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Latina Adolescent Use of the Internet to Search For Reproductive Health Information

Permanent Link: http://ufdc.ufl.edu/UFE0024464/00001

Material Information

Title: Latina Adolescent Use of the Internet to Search For Reproductive Health Information
Physical Description: 1 online resource (121 p.)
Language: english
Creator: Echevarria, Ilana
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2009

Subjects

Subjects / Keywords: adolescents, education, health, internet, latina, reproductive, sexual, website
Journalism and Communications -- Dissertations, Academic -- UF
Genre: Mass Communication thesis, M.A.M.C.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: The purpose of this study was to understand why and how Latina adolescents are using the Internet to search for reproductive health information. This qualitative study used two methods of data collection for the purpose of triangulation. These two methods included focus groups with Latina adolescents and in-depth interviews with sexual health educators. A total of seven focus groups were conducted with 23 participants between the ages of 14-18. Five in-depth interviews were conducted with educators from YMCAs, Planned Parenthood offices and church youth groups. The main research questions for this study were: What role, if any, does the Internet play in Latina adolescents? search for reproductive health information? An additional six sub-questions were asked to investigate to what extent Latina adolescents use the Internet, what prompts Latina adolescents to search for reproductive health information online, how they decide what Web sites to visit, what aspects of a Web site are appealing, what criteria they use to determine the credibility, and whether they discuss the information found on the Web sites with peers, parents, siblings, and medical professionals. Discussion with participants revealed that both younger and older Latina adolescents had searched for reproductive health information for themselves, a friend, or a class assignment. However, younger Latina adolescents did not use the Internet to search for reproductive health information because they felt the information was too broad and they believed the information online was based on opinion; they preferred to use parents and doctors as sources for information. Also because most of the younger girls were not sexually active, they were not worried about their parents? reaction to a question related to sex; the same was not true for the older participants. Unlike younger Latina adolescents, older Latina adolescents searched for reproductive health information online because it was anonymous, accessible, convenient, effortless, and it helped avoid confrontations with parents. Most participants had a tough time explaining how they determined if a Web site was credible and/or accurate. Most participants only explored the first few links offered from a search engine and relied on sites based on popularity. Other methods participants used to determine credibility were attractiveness of a Web site, recognizable logos of companies, and quotes from trustworthy professionals. Lastly, when younger participants searched for reproductive health information online, they typically followed up with parents and doctors, unlike older participants, who only talked to friends about the information they had found online.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Ilana Echevarria.
Thesis: Thesis (M.A.M.C.)--University of Florida, 2009.
Local: Adviser: Walsh-Childers, Kim B.

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2009
System ID: UFE0024464:00001

Permanent Link: http://ufdc.ufl.edu/UFE0024464/00001

Material Information

Title: Latina Adolescent Use of the Internet to Search For Reproductive Health Information
Physical Description: 1 online resource (121 p.)
Language: english
Creator: Echevarria, Ilana
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2009

Subjects

Subjects / Keywords: adolescents, education, health, internet, latina, reproductive, sexual, website
Journalism and Communications -- Dissertations, Academic -- UF
Genre: Mass Communication thesis, M.A.M.C.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: The purpose of this study was to understand why and how Latina adolescents are using the Internet to search for reproductive health information. This qualitative study used two methods of data collection for the purpose of triangulation. These two methods included focus groups with Latina adolescents and in-depth interviews with sexual health educators. A total of seven focus groups were conducted with 23 participants between the ages of 14-18. Five in-depth interviews were conducted with educators from YMCAs, Planned Parenthood offices and church youth groups. The main research questions for this study were: What role, if any, does the Internet play in Latina adolescents? search for reproductive health information? An additional six sub-questions were asked to investigate to what extent Latina adolescents use the Internet, what prompts Latina adolescents to search for reproductive health information online, how they decide what Web sites to visit, what aspects of a Web site are appealing, what criteria they use to determine the credibility, and whether they discuss the information found on the Web sites with peers, parents, siblings, and medical professionals. Discussion with participants revealed that both younger and older Latina adolescents had searched for reproductive health information for themselves, a friend, or a class assignment. However, younger Latina adolescents did not use the Internet to search for reproductive health information because they felt the information was too broad and they believed the information online was based on opinion; they preferred to use parents and doctors as sources for information. Also because most of the younger girls were not sexually active, they were not worried about their parents? reaction to a question related to sex; the same was not true for the older participants. Unlike younger Latina adolescents, older Latina adolescents searched for reproductive health information online because it was anonymous, accessible, convenient, effortless, and it helped avoid confrontations with parents. Most participants had a tough time explaining how they determined if a Web site was credible and/or accurate. Most participants only explored the first few links offered from a search engine and relied on sites based on popularity. Other methods participants used to determine credibility were attractiveness of a Web site, recognizable logos of companies, and quotes from trustworthy professionals. Lastly, when younger participants searched for reproductive health information online, they typically followed up with parents and doctors, unlike older participants, who only talked to friends about the information they had found online.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Ilana Echevarria.
Thesis: Thesis (M.A.M.C.)--University of Florida, 2009.
Local: Adviser: Walsh-Childers, Kim B.

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2009
System ID: UFE0024464:00001


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1 LATINA ADOLESCENT USE OF THE INTERNET TO SEARCH FOR REPRODUCTIVE HEALTH INFORMATION By ILANA ECHEVARRIA A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS IN MASS COMMUNICATION UNIVERSITY OF FLORIDA 2009

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2 2009 Ilana Echevarria

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3 ACKNOWLEDGMENTS This thesis would not have been completed successfully without the support, encouragement, and guidance of many people. I would like to thank my thesis committee chair, Dr. Kim Walsh Childers, for her valuable feedback, her attention to details, her constant support, and optimistic spirit. I would like to thank Dr. Debbie Treise for her guidance and support, and the opportunities she has shared with me to expand my academic skills. Finally, I would like to thank Dr. Youjin Choi for her excellent insights and words of encouragement. I would like to thank my parents for always believing, listening and encouraging me throughout this journey, especially on the toughest days. Through their work ethic they have giving me the skills to never give up on myself and have inspired me to pursue my dreams. I share this accomplishment with you. I am eternally grateful to m y husband Nate Stewart, for always listening and encouraging me in my darkest moments. For proofing every word I ever wrote, taking on all the daily responsibilities when all I did was write, and always helping me find new solutions when I all I could see were barriers and obstacles. For always believing in me and rooting me on, I love you. I would like to thank The Career Resource Center and particularly Heather White for being far more than a boss, but a friend who was not only flexible with my work sche dule, but also listened to me on a daily basis, and gave me constant advice. Finally, I would like to thank the YMCA Youth Achievers program for helping me find participants throughout North Central Florida and for dedicating their lives to helping the Hi spanic youth.

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4 TABLE OF CONTENTS page ACKNOWLEDGMENTS .................................................................................................................... 3 ABSTRACT .......................................................................................................................................... 6 CHAPTER 1 INTRODUCTION ......................................................................................................................... 8 Defining the Problem .................................................................................................................... 8 Latina Adolescent Sexual Trends ................................................................................................. 9 Latina High School Dropout Rates ............................................................................................ 10 Latina Acculturation ................................................................................................................... 12 Latin American Cultural Values ................................................................................................. 13 Latino Health Care and Information Access ............................................................................. 14 2 LITERATURE REVIEW ........................................................................................................... 17 Media Influence ........................................................................................................................... 17 Researching Health Information Online .................................................................................... 22 Advantages and Disadvantages ........................................................................................... 23 Internet Behaviors of Adolescents ...................................................................................... 27 Summary and Research Questions ............................................................................................. 30 3 METHODS .................................................................................................................................. 32 Grounded Theory ........................................................................................................................ 33 Focus Groups ............................................................................................................................... 34 In -depth Interviews ..................................................................................................................... 36 Method of Data Collection ......................................................................................................... 38 Question Guide ............................................................................................................................ 40 Means of Data Collection ........................................................................................................... 42 Methods of Data Analysis .......................................................................................................... 44 4 RESULTS .................................................................................................................................... 47 Convenience ................................................................................................................................ 49 Effortless .............................................................................................................................. 49 Privacy .................................................................................................................................. 50 Credibility .................................................................................................................................... 51 Reliability ............................................................................................................................. 51 Attractiveness ....................................................................................................................... 53 Status .................................................................................................................................... 53

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5 Distrust ......................................................................................................................................... 54 Broadness ............................................................................................................................. 54 Opinion -Based ..................................................................................................................... 55 Uncertainty ........................................................................................................................... 55 Motivation .................................................................................................................................... 56 Surroundings ........................................................................................................................ 57 Self Interest .......................................................................................................................... 58 5 DISCUSSION .............................................................................................................................. 71 Limitations ................................................................................................................................... 81 Future Research ........................................................................................................................... 82 APPENDIX A QUESTION GUIDES ................................................................................................................. 85 B FOCUS GROUP TRANSCRIPT ............................................................................................... 92 C INTERVIEW TRANSCRIPT .................................................................................................. 102 D PARTICIPANT LIST ............................................................................................................... 112 LIST OF REFERENCES ................................................................................................................. 114 BIOGRAPHICAL SKETCH ........................................................................................................... 121

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6 Abstract of Thesis Presented to the Graduate School of the University of Florida in Parti al Fulfillment of the Requirements for the Degree of Master of Arts in Mass Communication LATINA ADOLESCENT USE OF THE INTERNET TO SEARCH FOR REPRODUCTIVE HEALTH INFORMATION By Ilana Echevarria May 2009 Chair: Kim Walsh -Childers Major: Mass Communicat ion The purpose of this study was to understand why and how Latina adolescents are using the Internet to search for reproductive health information. This qualitative study used two methods of data collection for the purpose of triangulation. These two m ethods included focus groups with Latina adolescents and in -depth interviews with sexual health educators. A total of seven focus groups were conducted with 23 participants between the ages of 1418. F ive in depth interviews were conducted with educators f rom YMCAs, Planned Parenthood offices and church youth groups. The main research questions for this study were: What role if any, does the Internet play in Latina adolescents search for reproductive health information? An additional six sub questions w ere asked to investigate to what extent Latina adolescents use the Internet, what prompt s Latina adolescents to search for reproductive health information online, how they decide what Web sites to visit, what aspects of a Web site are appealing, what crite ria they use to determine the credibility, and whether they discuss the information found on the Web sites with peers, parents, siblings, and medical professionals. Discussion with participants revealed that both younger and older Latina adolescents had s earched for reproductive health information for themselves, a friend, or a class assignment.

