weekend plans and school happenings, many adolescent use                   LHD Profile: Benton County, Oregon
the following SNS mechanisms:
                                                                              The Benton County (OR) Health Department (BCHD) developed
                                                                              MySpace and Facebook profiles to inform youth in the
•       Comments: Comments are visible to anyone who views
                                                                              community about health information available on the Internet
        a user’s profile. Comments may be brief (e.g., “Happy
                                                                              by linking from the page to general health resources, community
        Birthday”) or lengthy (e.g., detailed reactions to a user’s
                                                                              resources, and LHD services. Both of Benton County’s SNS sites
        photos or videos).
                                                                              highlight the Male Advocates for Responsible Sexuality (MARS)
•       Bulletins/Notes: Bulletins are similar to mass e-mails, with          program, a peer education initiative for males ages 13–25.
        all or a subset of the user’s friends as the recipients. They         Communicating through these SNS pages, staff and volunteers
        can be viewed only by friends of the sender and are often             post sexual health and relationship-skills information, contact
        used to promote an event.                                             numbers, multimedia (including videos), a blog, and an instant
•       Private Messages: Most SNSs allow users to send private               messaging (IM) function to answer questions.
        messages to other users. This is most similar to traditional
        e-mail and is the most private of all the communication
        methods. These messages are accessed via private log-in to
        the SNS mailbox.

Creating a profile on Facebook, MySpace, and other SNSs is
one low-cost way LHDs are reaching out and communicating
with adolescents in their community. LHDs can use these sites
to communicate information to adolescents about clinic hours,
special events, fact sheets, etc. LHDs can recruit adolescents
by connecting online or in person with a core group of young
people who also refer their friends to visit the LHD’s page
and become a part of the LHD’s network. This way, LHDs can
expand their reach through natural networks of young people,
employing outreach methods to target adolescents attending                    BCHD launched the MARS program in 2007 by first posting
specific high schools in their area with messages about events                a profile for the program on MySpace. Staff recruited young
sponsored by the LHD. However, this feature is limited to some                people they knew and asked students at schools where MARS
segments of the population targeted for adolescent health                     activities were taking place to provide their screen names
promotion. Profiles for SNS users under the age of 16 are private             so LHD staff could invite them as friends on these sites. The
and cannot be viewed by people outside their “friends” network.               page’s friend portfolio has grown through these efforts as well
                                                                              as through the work of the health educators, volunteers, and
                                                                              student interns who frequently update the page.
    Tips for Starting Internet-Based Adolescent
    Health Campaigns                                                          To draw more users to the page, BCHD has (1) posted links to
                                                                              outside resources (such as MySpaceTV); (2) hosted a poster
    •      Identify ways to maintain and update the site                      contest requiring entrants to download the entry form from
           consistently. For example, one LHD uses interns                    MySpace; (3) ensured that the content of the page is current
           to give a youthful perspective to its MySpace and                  and dynamic; and (4) posted events on community calendars
           Facebook pages while the intern earns school credit.               accessible to MARS network members.

    •      Keep content up-to-date and relevant consistently                  To keep an LHD’s SNS pages relevant to youth in communities,
           in order to maintain a youth-centered Web site. Plan               a program coordinator of the MARS initiative recommends
           to develop procedures to ensure that links to outside              the following: “One of the most important things that health
           Web pages are culturally competent, age appropriate,               departments can do is to use youthful language, make the
           and user-friendly.                                                 pages not read like a health department Web site, and engage
                                                                              young people from the community to help keep the page in
    •      Explore new ways to involve youth in the planning
                                                                              sync with youth trends and technology.”
           and design of Web-based resources. For example,
           many school districts require students to log volunteer
                                                                              Recent funding challenges have forced the Benton County
           hours, which could be used to help develop Internet-
                                                                              Health Department to reduce the scope of the MARS program,
           based activities at an LHD.
                                                                              which now serves only young men in custody.

[2]     YouTube, Facebook, MySpace, Blogs, and More: Innovative Ways Local Health Departments are Reaching Adolescents
Web Traffic for Informational and Social Networking Sites, Unique Visitors

    Health Information Sites		                 August 2008		               Social Networking Sites	              August 2008			                              15,338,592		   		                         60,000,000			                                 2,641,468		   		                        40,000,000			                                101,000		    		                           1,500,000

Health Information/Education Sites                                        required to build the site, the need of graphic designers, and the
                                                                          degree to which the site’s content must be password-protected.
The fact that more than 75 percent of adolescents report                  However, LHDs can create online content inexpensively. For
that they have searched the Internet for health information               example, LHDs can turn to the adolescents in their communities
indicates that adolescents do not use the Internet merely for             for guidance and expertise in creating content for the Internet,
socializing with friends and playing games.8,9 Health-promoting           given that almost a third of adolescents have created or worked
organizations, therefore, have the opportunity to interact with           on Web sites or blogs for others, including groups that they
young people online, where adolescents are, by advertising                belong to, friends, or school assignments.10 This is a great way
and directing people to visit health information/education                to involve adolescents in local public health and help them
sites. These health information/education sites can be thought            become passionate about issues that affect their lives.
of as online libraries of health information that may focus on
one specific topic or a series of topics that deal with a common          When developing a new Web page, LHDs should consider the
theme.                                                                    capabilities of their internal information technology resources
                                                                          and their ability to staff and maintain their sites to keep them
A number of health education/information sites on the Internet            current and respond to inquiries. LHDs may run into barriers
deal with a variety of adolescent health issues. (www.         with their ability to publish Web sites on their servers. LHDs is an example of a site that is aimed at providing            should weigh all the potential positives and the potential
adolescents with information regarding sexual health (SexEtc.             barriers before deciding whether creating their own site is more
org is the online version of Sex, Etc. magazine published by              useful then directing traffic to an already existing information/
the Answer Initiative at Rutgers University.). The site regularly         education site. Once that decision is made, LHDs can direct
has over 3,000 current visitors, shows the number of people               traffic to either their own site or other established information/
on the Web site at the present moment, and features health-               education sites via their SNS pages.
related content. While all of the information is fact-checked
by professional health educators, the content is created by
adolescents and features various topics from the adolescent               LHD Profile: Multnomah County, Oregon
perspective. Health information/education sites such as SexEtc.           The Multnomah County (OR) Health Department (MCHD),
org provide a place for adolescents both to ask questions and             in conjunction with 13 school-based health centers (SBHCs)
get answers (which are often personalized) and also to share              affiliated with the LHD, has created a health information/
their experiences, 24 hours a day.                                        education Web page with a wide range of information relevant
                                                                          to adolescent health. This page, EHealth4Teens (www.eh4t.
SNSs are uniquely positioned to communicate with large                    org), was funded by a grant from the U.S. Department of
numbers of adolescents because their daily traffic is so high.            Commerce; a youth steering committee and health educators
According to, a Web site that tracks Web                  led its development with input from key content experts from
traffic, the most popular SNSs are visited much more frequently           the LHD.
than even the most popular health and wellness sites. Web sites
such as and                      The Web site includes information about nutrition and exercise,
are free and easy for LHDs and other organizations to use to              sexual health, including LGBT (lesbian, gay, bisexual and
monitor the number of hits to their sites.                                transgender) health, as well as interactive tools to tabulate the
                                                                          calories in food and calculate the long-term costs of smoking.
While an information/education site is a relatively easy method           The site also includes links to current events, resources for
for making information available to adolescents, not every LHD            homework help, public transportation in the community,
has the resources to hire its own developer to create a Web page          volunteer opportunities, and information about emergency
specifically for adolescent health topics. The cost to launch a           hotlines and resources.
site varies widely and is based on the level of technical expertise