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7 However, younger Latina adolescents did not use the Internet to search for reproductive health information because they felt the information was too broad and they believed the information online was based on opinion; they preferred to use parents and doctors as sources for information. Also because most of the younger girls were not sexually active, they were not worried about their parents reaction to a question related to sex; the same was not true for the older participants. Unlike younger Latina adolescents, older Latina adolescents searched for reproductive health information online because it was anonymous, accessible, convenient, effortless, and it helped a void confrontations with parents. Most participants had a tough time explaining how they determined if a Web site was credible and/or accurate. Most participants only explored the first few links offered from a search engine and relied on sites based on p opularity. Other methods participants used to determine credibility were attractiveness of a Web site, recognizable logos of companies, and quotes from trustworthy profession al s. Lastly, when younger participants searched for reproductive health informat ion online they typically followed up with parents and doctors, unlike older participants who only talked to friends about the information they had found online.

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8 CHAPTER 1 INTRODUCTION Defining the Problem Latinas are an especially important cultural group to examine because of their re cent disproportional increase in population and the disturbing statistics for Latina adolescents unintended pregnancies and low use of contraceptives. In 2006, Latinos were the largest minority group in the Un ited States, with a population of 44.3 million (U.S. Census Bureau, 2007). Between 20052006, Latinos were the fastest growing minority group, accounting for almost half (1.4 million) of the national population growth (U.S. Census Bureau, 2007). The Latino population in 2006 was much younger than other groups, with a median age of 27.4 compared to the 36.4 median age of the overall population. This statistic is significant to note because of the high percentage of young Latinos in the United States who use the Internet on a daily basis (Lenhart, et al., 2005). The trend of using mainstream media, such as the Internet, to search for health related information is quickly growing among secondand third -generation Latinos. According to the Lenhart, et al., (20 05), 89% of English-s peaking Latino adolescents reported spending free time online Furthermore, about 53% of all female adolescents, regardless of ethnicity, search for health -related information online, such as information about drugs, sexual health or d epression (Lenhart, et al., 2005). With the increasing statistics of unintended pregnancies among Latina adolescents and the increasing use of the Internet to gather health -related information, it is important to learn what role if any, the Internet play s in informing Latina adolescents about sexual/reproductive health.

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9 Reproductive health as defined by the World Health Organization, WHO, is: a state of physical, mental, and social well being in all matters relating to the reproductive system at all sta ges of life. Implicit in this are the right of men and women to be informed and to have access to safe, effective, affordable, and acceptable methods of family planning of their choice, and the right to appropriate health -care services related to reproduct ion and sexually transmitted infections. It also includes sexual health, the purpose of which is the enhancement of life and personal relations (Progress #45, 1998, p.3). For this reason the terms reproductive health and sexual health will be used i nterchangeably throughout this research. The purpose of this study is to understand why and how Latina adolescents are using the Internet to search for reproductive health information. Latina adolescents increasing rates of unintended pregnancies are du e to many factors that will be discussed in the following sections. These include risky sexual behaviors, acculturation, increased high school drop-out rates, and a lack of health insurance, which may lead to adolescents having insufficient health informat ion. Latina Adolescent Sexual Trends Many studies indicate that Latina adolescents are increasingly engaging in potentially risky sexual behavior. For instance, according to Driscoll, et al., (2001) Latina adolescents who engage in sexual relations befor e the age of 18 are more at risk of exposure to negative outcomes such as forced sexual relations, less likely use of contraceptives, unintended pregnancy, and sexually transmitted infections In addition to these risk factors, Latina adolescent s have stea dily maintained the slowest decline in birth rates between 1999 and 2001, registering only a 23% drop, compared to a 54% decrease among African -American teens and a 47% drop among nonHispanic white teens (Ventura, 2001). One possible explanation for the slow decline in birth rates may be that contraceptive use is lower among Latino adolescents than among nonHispanic whites or African -Americans (Driscoll, et al., 2001). In a 2007 study conducted by the Turner Foundation, Latina high school

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10 students were less likely to have used birth control pills the l ast time they engaged in sex (9% ) comp ared to non Hispanic whites (27%) and African Americans (11% ). According to the Youth Risk Behavior Survey (2005), both Latino males and females are 34% less likely to use condoms than either non Hispanic whites and African -Americans. This behavior leaves young Latinos relatively more vulnerable to a host of negative outcomes, including sexually transmitted infections and unintended pregnancies. While Latinos may not re present the highest risk group for all negative consequences, the rates are still worrisome. According to the Division of STD Prevention at the Centers for Disease Control and Prevention, infection rates have steadily increased for all teens but at a fast er rate for Latino male youth. Young Latina females are nearly seven times more likely than Latino males to be diagnosed with Chlamydia ( 2005, p. 1). Latina High School Dropout Rates Another factor that contributes to countless Latino adolescents risky s exual behavior, especially unintended pregnancies, is a lack of education. Latino teens are more likely to drop out of high school than any other group in the United States (Laird, et al., 2006). In 2000, 36% of Latinos between the ages of 16 24 did not re ceive a high school diploma or complete the General Educational Development (GED) credentials ( Llagas & Snyder, 2003). Latina adolescents who drop out at a young age are more likely than their older counterparts to have unintended pregnancies (Turner Found ation, 2007). In a study conducted by Manlove (1998), Latina and non Hispanic white adolescents, regardless of socio -economic status, family structure and personal characteristics, were less likely to become pregnant the longer they attended school. Sixty percent of Latina adolescents become pregnant after dropping out of high school, compared to 53% of African-Americans and 22% of nonHispanic whites (Turner Foundation, 2007).

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11 Because a large number of Latina teenage mothers are younger than age 20 and lac k a high school diploma it can be difficult for them to locat e and understand information about sexual healt h (Giachello, 1994). Often this leads to a tendency among Latina teens to harbor misconceptions about the potential effects of taking oral contrac eptives which results in women discontinuing or even avoiding oral contraceptives (Gillam et al., 2004). For example, in a study conducted by Krishnan (1996), contraceptive and STI information was provided to low income women through pamphlets/brochures a nd nurse interactions. These communication methods were ineffective because much of the information provided by health educators was saturated with jargon and expert vocabulary and thus could not be understood by uneducated women. Another factor that infl uences the decision -making process of Latino youth is parental involvement. Adolescents who come from households headed by uneducated parents usually receive less family encouragement and p arental involvement (Manlove, 1998) Further, low parental involvem ent also has been associated with higher rates of school age pregnancy (Manlove, 2001). In a survey conducted by The National Campaign to Prevent Teen Pregnancy (2001), Latino parents inability to spend time with their children and to engage in productive activities and conversations are among the top reasons why Latina adolescents believe that they become pregnant Latino teenagers also feel that parents do not know how to discuss the topic of sex or how to communicate consistent messages about the topic, which in part could be caused by the parents own lack of education and understanding of the available information ( Vexler 2007) Family size and structure also has a positive correlation with school age pregnancy. Teenage pregnancy is more prevalent am ong Latina adolescents who live in broken families, rather than intact families that include both parents and siblings and have a higher socio-

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12 economic status (Manlove, 1998). Larger families also have a tendency to have fewer available resources and less time to be involved in the daily lives of these adolescents which contribute s to school age pregnancy. Latina Acculturation Many studies have determined a significant difference in how Latinas with moderate and low levels of acculturation negotiate sex ual behavior. Acculturation as defined by Marvin (1987), is the change or modification of values, norms, and behaviors in a minority group when they are exposed to cultural patterns specific to the United States. L ess acculturated Latinas are less likely to use contraceptives because of religion, language barriers, economic resources, and partner influence (Minnis & Padian, 2001). One study found that Latinas who were less acculturated were more likely to have older boyfriends (Vanoss, 2000). This is accep table in the Latin American culture, in which most women have husbands up to 10 years older than they are (Vanoss, 2000; Vexler 2007). Even though these types of relationships are common, they also may contribute to an increased number of unplanned pregna ncies and sexually transmitted diseases. Latinas, in general, are not comfortable negotiating contraceptive use with older males and prefer to keep these decisions private. In one study, a higher proportion of Latina women who were using oral contraceptive s but did not communicate this fact to their partners were more likely to discontinue the pill prematurely (Kerns et al 2003). Also, women who were in short term relationships rather than longterm relationships were more likely to use no contraceptives A womans decision to tell her partner about her choice of contraceptives depends on the perceived support of her partner (Kerns, et al 2003). Because this support is less likely to occur between adolescents, it may cause a decrease in the knowledge an d use of contraceptives, such as condoms or birth control pills

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13 High acculturation, usually associated with the amount of time spent in the United States, is often a contributor to unintended pregnancies because Latinas who typically have a higher level of acculturation engage in earlier sexual activity and have more non-marital births compared to their less acculturated counterparts (Hines, 1998; Minnis & Padian, 2001). More acculturated adolescents are less likely to use contraceptive methods if they p erceive that their friends are not using them (Gibson & Lanz, 1991). With 40% of Latinos in the United States being foreign born, acculturation clashes between parents and their more Americanized teens are unavoidable ( Fry 2005). There seems to be even a bigger clash between parents and daughters. Among Latino immigrants, there's an old world tendency to isolate young women, says Hector Sanchez -Flores, a researcher at the University of California at San Francisco's Center for Reproductive Health. Fami lies may try to shelter a young woman and say she can't go out, but the fact is, [in America] she is going to go out ( q uo t e d in Elkins, 2007, p. 1 ). Because Latinos who are less acculturated typically speak Spanish and those who are more acculturated t ypically speak English, language clashes among parents and teenagers regularly arise. Latina adolescents living in an English -speaking household are less likely to engage in unprotected sex and have an unintended pregnancy, unlike Latina adolescents who li ve in a bilingual or Spanish -speaking household ( Allen, et al., 2008). Because Latinos who commonly speak Spanish are usually less acculturated and have more culturally traditional views, friction may be occurring among parents and their teenagers. Latin A merican Cultural Values The vast majority of Latinos share distinctive cultural values, particularly among first and second generation Latinos (Marin, 1989). These include familialism and collectivism, among others (Marin, 1989). Familialism is known a s the importance and influence of family. Parental