                            YouTube, Facebook, MySpace, Blogs, and More: Innovative Ways Local Health Departments are Reaching Adolescents   [3]
Using its connection to the SBHCs, MCHD leads classes on health               LHD Profile: Pinellas County, Florida
and wellness at elementary and middle schools in the county,
                                                                              The Pinellas County (FL) Department of Health has combined
promoting the EHealth4Teens site as a resource for students. Staff
                                                                              the elements of a health education/information site and a
members direct students to the site for answers to health-related
                                                                              UGC site in its project. Pinellas County created
questions and distribute promotional items containing the site’s
                                                                     with the help of six adolescent volunteers
Web address. MCHD staff also encourage nurse practitioners
                                                                              who met weekly with a Web designer to develop the logo,
at the SBHCs to refer clients to the site during consultations by
                                                                              color scheme, format, topics, and content for the Web site.
supplying them with the Web address or by printing out pages of
                                                                    , which is maintained, designed, and administered
interest for clients to take when they leave the health center.
                                                                              by adolescents, includes basic health information, as well as
                                                                              the Teen Village Forum for teens to both post and respond
Since the conclusion of the grant award, the responsibility for
                                                                              to questions. The Teen Village Forum, moderated by trained
maintaining the site has been delegated to the information
                                                                              adolescent volunteers called the “Village Council,” allows teens
technology staff at MCHD.
                                                                              to submit questions and engage in real-time discussions in a chat
                                                                              room. This is a moderated forum that requires questions and
User-Generated Content (UGC) Sites                                            comments to be reviewed before being posted on the general
User-generated content (UCG) sites allow users to share media                 Web site.
that they have created such as blogs, videos, music, and photos
via the Internet without the need for production companies to        features an MP3 music player and links to
develop and distribute their materials. Fifty-seven percent of                local music, events and news to encourage users to check
online adolescents report having created content for the Internet,            back frequently and engage users who may not be specifically
illustrating the popularity of these sites.11 The rise of UGC sites           searching for health information. Future plans for the site include
such as YouTube has been well documented and even resulted                    incorporating a video game arcade and options for users to
in “You” being named Time Magazine’s Person of the Year                       create avatars, 3-D virtual representations of themselves, to use in
in 2006.12 YouTube ( is a site where users                    Universal World, a multiplayer online game.13
can register free of charge and begin uploading videos to the
Internet for others to watch. Not only are adolescents viewing                To understand better who is visiting, the Pinellas
YouTube content, they are also creating their own pieces, even                County Health Department partnered with a public health
on health-related topics such as sex education. A quick search of
“sex education” on YouTube returns over 10,000 results. Many of
these videos, some of which have been created by adolescents,
have been viewed over 500,000 times.10
                                                                                           Social Networking Sites
LHDs interested in raising public awareness about specific health                          link users with common characteristics (such
issues or their own programmatic activities should explore using                           as school, geographic area, or mutual friends)
YouTube to share video clips and presentations. In addition to                             on the site.
hosting general information about LHD activities, UGC sites such                 
as YouTube provide LHDs with a unique platform to share what                     
they, and adolescents in their community, are doing to address                   
adolescent health issues. LHDs can use UGC sites to share media,
such as videos created by peer educators; essays, poetry, and                              Health Information/Education Sites
other writing created by adolescents; and photos of health fairs,                          may focus on one specific topic or a series
for example, with the rest of the world.                                                   of topics that deal with a common health-
                                                                                           related theme.
       In an effort to address the growing concerns regarding Internet           
       safety, both MySpace and Facebook have mechanisms in place to
       help protect young SNS users. Preteen users are not legally allowed                 User-Generated Content Sites
       to create profiles on these sites; if underage users are identified,                allow users to share media that they have
       their accounts are deleted. While Facebook does not allow parents                   created such as blogs, videos, music, and
       to access an account created by their child, MySpace does provide                   photos via the Internet.
       instructions for parents to delete their child’s account.

[4]   YouTube, Facebook, MySpace, Blogs, and More: Innovative Ways Local Health Departments are Reaching Adolescents
                                                                           Macgill, A. (2007). Memo: Parent and teen Internet use. Pew
                                                                          Internet & American Life Project.