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14 sexual behavior sibling sexual behavior, family structure and religiosity are among the factors that determine the familys effect on adolescent girls sexual experiences (Marin, 1989; Minnis & Padian, 2 001). Adolescent sexual attitudes are influenced by the frequency and type of communication that occurs within the fa mily (Hovell, et al 1994, p. 974). One study found that when Latina mothers spoke with their young adolescent daughters about sex in a productive and healthy manner, the adolescent girls were more likely to refrain from or delay sexual intercourse (Romo et al 2002). Collectivism refers to the importance of friends, especially close friends and members of the family (Marin, 1989). A ccording to Unger (2007), if women who are moderately acculturated perceive that their friends or family will disapprove of their use of contraceptives, they are less likely to use any method of contraceptive. Religion also plays a crucial role in the negotiation of sexual relations and the use of condoms and birth control pills. Most Latinos practice the Roman Catholic religion, which is opposed to the use of any form of contraceptives and encourages abstinence until marriage (National Campaign to Prevent Teen and Unplanned Pregnancy, 2001) This may discourage adolescents from us ing condoms or birth control pills, even when they are engaging in sex. Even though Latinas may associate contraceptives with defying church morals, they do not associate virginit y with religious values, but rather as a form of self respect (Villarruel, 1998). In other words, Latinas are more discouraged from using contraceptives than they are from engaging in sexual encounters. Latino Health Care and Information Access Latinos a re among the least well served by the United States health care system. On average, Latinas have less access to health care and health insurance and thus have less access to health information. According to the United States Census (2000), 33% of Latinos l ack health

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15 insurance. This statistic clearly shows why it is essential to find other channels, outside the health care system, through which to reach the growing segment of the uneducated low -income population. In a study conducted by Cheong (2007), 737 re spondents were interviewed in two predominantly Hispanic communities. They were interviewed based on status of insurance and their preferred outlet for health communication. In this study, uninsured Latinos were less likely to have a regular place for heal th care or to visit a physician. Insured Latinos visited local community and county clinics for their health care. Compared to the insured Latinos, most of the uninsured Latinos had lower household income s and were first generation immigrants. Most uninsur ed Latinos had an annual income of less than $20,000 and an eighth-grade education or l ess If uninsured Latinos needed immediate health care attention they would more than likely visit an emergency room. The uninsured were more likely to receive their he alth information via television radio, newspapers, and interpersonal sources (Cheong 2007). The most dominant sources of information for the uninsured were ethnically targeted TV programming and interpersonal communication. This differed for insured Latin os who preferred receiving information from health care providers and by using the Internet. They primarily used mainstre am media, such as English -language TV channels and Web sites. Findings suggest that first -generation Latinos would rather communicate interpersonally and use ethnically appropriate materials, such as Spanish TV and newspapers. On the other hand, s econdor third -generation Latinos are more likely to use mainstream media such as English language Web sites, pamphlets/brochures, and TV H owever, the fact that second or third generation Latin o s are using more mainstream media does not mean they necessarily understand the information any better than their uninsured counterparts.

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16 Sexual health information distributed to Hispanics is usually written in the same way as information distributed to nonHispanic whites and blacks except that it is translated into Spanish (Elkins, 2007). According to Bill Albert, the National Campaigns of Latino Initiative, many Latinos misconstrue such messages as anti baby or anti -family anathema for a culture that so reveres the family unit. We need to make clear that it's a matter of sequencing, says Albert. The message isn't Don't have children, it's 'Don't have children when you're seventeen' (q u o t ed in Elkins, 2007, p. 2). Despite being acculturated, Latinos still maintain distinct characteristics from the majority of non -Hispanic whites and possess unique cultural values that have been linked to the increasing rates of high school dropouts and unintended pregnancies. Because a larger proportion of Latino adolescents use the Internet in their daily lives, compared to nonHispanic Whites and African Americans (Lenhart, et al., 2005) it is very possible that this culture group is using the Internet to search for information on reproductive health. With the increasing numbers of unintended pregnancies among Latina adolescents and the increasing use of the Internet to gather health -related information, it is important to learn what role if any, th e Internet plays in informing Latina adolescents about sexual/reproductive health. This is why the purpose of this study is to understand why and how Latina adolescents are using the Internet to search for reproductive health information. Chapter 2 will d escribe this new trend and highlight the advantages and disadvantages of using the Internet as a health resource. Chapter 3 will describe the methods used in this study. In Chapter 4, the results of the study are reported, and Chapter 5 includes discussion s of the findings of the study and conclusions.

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17 CHAPTER 2 LITERATURE REVIEW Media Influence Teens have more unsupervised access to television, music, and movies than ever before, and these media portray glamorous characters teens often admire (Huston 1998). Characters found in prime time television shows usually engage in non -marital sexual relations that are portrayed as having no negative conseque nces, such as pregnancy and sexually transmitted infections (STIs) (Lowry & Shidler, 1993). The televis ion shows adolescents commonly watch are aired between the hours of 8 p.m. and 11 p.m. and are full of sexually explicit material (Brown, et al., 2002). These shows are usually promoted with a high sexual content in order to attract more viewers and increa se ra tings (Lowry & Shidler, 1993). In a study conducted by Co pe -Farrar and Kunkel (2002), 82% of prime time television had some sort of sexual tone. Most of the sexual tones of these programs were modest with no portrayal of consequences. Even though each individual may analyze prime time televisions portrayal of sex differently, they are undoubtedly influenced by these sexual messages (Ward, Gorvne, & Cytron, 2002). In addition to prime time television, Latina adolescents have access to a considerable amount of Spanish language television. Channels include Telemundo, Univision, CNN en Espanol, and Telefutura, among others. Telenovelas, Spanish-language soap operas, are similar to prime time shows because both consistently revolve around romantic and sexually explicit interactions. Adolescent Latinas are interested in learning about these sexual topics and, therefore, use the media to answer questions that they might otherwise be embarrassed to ask (Moran, 2003). In a study conducted by Moran (2003), Lati na adolescents who watched telenovelas felt that sex was portrayed too often, but in a very realistic manner. The adolescent girls did not feel compelled to engage in sexual relations by seeing such behavior in the

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18 programs. Rather, they judged the charact ers as doing wrong if they engaged in relations with too many partners. However, the teens believed these programs should only be watched with adult supervision because the contents are commonly explicit. Teens also look to movies to understand the rela tionships they seek and often have for themselves (Steele, 2002). R rated movies tend to include more sexually explicit story lines than prime time television (Greenberg, et al., 1993). These storylines usually involve non-married characters engaging in passionate sexual relations (Huston, 1998). Even though most sexually explicit story lines exist in R -rated movies that are not intended for children younger than 17, most children today have seen an R rated movie without a parent or adult present (Greenber g, et al., 1993). Music videos usually have implicit and explicit sexual elements that influence teens sexual perceptions (Brown & Steele, 1995). Women are often portrayed as sexual objects who conform to stereotypical gender roles (Seidman, 1992). On the other hand, men are portrayed as aggressive, dominating, adventuresome, and never sexually objectified (Seidman, 1992). In particular, rap music has extremely explicit sexual and violent messages as well as visual content (Brown & Steele, 1995). This is concerning because of the popularity of rap music today. According to the 2008 Billboard charts, four of the top 10 songs were sexually explicit rap songs. In these songs, w omen are usually portrayed as being vulnerable and needy or as sex symbol s On the other hand, men are portrayed as being aggressive, controlling, and tough. Magazines are by far one of the most important sources from which adolescent girls obtain sexual health information (Walsh Childers, et al., 2002). Teen magazines do a good jo b targeting girls between the ages of 12 15, and adult women s magazines are also effective in targeting girls between the ages of 16 19 (WalshChilders, et al., 2002). Many adolescent girls

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19 read teen and adult magazines to fulfill their curiosity about ma ke up and celebrity gossip but also are likely to come across sexual health information. According to Garner et al., (1998) teenage magazines encourage girls to be submissive and sexy for their male partners. They do not discuss abortion, homosexuality, masturbation, STDs, etc. in educational articles. This can lead adolescents to believ e that they should act as sexual objects without learning the consequences associated with such actions. In one study Walsh Childers and colleagues content analyzed 16 magazines including 4 popular teen magazines published between 1986 and 19 96. The number of health related sex topics compared to non -health related sex topics gradually decreased in the magazines over the 10 year period. Women s magazines were more lik ely to concentrate on how to attract a partner and keep him satisfied rather than providing information about health related topics such as pregnancy and STIs. In teen magazines the difference between health related sex topics and non -health topics was no t as drastic but still gave cause for concern. Less focus was given to sexual health related information in teen magazines than in the past, although pregnancy and STI information w as still more prevalent than in womens magazine. Some of the topics covere d in teen magazines were the first time, rape and sexual abuse, which were considered non-health sex related topics but in essence really are issues that concern sexual health. According to Walsh -Childers, et al., (2002) girls also need encouragement to view those sexual health issues as at least equal [in] importance to sexual attractiveness and successful performance (p.169). The authors argue that these issues are not receiving the proper emphasi s in women s magazines. Even when teen magazines addres s some of these issues, they are not comprehensive in discussing contraceptives, which can ultimately prevent both unintended pregnancies and STIs.

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20 Most Latinos are exposed to about 70% of Spanish -language me dia once a week, compared to 50% of English -language media (Taylor & Bang, 1997). Latino magazines are one of the hottest trends, targeted to secondand third -generation immigrants who want to maintain a close connection with their culture (Fest, 1997). A study conducted by Johnson, et al., (1999) is one of the few that analyze the sex and reproducti on content in Latina magazines. Sixteen adult Latina magazines were analyzed for content on HIV/STIs, contraception, planned and unplanned pregnancy, and consequences and responsibilities. Most of the a rticles concerning infections talked about HIV instead of other STIs. Contraceptives were commonly mentioned, but only two methods were discussed: birth control pills and condoms. Morningafter pills and IUDs were barely mentioned. Unplanned pregnancies we re discussed less frequently than planned pregnancies, although when unplanned pregnancies were mention ed, the articles typically discussed the results and implications. Abortion was only mentioned in articles regarding consequences and responsibilities. A study conducted by Kaplan (2003) showed that Latina adolescents were more interested in magazine articles concerning pregnancy and sexual abuse articles than were non -Hispanic whites, who were more interested in articles about clothes and boys. One possib le explanation for the different interests of these two groups may be the greater likelihood that Latina adolescents in low socio -economic areas are concerned with the increasing numbers of unintended pregnancies (Singer, et al., 2006). Research has demon strated that adolescents who have a heavy Sexual Media Diet (SMD), which includes all aspects of media such as prime time television, movies, magazines, and music, are more likely to engage in sexual relations (Brown 2006). This most likely occurs because adolescents look to the media for information on how to date, kiss, and engage in other sexual behaviors, as they identify which sexual desires they are interested in pursuing (Pardun, et

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21 al., 2005). Another explanation for this correlation is media dependency theory. Media dependency theory suggests that individuals depend on the media to meet certain needs and goals that are not being fulfilled. According to DeFleur and Ball -Rokeach (1982), dependency on media increases when individuals feel the necessity to deepen their understanding of a certain topic. For example, if adolescents feel as though they are not receiving accurate or sufficient amount s of information about sex through school programs and parents, the media become their primary source of infor mation about sex (Garner, et al., 1998). In one study, Georgia et al., (2006) found that Latino students between the ages of 1418 received most of their sexual information from the media. The students were able to identify the differences between sexual health facts taught in schools and the medias inaccurate portrayals, yet still felt pressured to participate in media influenced sexual activities The Latino adolescents admitted that sex portrayals in the media desensitized them to the risk of sexual ac tivities and increased their likelihood to engage in these behaviors. The students perceived that sex sells everything and acknowledged this as a pressure to expect the same behavior from friends and partners (Georgia, et al., 2006, p.64). This study ill ustrates how the media reinforce and teach teens in the United States how to engage in numerous sexual behaviors. With such a large array of media outlets available and given the amount of time adolescents spend with these outlets; including magazines, t elevision, movies, and music, it is no wonder adolescents are affected by the medias portrayal of sex. The average adolescent spends up to half of his or her time awake engaged in some form of media use (Brown, et al., 2002). Multiple studies have been co nducted that show a strong relationship between an adolescents sexual media diet and the likelihood of engaging in sexual relations (Brown, 2006). However, these types of media do not always offer adolescents the ability to search for information in a

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22 con venient, fast, free, and private environment. This can deter teens from using these types of media and encourage them to use the Internet. Nevertheless, adolescents are receiving direct and indirect sexual health and non-health related information on a dai ly basis from the media. With the Internet becoming a staple in the lives of adolescents, combined with the increasing concern about sexual health amongst teens, it is crucial to understand how the newest form of media is being used to search for this type of sensitive information, whether it is to inquire about information initially acquired from the radio, television, magazines, music or movies, or to search for personal sexual health information. Researching Health Information Online The trend of using mainstream media, such as the Internet, to search for health related information is quickly growing among secondand third -generation Latinos. The Internet has become a widely used source of information among adolescents between the a ges of 1217. Betwe en 75 and 83% of adolescents have Internet access at home, and almost all teens have Internet access at school (Rideout, 2002; Kanuga, et al., 2004; Borzekowski, et al., 2001). According to the Pew Internet and Ame rican Life Project, in 2005, 87% of U.S. a dolescents used the Internet on a consistent basis. Of this percentage, 31% used the Internet to look up health informat ion, a 5% increase since 2000 (Lenhart, et al., 2005). Eighty-nine percent of Englishspeaking Latino adolescents reported spending f re e time online, compared to 77% of African Americans teens (Lenhart, et al., 2005). This survey also showed that adolescent girls used the Internet to look for health -related information more frequently than boys (Lenhart, et al., 2005). Girls between the a ges of 1517 (34%) were more likely than boys (18%) and younger girls, those between the ages of 1214 (19%), to search online for information on difficult health topic such as drugs, sexual health or depression (Lenhart, et al., 2005). According to a study conducted by the Kaiser Family Foundation, adolescents seeking health information commonly research

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23 topics on sexual health issues, drug and alcohol abuse, sexual assault, and weight loss (Rideout, 2002; Skinner, et al., 2003). In particular, when resear ching sexual health, adolescents generally look for information on birth control, pregnancy, STIs, and HIV (Rideout, 2002). Advantages and Disadvantages The appeal of using the Internet to gather information on a sensitive subject, such as reproductive h ealth information include s the ability to ask questions anonymously free access, the ability to find varying opinions, knowing who produced the information, convenience, and the ability to find people in similar situations (Rideout, 2002). Discussing inf ormation with peers in similar situations is more commonly found among females (73%) than males (63%) (Rideout, 2002). Rather than just discussing the information, African-Americans (52%) are more likely to change their behaviors based on the information t hey learn from their queries, unlike Hispanics (42%) and nonHispanic whites (37%) (Rideout, 2002). The Internet provides an easy and accessible way for teens to search for sexual health information without the teens having to confront their parents about the relatively sensitive topic of sexual health (Kanuga, et al., 2004). Not surprisingly, adolescents with Internet access in the privacy of their bedroom s are 10% more likely to search for health information than those without Internet access (Rideout, 2 002). Nevertheless, there are many disadvantages and concerns associated with adolescents searching online for reproductive health information. According to a study conducted by t he Kaiser Family Foundation, 70% of adolescents between the ages of 15 17 a re unintentionally exposed to pornographic Web sites when searching for sexual health information (Rideout, 2002). Pornographic exposure usually occurs accidentally and frequently due to the ease of mistakenly typing a URL. Kanuga, et al., (2004) gives var ious examples of Web sites that are educational sources, but if mistyped direct Internet users directed to a pornographic site. For example, the Teen -to Teen Sexuality Education Project, affiliated with Rutgers University,

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24 produces www.sx etc.org a reputab le sexual health site for teens ; however, a simple mix up of the words will lead teens to sexetc.com, a portal for pornographic sites. The frequency of adolescents being exposed to available online pornography is concerning. Exposure to pornography also ea sily occurs when teens typ e any word associated with sex in any search engine (Flowers Coulson et al., 2000), especially since adolescents commonly look for information by using one -word search terms (Skinner, et al., 2003) According to Zillman (2000), ad olescents who are frequently exposed to pornography have a distorted view of sexuality because sodomy, group sex, and bestiality are among some of the more typical behaviors portrayed through pornographic Web sites Adolescent who commonly are exposed to p ornography engage in earlier sexual activity and develop unrealistic expectations about male and female relationships (Benedek & Brown, 1999). There are also speculations that link pornography use with cynicism about mon ogamous relationships and love (Zill man, 2000). Additionally, the ease of finding chat rooms, instant messaging services and Web sites to discuss sexual health topics facilitates unwanted sexual encounters and sexual exploitation (Kanuga, et al., 2004; Skinner, et al., 2003). The Internet fa cilitates sexual encounters through chatting and dating services more easily because users can connect with like-minded people instantly and anonymously (Rietmeijer, et al., 2001). In a study conducted by Gross (2004), adolescents occasionally pretended to be a person of another sex, identity, and/or age while interacting with a friend or unknown individual online. However, the concern is not the online interaction but the face -to -face interaction that may potentially follow. In a study conducted by Rietm eijer et al., (2001) individuals who actively sought sex on the Internet had more sex partners than individuals who did not search for sex onlin e. The study also found that 65% of the individuals who sought sex online actually had sexual encounters with t he desired partner and

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25 only 44% used a condom. These statistics draw attention to the risks to adolescents who already actively engage in unprotected sex and believe themselves to be invincible (Rietmeijer, et al., 2001). Sexual exploitation is also a conc ern for adolescent s who use alternate personas in chat rooms and inadvertently i nteract with sexual predators. There have been an abundance of cases in which sexual offenders have used the Internet to exchange child pornography as well as seduce and locate children for sexually abusive intentions (Quayle & Taylor, 2001). Conversely, the ease of using Web sites that provide questionand answer services ( via instant messaging) have proven to be not only helpful but also successful. In 1996 the no t -for profit organization Campaign For Our Children Inc. (CFOC) created a Web site for the use of individuals interested in receiving more information about sexual health issues (Flowers Coulson et al., 2000). Additionally, a question and answer service was implemente d called Ask the Expert, which focused on answering any questions the public had regarding sexual intercourse, sexually transmitted infections and pregnancy. A nswer s were usually provided within a 24 -hour period and attempted to utilize empirically based information. Unexpectedly, rather than health professionals interested in discussing research and issues related to teen pregnancy concerned adolescents and young adults used the question andanswer service to investigate personal questions (Flowers Coul son et. al., 2000). This example illustrates the usefulness of an anonymous and available sexual health information source. Although carefully designed Web sites maintained by legitimate health-focused organizations may serve as good sources of reproducti ve health information for teens, t he Internet also offers a wealth of information with no screening for accuracy and reduces doctor patient interaction, which may cause information overload and can leave teens with misconceptions about sexual behavior (Rid eout, 2002). Content and quality of information are

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26 frequent concerns for adolescents when searching not only for health information but for all information found online (Rideout 2002; Gray, et al., 2002; Rietmeijer, et al., 2001). The biggest difficulty f or most adolescent s is being able to distinguish between facts and opinion (Gray, et al., 2002). Additionally, most individuals, including most adolescents, usually explore only the first few links offered from a search engine, which may mean they are rely ing on sites promoted based on i ndirect measure s of popularity rather than informational credibility (Eysenbach & Kohler, 2002). Even though there are very few documented cases in which information presented on the Internet has been shown to have caused i mmediate harm, there is still a great potential for these types of incidents (Kanuga, et al., 2004). Despite increasing use of the Internet for health information, adolescents still reported greater trust in health information received from television (76 %) and newspapers (72%) than through the Internet (40%) (Rideout, 2002). Lastly, d octor -patient interactions are also changing with the increased use of the Internet to seek health information. It is believed that the use of the Internet to self diagnose minor problems may not only decrease health care cost s but also will encourage patients to be more proactive in their healthcare management (Levy & Strombeck, 2002). In the 2000 a U.S. Census Bureau survey, 48% of online health seekers reported that the i nformation they found online had improved the way they took care of themselves, 55% said access to the Internet had improved the way they received medical and health information, and 81% said they had learned something new. Additionally, 70% reported being influenced by information gathered on how to treat a specific illness or condition during a final decision, and 50% of the respondents asked doctors new questions and even decided to get a second opinion.