                                                                            Lenhart, A. & Madden, M. (2007). Teens, privacy & online
                                                                          social networks: How teens manage their online identities and
                                                                          personal information in the age of MySpace. Pew Internet &
                                                                          American Life Project.

                                                                           The Henry J. Kaiser Family Foundation. (2001). Key facts: Teens
                                                                          online. Menlo Park, CA.

                                                                           Boyd, D. & Ellison, N. Social network sites: Definition, history,
                                                                          and scholarship. Journal of Computer-Mediated Communication,
student from the University of South Florida to develop and               13(1), article 11.
implement a survey of users. The goal of the survey was to learn          ellison.html
about the kinds of sexual health information adolescents are
seeking, where they go for this information, and the knowledge
                                                                           Schonfeld, E. (2008). Facebook Is Not Only The World’s Largest
they already have about these health topics. The survey was               Social Network, It Is Also The Fastest Growing.
answered by 280 young people and provided details about
the information that they seek online and the tools, such as
                                                                           Boyd, D. & Ellison, N. (2007). Rumors of the decline of
computers and cell phones, they use to do so. These results               MySpace are exaggerated.
supplemented what the LHD already knew about its target
population’s use of technology to learn about health.
                                                                           Keen, J. Malls’ night restrictions on teens paying off. (2007,
                                                                          March 15). USA Today.

Conclusion                                                                8
                                                                           Lenhart, A. (2007). A timeline of teens and technology:
The field of Internet-based health outreach has developed largely         Presentation given to policy and advocacy in the schools meeting
in the past decade, and evaluation of these outreach techniques           APA. Pew Internet & American Life Project.
is somewhat limited. Some LHDs have collected data about the
number of people visiting their Web sites and SNS pages, but
                                                                            Rideout, V. (2001). Generation How young people use
the impact of these types of interventions is not well evaluated.         the Internet for health information. Menlo Park, CA: The Henry J.
However, research about adolescents’ use of the Internet                  Kaiser Family Foundation.
clearly demonstrates that the majority of young people use the
Internet, that many seek health information online, and that               Accessed July 10, 2008, from

the potential for LHDs to gain access to this population is large.        watch?v=jak56hI
Because Internet use among adolescents is rising, LHDs should
become familiar with this aspect of youth culture and consider its
                                                                             Horrigan, J. & Rainie, L. (2006). The Internet’s growing role in
potential value in outreach to adolescents on health issues.              life’s major moments. Pew Internet & American Life.

                                                                           Accessed July 29, 2008, from


     Many LHDs have either created stand-alone Web                        13
                                                                            Accessed July 29, 2008, from
     sites dedicated to adolescent health or have posted                  avatar_(virtual_reality)
     adolescent health-related information on their
     organizational Web sites. Visit
     topics/hpdp/infectious/newtech.cfm for a list of
     LHDs with adolescent health Web sites.

                           YouTube, Facebook, MySpace, Blogs, and More: Innovative Ways Local Health Departments are Reaching Adolescents   [5]
  October 2008

  This issue brief is supported by Grant # U45MC07533
  from the Maternal and Child Health Bureau’s Office
  of Adolescent Health, Health Resources and Services
  Administration, Department of Health and Human
  Services. NACCHO is grateful for this support.

  NACCHO thanks the following staff who contributed
  to this issue brief: Angela Ablorh-Odjidja, MHS; Cara
  Biddlecom, MPH; Jennifer Joseph, PhD, MSEd; Kate
  Petersen, MPH; Cindy Phillips, MSW, MPH; and Tasha
  Toby, MPH.

  For more information, Please contact:
  Kate Petersen, MPH
  Program Associate

  (202) 507-4251

                                                          NACCHO is the national organization representing local health departments.
                                                          NACCHO supports efforts that protect and improve the health of all people
                                                          and all communities by promoting national policy, developing resources and
                                                          programs, seeking health equity, and supporting effective local public health
                                                          practice and systems.

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