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27 Even though there are many disadvantages associa ted with the Internet, it facilitates access to health information that individuals of all ages might find harder to obtain through a physician because of lack of time, lack of insurance or the individuals embarrassment about asking questions, especially related to sensitive topics such as sex. The Internet allows individuals to search for information on topics that would otherwise be ignored, such as sexually transmitted diseases, sexuality, pregnancy, etc, in an anonymous and timely manner. The informati on provided from the Internet also can serve as a supplement to information previously obtained from a physician or peer. Internet Behaviors of Adolescents Adolescents use varying types of resources depending on the health information for which they ar e searching (Gray, et al., 2005). According to a study conducted in 2001, girls (58.4%) were more likely than boys (41.7%) to identify their mothers as the primary source for health -related information (Ackard & Neumark -Sztainer, 2001; Gray, e t al., 2002). However, younger boys and girls attending fifth and sixth grades were more likely than older boys and girls attending tenth, eleventh and twelfth grades to ask their mothers about information concerning health issues. Physicians located in both schools and hospitals were also regularly identified as a source of health information, even though only about 23.9% of boys and 18.2% of girls used this resource (Gray, e t al., 2002) Despite the fact that these adolescents used both mothers and physicians to gathe r health -related information, some additional topics such as drugs, sexually transmitted infections, alcohol use, and eating behaviors were not discussed as desired by the teens. Borzekowski, et al., (2001) found that adolescents also commonly used magazines, health campaigns, and friends as additional resources for health information. Interestingly, males and females differed on the sources they used to search for information concerning sex, diet/nutrition, dating, and violence (Borzekowski et al., 2001). Females often used friends,

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28 magazines, books, physicians, and the Internet when gathering information on healthrelated issues, unlike males, who turned to religious leaders, health classes, and the Internet for the same health -related information (Borzeko wski et al., 2001). In the same study, both female and male adolescents accessed sex related (42.1%) information on the Internet more than any other topic. Information about sexually transmitted infections (37%) also was regularly accessed. However, females rated the information accessed via the Internet regarding pregnancy, birth control, sexual abuse, and dating violence as more valuable and useful than males (Borzekowski et al., 2001). Adolescents lack the confidence or time to discuss these issues with physicians, friends, or parents, which makes them more likely to turn to a more anonymous and readily accessible source like the Internet (Ackard & Neumark Sztainer, 2001; Borzekowski et al., 2001; Skinner, et al., 2003) Adolescents typically use search engines to locate health information online, even though only a small percentage find information while surfing the Web (Rideout, 2002). The most popular search engines in the 2002 study conducted by the Kaiser Family Foundation were Yahoo! (42%), Google (10%), AOL (8%), and MSN (8%) (Rideout, 2002). Rather than using a medical portal to search for health information, individuals typically use search engines in an effort to locate pertinent Web sites (Eysenbach & Kohler, 2002). Some individuals are even in clined to guess the URL of potential Web sites (Eysenbach & Kohler, 2002). Even though adolescents search for health information by using a similar method, they often encounter more difficulty when accessing sensitive health related issues. In a focus -grou p study conducted in Great Britain, 13 females were asked about the accessibility and ease of researching information through search engines on public computers (Gray, et al., 2002). The females encountered difficulties when trying to access information on HIV and sexual health because many of the

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29 sites were automatically blocked by filters on both school and library computers (Gray, et al., 2002; Flowers Coulson, et al., 2000). For adolescents, the Internet is not only a convenient and anonymous source to gather information ; it is a vital part of their daily lives (Ackard & Neumark Sztainer, 2001). Students talked about the Internet as an important source fitting comfortably into the context of their everyday life, and their surrounding media environment (Ackard & Neu mark Sztainer, 2001, p. 1471). One older teen boy explained, My computers right next to my TV, so I just do both at the same time! (as cited in Ackard & Neumark Sztainer, 2001, p. 1471). Adolescents engage in various forms of media use at t he same time (e.g. telephone, television, and computer), and also multi -task while online ( e.g. research information, play games, ins t ant messaging) (Gross, 2004). I prefer to communicate with my friends online because that way, I can talk to them while d oing other stuff online. When youre talking to them in person or on the phone, it seems rude to be doing something else because they notice and you get distracted (as cited in Gross, 2004, p. 641). One study ( Skinner, et al., 2003) suggests that adolesce nts use the Internet for five main reason s, including e ntertainment (e.g. finding information about personal interests, chat rooms, playing games), information (e.g. school work), communication (e.g. interac ting with friends and strangers), o rganization (e .g. projects and organizing people/events), and support (e.g. connecting with others to give or receive support). Adolescents typically take an active approach when searching for health information online (Ackard & Neumark Sztainer, 2001; Gray, e t al., 200 2 ). Even though most respondents in the 2001 Ackard and Neumark -Sztainer study were actively seeking health information, they were skeptical about the information they gathered (as cited in Skinner, et al., 2003) Most respondents believed that the Interne t was a good source to find information on minor health

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30 issues, but did not find it a credible source to answer questions about life threatening diseases. Youre not going to go on the I nternet if you have cancer If youve got a big tumo r or something, youre not going to go online to fix it! But if you have like problems like I dont know, your cuticles are cracking like Ill go online Ill see if they have remedies for bad cuticles or something [US female, 16 18 years] (as cited in Ackard & Neumark Szt ainer 2001, p. 1472). Ackard and Neumark -Sztainer suggest that the reasons adolescents search for health information online is for themselves or a member of their social circle and to research subjects for school health classes (2001, p. 1475) Summar y and Research Questions There is no doubt that the Internet is becoming the new medium for adolescents, especially females, to gather sensitive information regarding reproductive health. With such a large proportion of Latino adolescents who use the Int ernet in their daily lives, compared to non Hispanic whites and African Americans (Lenhart, et al., 2005) it is very possible that this cultur al group is using the Internet to search for information on reproductive health. However, very few studies have b een conducted that explore how adolescent girls use the Internet to gather reproductive health information. Furthermore, no studies have been conducted that explore how Latina adolescents use the Internet to gather reproductive health information. Learning how, why and when Latina adolescents are using the Internet to search for reproductive health information can be useful in the development of future campaigns, programs and Web sites that are appealing to this specific culture and age group. The main r esearch question that will examine Latina adolescents use of the Internet for reproductive health information is:

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31 RQ 1: What role if any, does the Internet play in Latina adolescents search for reproductive health information? RQ 1A: To what extent do Latina adolescents use the Internet to gather reproductive health information? RQ 1B: What prompts Latina adolescents to search for reproductive health information on the Internet? RQ 1C: When Latina adolescents search for reproductive health information on the Int ernet, how do they decide what W eb sites to visit? RQ 1D: What aspects of a W eb site containing reproductive health information are appealing to Latina adolescents? RQ 1E: What criteria do Latina adolescents use to determine the credibility of a W eb site that contains reproductive health information? RQ 1F: Do Latina adolescents discuss the informa tion found on these W eb sites with peers, parents, siblings, medical professionals, etc.?

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32 CHAPTER 3 METHODS Resear ch questions for this study wer e designed to help the researcher gain insight into Latina adolescents behaviors and attitudes toward reproductive health information located online. These questions were meant to investigate the criteria that Latina adolescents use while searching for he lpful reproductive health information. Due to the complex nature of topics related to reproductive health it was most appropriate to use a qualitative research method Qualitative research, as defined by Creswell (2007), attempts to investigate problems b y probing the meaning of individuals human and social interactions. Qualitative researchers use these social interactions to collect data in a natural setting sensitive to people and places under study and data analysis that is inductive and establishes patterns and/or themes (Creswell, 2007, p. 37). Latina adolescents are a diverse group representing a spectrum of different socio -economic standards, generations, education levels, and degrees of acculturation and technology availability, amon g others. Th is diversity can only be encapsulated by including the voices of participants, complex description an d interpretation of the problem, as well as the reflexivity of the researcher (Creswell, 2007, p. 37). In order to understand the complex issue of Lat inas use of the Internet and the process of researching sexual health information, it was essential to understand the topic using personal accounts to obtain thick description (Gertz, 1973). To understand the context of the problem and t o investigate th e behaviors and attitudes of these adolesce nts, this study used focus groups and in -depth interviews to collect substantial data. Grounded theory was used to guide the researcher in data analy sis. Triangulation was achieved in this study by using both f ocus groups and in-depth interviews. Triangulation compares and contrasts two or more forms of evidence with the goal

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33 of reaching convergence (Lindlof & Taylor, 2002). If data from two or more methods seem to converge on a common explanation, the biases of the individual methods are thought to cancel out and validation of the claim is enhanced (Lindlof & Talyor, 2002, p. 240). Triangulation adds confidence to the interpretation of research data and it can stimulate the creation of inventive methods (J ick, 1979, p.608). Grounded Theory Due to the lack of research thus far on how adolescents, especially Latinas, use the Internet to gather sexual heath information, it was not appropriate to use a theoretical perspective that would lead to hypotheses (Gra y, et al., 2002; Skinner, et al., 2003) Instead, grounded theory, a qualitative research design in which the inquirer generates a general explanation (a theory) of a process, action, or interaction by the views of a large number of participants, (Creswe ll, 2007, p. 63) was the most suitable framework. Therefore, qualitative research is the means required to develop theory and formulate conceptual parameters (Creswell, 2007). Barney Glaser and Anselm Strauss first introduced grounded theory with the basi c premise of generating a theory by using a zigzag approach of gathering data, analyzing data, obtaining more data, analyzing the newly gathered data, and so forth (Creswell, 2007). Grounded theory is arrived at by analyzing data using the constant -compa rative method, which constantly compares new data to existing and emergin g categories (Creswell, 2007). In order to apply grounded theory, the data must be readily understandable, closely fit the substantive area, sufficiently general to apply to a multit ude of diverse daily situations within the substantive area, must allow the user partial control over the structure, and the process of daily situations as they change through time (Glaser & Strauss, 1967, p. 237). The constant -comparative method has beco me an influential model for qualitative data analysis due to the extensive coding process it entails. Open coding, axial coding, and dimensionalization, which involves shaping definitions to

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34 identify themes, force researche r s to revise and reshape categori es to conceptualize deeper meanings and reach theoretical saturation (Lindlof & Taylor, 2002; Glaser & Strauss, 1976). This is an inductive method of theory development. To make theoretical sense of so much diversity in the data, the analyst is forced t o develop ideas on a level of generality higher in conceptual abstraction than the qualitative material being analyzed ( Glaser & Strauss, 1976, p. 114). Focus Groups The f ocus group is a type of data collection in which the research er determines the topi c, and data are collected through group interactions (Morgan, 1997). According to Morgan (1997), the main advantage of focus groups as a means of qualitative research is the opportunity to observe a large group of individuals in a limited amount of time. T his makes qualitative research a much more efficient means of gathering data from a group of participants. For example, two eight person focus groups can produce as many significant ideas as ten individual interviews (Fernz, 1982). Even though participant observation has several advantages, such as a greater variety of interactions and more open discussion, its prevailing disadvantage is the difficulty in locating and gaining access to settings in which a substantial set of observations can be collected on the topic of interest (Morgan, 1997, p. 9). By using focus groups, interviewers are able to study individuals in a more natural social setting than in one -on-one interviews (Marshall et al., 1999; Morgan, 1997 ). With the ability to observe participants i n social groups unexpected issues can arise and add to the pool of knowledge. Especially when complicated topics are being discussed focus groups can uncover factors that influence opinions, behaviors, and/or motivators of a homogeneous group by creating a permissive environment that encourages participation (Kruger & Casey, 2000). Focus groups are especially useful when trying to uncover habit ridden or not thought out in detail information (Morgan, 1997) which likely is an accurate

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35 description of Latina adolescents use of the Internet for reproductive health information According to Schiffner et al., (2006), focus groups are a comfortable scenario for Latinas to discuss personal sexual experiences in a culturally sensitive environment (p. 695). F urthermore, focus groups have proven to be successful when discussing topics that are highly controversial, such as family planning or sexually transmitted diseases (Knodel et al., 1984; OBrien, 1993). Focus groups are low in cost and can provide informat ion in a timely manner. The overall benefits of focus groups are the interactions that generally disclose real experiences and perspectives that otherwise would not be accessible without this group dynamic (Morgan, 1997). Selecting appropriate research p articipants purposefully diminished generalizability and bias because participants were selected from a limited and non random source (Morgan, 1997). According to Krueger and Casey (2000) a group size of six to ten participants is recommended for focus gr oups, but groups can range from four to 12 as long as the participants are in a comfortable and nonthreatening environment (Morgan, 1997). Additionally, Kruger and Casey (2000) recommend conducting at least three focus groups with similar participants. Ho wever, Morgan (1988) recommends five focus groups. For th ese reasons, the researchers original intent was to recruit six to eight participants for each focus group, which would be divided among older and younger teens, those ages 14 16 and those ages 17 1 8 with three focus groups for each age division. However, focus groups of six to eight participants were not possible to conduct due to the varying locations from which the teens were drawn and their conflicting schedules. Instead focus groups were conduc ted with small groups composed of 24 participants divided among older and younger teens.

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36 A total of seven focus groups were conducted, totaling 23 participants. Thirteen participants were between the ages of 14 16 and 10 participants were between the ag es of 17 18. Because adolescent girls between the ages of 1517 are more likely than younger girls to search online for information on sexual health (Lenhart, et al., 2005) Latina adolescents between the ages of 1418 were recruited for this study. Howe ver, because a study conducted in 2006 (Georgia et al.) found that Latino students between the ages of 1418 received most of their sexual information from the media 14 -year -old Latina adolescents were also included in this study. In addition, given that the highest numbers of unintended pregnancies occur to Latina adolescents between the ages of 15 19 (Vexler, 2007), 18 year old Latina adolescents also were included ; all participants, then, were 14 18 years old Separating the groups by age helped to create a comfortable, nonthreatening atmosphere within the different age groups. According to Krueger and Casey (2000), individuals are more likely to disclose information about themselves when they perceive that they share common characteristics with other group members, such as gender, age, ethnicity, occupation, etc. In a study conducted by Jourard (1964), subjects tended to disclose more about themselves to people who resembled them in various ways than to people who differ from them (p.15). This is als o known as segmentation, which can be used to carefully compose groups of homogenous participants (Morgan, 1997). Homogeneity in groups allows for more free -flowing discussion among participants and facilitates analyses that examine differences in perspectives between groups (Morgan, 1997, p. 35), in this case the 14to 16 year -olds and 17 to 18 -year -olds. Eligibility for this study required that the girls were of Hispanic decent and spoke English. In -depth Interviews In -depth interviews share a simi lar advantage to participant observation in that both methods allow the researcher to obtain more detailed information from each participant.

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37 However, individual interviews permit the researcher to have a great deal of control during the session, which can lead to more probing and in depth discussions (Morgan, 1997). In -depth interviews allow the researcher to collect data in the form of words that can only be uttered by someone who has been there or is there (Li ndlof & Taylor, 2002, p. 173). This int eraction is also known as experiential knowledge, which is embodied in the form of anecdotes and detailed accounts (Lindlof & Taylor, 2002). In -depth interviews can follow many styles and formats. For this research the most appropriate style for the in depth interviews was the combination of a cultural format and topical format. Cultural interviews explore shared meanings of members in a specific group (Rubin & Rubin, 1995), in this case professionals who work with Latina adolescent s An interviewer lea rns about the culture by eliciting examples and stories that reveal how people understand their world (Rubin & Rubin, 1995, p. 28). Cultural interviewing utilizes a more relaxed style, which allows participants to tell more extensive stories (Rubin & Rubi n, 1995). Conversely, topical interviewing has pre -determined topics and subjects that search for explanations and description of processes (Rubin & Rubin, 1995). The interviewer led the discussion and kept the discussion within a specific area, following a discussion guide developed for the study. Even though cultural and topical interviews differ slightly in the process of reporting results, they both report the expressions of the participants and interpret the meanings within a larger context (Rubin & Ru bin, 1995). It is not only important to understand the specific topic of Internet use for sexual health information but also the cultural interaction s that surround this issue

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38 As recommended by Rubin and Rubin (1995) encultured informants should b e selected for in -depth interviews because they have an extensive understanding about the culture and can articulate information for the purpose of research. For this reason educators who were immersed in the Latino culture were the most suitable particip ants for this study. As recommended by Kvale (1996), no pre -determined number of participants was set for the in -depth interviews. Even though many studies consider 10 15 participants to be a sufficient number of individuals to interview (Kvale, 1996), i t is difficult to set a specific number of participants because qualitative research is defined by gathering information until the point of saturation is reached (Morgan, 1997; Glaser & Strauss, 1967). Saturation is the point when additional data collect ed no longer provides new understanding ( Morgan, 1997; Glaser & Strauss, 1967). In this study, the researcher felt that the information gathered had reached the point of saturation after five interviews. In order to get the most comprehensive, honest and extensive interview s participants should feel relaxed and comfortable in the chosen environment (Lindlof & Taylor, 2002). A private, interruption -free and neutral site should be selected. Lindlof and Taylor (2002) even recommend allowing the participants to choo se the location for the interview, with the possibility of viewing the participants in a more natural environment, such as their office, locations where they normally meet the Latina adolescents, etc., that can prompt daily non verbal characteristi cs that w ould not otherwise be visible. For these reasons, all interviews were conducted in the participants work office s Method of Data Collection Focus group participants were recruited from the Orlando and Sarasota YMCA Achievers Program This progra m encourages the continuous growth of Hispanic youth in the areas of personal development, college preparation, community service and leadership, cultural

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39 enrichment, and recreation. Participants were also recruited from Ignite Life Center, a church youth group, and La Casita a Hispanic Latino Cultural Institute, both located in Gainesville. The areas of Orlando, Sarasota, and Gainesville were chosen in order to get a more diverse sample of Latina adolescents in North Central Florida. Because homogeneity w as important to achieve in each focus group, Latina participants were screened prior to participation. However, participants were not asked questions about their sexual behavior prior to the focus group. To assure focus group participants with similar expe rtise levels were interviewed at the same time, participants who were recruited from specific locations were grouped together. Screening questions were used to determine whether p otential participants were between the ages of 14 and 18, used the Internet on a weekly basis, and had a parent or legal guardian willing to sign the informed consent form Random selection was not used because a specific population was needed to investigate the topic and random sampling would slow the timeline for conducting foc us groups. For this reason convenience sampling was used Participants received a $5 Target gift card for participation. Additionally, refreshments were provided during the focus groups. Participants for the in -depth interviews were recruited from the Y MCA Achievers Program, Planned Parenthood and Ignite Life Center. The YMCA Achievers Program employs educators who coordinate community based workshops, after -school activities, and track the academic, community service, and personal development progress of each Hispanic teen enrolled in the program. Participants were interviewed from the Sarasota and the Deltona YMCA Achievers Program. The Sarasota Planned Parenthood clinic employs sexual -health educators who conduct middle and high school workshops in the Sarasota area, as well as conduct ing various sexual health series workshop for the Hispanic youth in the YMCA Achievers Program.

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40 The Ignite Life Center is a local ministry that that employs educators who conduct youth camps, youth conferences, inner city outreaches and religion classes for adolescents and young adults. Participants for the in -depth interviews were not screened because the only prerequisite for participation in the in -depth interviews was to be associated with Latina adolescents through the YMCA Achievers Program, Planned Parenthood or Ignite Life Center Participants were required to sign an informed consent form. Compensation was not given to the in depth interview participants because it was expected that the mission of the organization p roviding interview participants would be consistent with the purpose of this study Question Guide Two separate question guides were used for focus groups and in -depth interviews ; both were developed using the research questions as a guide Both questio n guides were organized into sections containing questions that were ordered from general to specific as recommended by Stewart and Shamdasani (1990). For example, in the focus group question guide, the first section asked participants general questions a bout their media use and information gathering process es For the in -depth interviews, the first section examined characteristics of the Latina adolescents with w hom the participants interact. Beginning with general questions such as these helped the resea rcher establish rapport with both sets of participants. The latter sections of the guides became more specific, yet still used nondirective questions to encourage participants to share their experiences in order to educate the researcher by pointing out the key features the routines, rituals, procedures, dramatis personae, cycles of group activity, socialization paths, and so forth (Lindlof & Taylor, 2002, p. 197). This is also known as a grand -tour question. Within these grand -tour questions are mini -tour questions that go into more depth and detail about the overarching topic or experience ( Lindlof & Taylor, 2002). Additionally, probing questions such as why, how, and where were included in the

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41 different sections to encourage participants to think be yond the general experience and offer more detail. These probing questions also slowed down potential participants who were answering to o quickly and really not thinking through the process (Lind l of & Taylor, 2002; Stewart & Shamdasani, 1990). The questi ons for the focus group guide asked participants to explain how they felt regarding the topic of reproductive health, how they defined the concept for themselves, and how they used sexual health information they had gathered. These questions were followed by more specific questions concerning the credibility, use, and participants experiences of using the Internet as a source to research reproductive health. The questions in the in -depth interview guide asked educators to describe their curriculum, their u se of the Internet to create the curriculum, how they defined reproductive health, and how reproductive health was included in the interactions with the Latina adolescents. Additionally, the in -depth interview guide asked questions directly concerning the observations of the educators. The final section in each question guide consisted of questions about how reproductive health information was located, and the personal interactions that participants and educators had after information regarding reproductive health was researched. These questions were placed at the end of the guides, as recommended by Lind lo f and Taylor (2002), because it was crucial to develop some trust before participants felt comfortable sharing personal information. (See Appendix A.) E ach question guide was pre -tested with three individuals prior to the first focus group and in -depth interviews to determine whether the wording of the questions was appropriate, made sense, and flowed nicely. Additionally, the researcher revised the guide slightly after the first few focus groups and interviews to ensure the questions were gathering germane data.

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42 Means of Data Collection Each focus group and interview lasted approximately 45 60 minutes and was videotaped. Using videotapes as a method of data collection carries with it certain ethical concerns. However, it is impossible for the principal investigator to serve as the moderator for the focus groups and the interviewer for the in -depth interview s while taking detailed notes. For this reason a videotape was necessary to allow the principal investigator to be an objective moderator and interviewer as well as capable of analyzing the data with great scrutiny and accuracy after the completion of the focus groups and interviews. Videotaping the focus groups and interviews can free up investigators to participate more fully in the interview (Lind lo f & Taylor, 2002, p. 187). T he disadvantage of using a video recorder during focus groups and interviews is the possibility that participants may expres s themselves for the purpose of the recording rather than for the interview (Lindlof & Taylor, 2002). Participants may feel self -conscious about the video recorder but this barrier can be overcome by creating a comfortable, non-threatening, and stimulatin g environment in which participants forget they are being recorded and become engaged in the discussion (Stewart & Shamdasani, 1990). It is also vital that the moderator builds rapport with the participants and explains the value of taping the focus group s and interviews. Explaining the value of the tape recorder and the purpose of the study occurred during the scripted introduction. The scripted introduction reassured participants of their confidentiality introduced the ground rules, set the agenda for th e session, and reinforced the value of differing opinions (Stewart & Shamdasani, 1990). However, when stating the purpose of the study, a funneling approach was used. As stated by Stewart and Shamdasani, (1990), the funneling approach introduces the topic in a general format and asks more topic -specific questions toward the end.

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43 This enables the researcher to introduce the topic without revealing the specific issues attached to the subject. It also determines whether the focus of the study is important enough for participants to bring it up during their answers and discussions (Stewart & Shamdasani, 1990). To begin establishing rapport with focus group respondents, a scripted introduction was used Immediately following the moderator introduction, respondents were asked to introduce themselves. Introduction of group members is often a good way to get sense of the group make up and to ease participants (Stewart & Shamdasani, 1990; Lidolf & Taylor, 2002). Once introductions were completed direct questions w ere asked of each participant about their media use in order to ensure participation. This technique was only used during the first section of questions and changed to an open -forum format to make certain that only participants who felt comfortable answeri ng questions did so. The moderator was also aware of experts and influentials, dominant talkers, disruptive participants, ramblers and wander er s, and shy participants during the focus group (Krueger & Morgan, 1997). Experts and influentials often perceive themselves as being very knowledgeable in the subject matter being discussed and domina te the conversa tion (Krueger & Morgan, 1997). When an expert or dominant talker was present in the focus group the moderator would turn away from the dominant talker a nd ask other individuals their opinion, while emphasizing the importance of hearing varying opinions (Krueger & Morgan, 1997). Disruptive participants usually interrupt others, believe their opinions are superior to those of other participants, and are offensive (Krueger & Morgan, 1997). Ramblers and wander er s usually use many words to express a point or just feel a necessity to speak with no real po int (Krueger & Morgan, 1997). When a rambler or wander er was present in the focus group the moderator would d iscontinue

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4 4 eye contact with the rambler after 30 seconds and as soon as the rambler took a breath the moderator would ask other participants to pitc h in (Krueger & Morgan, 1997). Lastly, shy participants tend to stay quiet and speak softly (Krueger & Morga n, 1997). To discourage shy participants from reaming quiet, the moderator attempt ed to place the shy individuals directly across for maximum eye contact (Krueger & Morgan, 1997). In addition, the moderator would directly ask the participant her opinion (K rueger & Morgan, 1997). To establish rapport with interview participants, a scripted introduction was used, followed by general questions regarding the type of job each interviewee perform ed U sing participant self -disclosure (Lindlof & Taylor, 2002), p articipants would be asked general questions about the characteristics of the adolescents with whom they normally interacted. This type of informal opening gave a general idea to the participants how informal the interview would be and helped encourage par ticipants to be honest and forthcoming (Lindlof & Taylor, 2002). Personal appearance can also help or hinder the moderator in establishing rapport. According to Lindlo f and Taylor (2002), interviewers should demonstrate positive and nonjudgmental express ions. Additionally, attire should also be carefully considered depending on the demographic of the participants. In this case the researcher dressed in jeans, a t -shirt, and a ponytail to demonstrate a casual and friendly demeanor This created a comfort able interactio n with both sets of participants Methods of Data Analysis The first step in analyzing data collected from a qualitative study is transcription. The purpose of transcribing focus groups and in-depth interviews initially is to fill gaps as well as to edit odd phrases. The risk of editing transcriptions is the possible loss of flow and group interaction ( Stewart & Shamdasani, 1990). However, editing increases readability and enhances

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45 the ability for the researcher to identify themes (Stewart & Shamdasani, 1990). Nevertheless, it is important to keep the character of the respondents comments (p. 104) even when poor grammar is used (Stewart & Shamdasani, 1990). Transcription occurred immediately after each focus group and in-depth interview, rather than waiting until all interviews were completed. Once all transcriptions were finished, data analysis was used to label and break down raw data in order to convert them into patterns, themes and conce pts (Lindlof & Talyor, 2002). The method of da ta analysis that was used was the constant comparative approach. The first step involved open coding, which requires t he researcher to examine the transcripts for significant categories supported by the text (Creswell, 2007). Following open coding, the int egration process utilized axial coding to begin forming connections between categories to create possible causal themes (Lindlof & Taylor, 2002). Axial coding used codes that connected and combined previous categories and thus created a new category or a t heme that covered many catego ries (Lindlof & Taylor, 2002). Axial coding allowed for flexibility to create unforeseen categories that could add to the emerging theory (Lindlof & Taylor, 2002). During the final stages of analysis integration and dimensiona lization were used to reshape the categories for the purpose of producing deeper meanings (Lindlof & Taylor, 2002). Dimensionalization further refined the categories to develop a relationship between data and categories to formulate suitable constructs (Lindlof & Taylor, 2002). Once all categories had been defined, the researcher was able to establish additional links between the categories, which were not previously visible. Toward the end of the analysis, member checks were also conducted to assure int erpretative validation (Lindlof, 1995). Member checks are primarily made up of critiques from individuals who are directly involved with the targeted group (i.e. insiders) and not directly involved with the targeted group (i.e. outsiders). The purpose of the member checks is to infer

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46 new information and insights that can be added to the established database for further interpretation (Lindl of, 1995; Bloor, et al, 2001). For the purpose of this research, focus group participants and in -depth interview parti cipants were contacted. Even though both focus group and in -depth interview participants were considered insiders for this research, the in -depth interviewees played the role of outsiders in their daily role as sexual health educators and were able to interpret the gathered information with an external viewpoint.

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47 CHAPTER 4 RESULTS Study participants were recruited in Spring 2009, primarily through a cold calling method. The researcher was aware of a YMCA program that targeted Hispanic youth and conta cted each program director in the area of North Central Florida. Two YMCA s in the Sarasota and Orlando area had enough Latina participants to enable the researcher to conduct four focus groups. Because the researcher wanted a larger representation of Latin a adolescents in the North Central Florida area, Gainesville church youth groups and the Hispanic -Latino Cultural Institute were contacted, which led to three more focus groups. In -depth interviews were conducted with educators from the YMCA Planned Parenthood and church youth group programs, who directly worked with the participants in the focus groups. Focus group participants were between the ages of 14 18 and were predominantly in high school with the exception of one 14-year old participant who was in middle school and three 18 year -old participants who were in college. The focus group participants identified themselves as citizens from the United States whose parents were born in Mexico, Argentina, Columbia, Ecuador, Puerto Rico, Cuba, El Salvador or Chile. S even focus groups were conducted, three with young Latina adolescents and four with older Latina adolescents. Even though the researcher had planned for the older participant groups to be composed of Latina adolescents between the ages of 1718, in three focus groups of older participants, one girl was 16 years old. In all three situations the 16 year -old girl was a junior in high school making her of the same comfort and maturity level as the other participants who were 17 or 18 and were juni ors and seniors in high school or freshmen in college. Five in depth interviews were conducted with educators all of whom were women. Two women were from Mexico and two women were from Puerto Rico. Only one of the in -depth

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48 participants had been born in the United States. For more demographic information on interview and focus group participants please refer to Appendix D Focus groups were conducted in small conference rooms located in the establishments of each organization from whi ch participants we re recruited. However, in -depth interviews were conducted either over the phone or in the offices of each educator. All focus groups and interviews were recorded to ensure maximum level of accurateness in transcription. A sample focus group tra nscript is l ocated in Appen dix B and a sample interview transcript is located in Appendix C Focus groups and in -depth interviews followed different question guides in order to get two perspectives on the media usages of Latina adolescents when concerning re producti ve health information. A sample of these g uides can be found in Appendix A In order to assure confidentiality, all participants names were removed from the transcripts and were replaced by pseudo names which will be used to reference the quotes of par ticipants in Chapters 4 and 5. In -depth interview participants are identified with an alphanumeric code, I001 through I005. A brief description of the each participant is available in Appendix C. Results collected from the interviews and focus groups wer e analyzed together and collapsed to examine the role the Internet plays in Latina adolescents search for reproductive health information. The results section has been organized into two main parts. First, themes will be discussed using supportive quotes from participants. Then these themes will be used to answer the research questions previously stated.

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49 Using the constant comparative method, four themes were identified to explain how and why Latina adolescents are using the Internet to search for reproductive health information. These themes were Convenience, Credibility Motivation and Distrust Convenience The Convenience theme was found primarily among participants who used the Internet to search for any type of information, not particular to repro ductive health, due to the degree of ease. All participants, regardless of age, believed the Internet was a convenient source for gathering information mostly because the search could be done quickly, at any location, in private, and without the searcher having any previous knowledge of the topic Older participants in focus groups # 1, 2, 5, and 6 had used the Internet to search for reproductive health information unlike younger participants in focus groups # 3, 4, and 7. Dialogue with older participants revealed that the reasons the Internet is a convenient source to search specifically for reproductive health information is because it is effortless and private. Effortless One of the main reasons participants used the Internet to search for reproductiv e health information was the sense of effortlessness when gathering information of a sexual nature. Multiple participant s like Anna had a question about reproductive health and was able to find similar questions that had already been answered online: It s easier. You dont have to read a lot. And sometimes the questions you have, they answer for someone else. So its easier to understand what is going on. Various participants used the words easy simple instant, and quick when asked why they would use the Internet to search for reproductive health information. Alicia succinctly explained why she always used the Internet to search for questions relating to reproductive health: It s easy to access ; you can find anything.

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50 Some participants believed t hat the Internet was a continuous source of information that was updated consistently with the most accurate information. Anna considered the Internet an effortless method for gathering information because she did not have to look in other venues for the m ost updated and accurate information: I would say it would be from the Internet because it is very updated. In another instance, Veronica also believed that the information on the Internet was regularly updated causing h er only to look at a couple of W eb sites and not to do an in depth or time -consuming search: I would just read a couple and thats it she said. Privacy One aspect consistently discussed within the terms of convenience was privacy. Approximately half of the participants mentioned pr ivacy as the key reason for searching for reproductive health information online, primarily to avoid conflicts with parents, embarrassment, and discomfort. In this example, Blanca explained that she would rather look up information relating to sex online to avoid unnecessary conflicts with her parents: I guess I would have to look it up. I cant really talk to my parents about it. My parents are really conservative and it s not like my parents would be like they would assume that I am having sex and the y would say W hy do you want to know ? So not my parents. I would look it up online, well so far I have looked it up online. In another discussion, Anna mentioned that she searched for reproductive health information online because she did not want to a sk anyone about a personal sexual health problem she was having: I had a question about my reproductive health and stuff like that. And I went on to Google because I did not want to ask. I wanted to know how much time it would take the herpes disease to appear. This view was also shared by Jessica who looked for personal sexual health questions online: Like in the computer you type the question so its more specific. Its more personal.

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51 All three participants were looking for a sense of comfortabl eness when searching for this type of information online, as Isabel explained: I think you would feel the most comfortable because nobody is there ; its just you and the computer. Even though some participants, such as Stephanie are comfortable speakin g to their mothers about reproductive health she did not want her younger siblings to eavesdrop on her conversation, so she would rather search for information on her computer in the privacy of her room Well, I have three siblings and they are little and I do not want them to hear my conversation, so I will also go online so I can have my privacy. Credibility In addition to the Convenience theme, a second theme was identified when participants were asked why they used the Internet when searching for reproductive health information. The Credibility theme was frequently mentioned when participants discussed how they deciphered whether the information they found online was accurate in terms of reliability, attractiveness, and status. Once again this them e was only found among the participants in focus groups # 1, 2, 5 and 6, who used the Internet on a regular basis to search for reproductive health information. Participants in focus groups # 3, 4, and 7 did not find the Internet to be a credible source s o their answers aligned with a theme of Distrust which will be discussed later. Within the main theme of Credibility, participants answers revealed three subthemes reliability, attractiveness and status. Reliability Reliability was discussed within various aspects of credibility, relating to professional authorit y, and organization trustworthiness Professional a uthority was identified as W eb sites offering information directly from a doctor or clinic. Due to the influence a doctor has in society,

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52 a site recommended by a doctor or in which a doctor was quoted was automatically perceived as accurate. For example Alejandra mentioned that she would have to see the name of a doctor to believe it. Organization trustworthiness is very similar to profes sional authority, with the difference being that the trust comes not from the profession but from the type of organization sponsoring the W eb site, such as an educational institution, a non -profit organization, governmental entity or a recognizable brand. In these quotes three participants mention the importance of organizational identification: (Michelle ) Sometimes you have to look if they are real pages, if they end in org or inc. or something like that. That they are not made up pages from people. The y are from doctors and stuff. (Stephanie ) Yeah anything on the computer can be a lie ; if I find that the W eb site is credible enough like a government seal or something official or like a compan ys W eb site. (Carmen) I believe it [W eb site] if there are names of scientists or colleges. Other than professional authority and organization trustworthiness participant also determine d reliability by comparing multiple sites to obtain a universal answer. Monica explained that by typing a question or word in Google and skimming multiple W eb sites delivered by the search, she could find reliable answers : Like in Google you can type in stuff and a whole bunch of sites come up and you can compare what sites all have the same thing. Other participants, inclu ding Melissa agreed with the value of determining reliability by identifying c onsistencies amongst webpages: I look at m ultiple W eb sites and if it has about the same information, then I assume its pretty credible One of the health educators, in h er interview, discussed her perception that Latina

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53 adolescents rarely take sufficient action to determin e the credibility of the information they find. Even though the participants tried to explain how they determine credibility, in reality they believe ev erything they read, according to I001: I think they believe it. I can t recall a particular comment, but I know that what they read or hear they believe. Which is what we are trying to fine tune. Which is dont believe everything you hear or read, look fo r other sources and search more before you decide what you believe. Attractiveness Another method the girls used to determin e the credibility of a W eb site was by the attractiveness of the webpage. If the webpage had logos, colors and looked professional it was considered more credible. For example, Jessica looked for logos of recognizable organizations and fancy layouts: Like a compan ys logo you trust. For some W eb site it s how it looks too. Like if it looks to o cheapycome on. If they didnt put ti me into it and it s just like click here, I dont really trust this one. Anyone can do it. The ones that are really fancy or creative. I look for colors. Even though participants had a difficult time defining professional they used this word to descr ibe what a credible site would look like. Melissa mentioned that if a site looks crappy, th e n someone could have just made it up. Maribel never looked at or read the information on a site unless it looked professional and had the right layout. Status Status was regarded as the final factor determining credibility when searching for reproduct ive health information online. Participants mentioned Google to be a credible search engine because it is popular and everybody use s it. Words such as popularit y reviewed and famous, were used to describe the status of W eb site s and search engine s that are considered credible. Melinda mentioned that she used Google because a lot of people use it. Blanca also had a similar sentiment when discussing the status of Google and W eb sites:

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54 I mean I know that not all of them are credible, but usually if it is Google and if it is the top ones that usually means it s been viewed a lot of times, so I hope that people arent viewing something that isnt. You can also te ll if someone made something sound really really good or it s justyou can tell, misspellings and stuff, oh and copyright, definitely copyright. Other participant s mentioned that the number of times a web page had been viewed would determine if they bel ieved t he information on the Web site. For example if a W eb site had been viewed 1,000 times and another site had been viewed 10 times they were more likely to believe t he information provided on the W eb site with 1,000 hits because of its popularity. D istrust The theme of Distrust was found primarily among younger participants in their explanations of why they did not use the Internet to search for reproductive health information. Three reasons for distrust were mentioned among participants in focus gr oup s # 3, 4 and 7. These were that the information was too broad, information found on the Internet was primarily opinion-based or subjective and that because the information was new to them, they were uncertain that the information they found was correct and would rather speak to an adult. Broad ness The first reason young Latina adolescents did not use the Internet to search for reproductive health information or any health information for that matter, was because the information they usually found wa s too broad and did not answer personal questions. Lola expressed that when she did have questions about reproductive health it was primarily to answer a question about her body: I probably wouldnt do that online I think it s because sometimes, I d rat her go to the doctor because your body is different from everyone else. You are asking about your body to your doctor and it s not general like online. Most of the participants in these specific focus groups, # 3, 4, and 7, also felt that it was diffic ult to find the information they were looking for due to the extensive amount of editing they

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55 had to do to their question to find an answer that was remotely close For example, Jessica often had to change the phrasing of the questions she would type into the search engine to find an answer that she believed was correct and relevant. Another participant, Lola also had a similar comment about the difficulty of finding information online due to the vastness of the Internet: It s broad; if you wanted somet hing in detail, like thats not reliable. You need to get a book about one thing that you need. Opinion -Based The term opinion -based emerged numerous times when partici pants were asked what specific W eb sites they used to search for reproductive heal th information. About half of the participants, such as Alejandra mentioned the Wikipedia W eb site as an untrustworthy source whose information was based solely on people s opinion s : Yeah, like Wikipedia anyone can edit things out; I trust the TV more tha n I trust the computer. Interestingly enough when this comment was made it was usually followed by a hesitation and an apparent realization that most of the information online was opinion-based no matter what source or W eb site it was from. A comment f rom Michelle demonstrates this realization: UmmwellI dont know, probably look at the books and then the Internet. To confirm or something. Wellyeah because the Internet is opinions from people ; it is not real information Uncertainty Uncertaint y was the main reason why younger participants would not use the Internet to search for reproductive health information. When asked if they were satisfied with the information they gathered online mult iple participants, such as Maria Anna and Lola answe red the question with varying versions of no:

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56 I dont get satisfied just by looking at a W eb site, so I either go to a parent or friends. I have to talk to somebody else. I would go to my mom. I was kinda satisfied. But I wanted a doctor to check. I n eeded to talk about it with a doctor. Not very, because the information you find online it is not like you are going to believe it. For me I dont believe it right away, I would ask someone else, or find information in different resources if it is the s ame then I believe it. These participants preferred to ask parents, specifically their mothers, professionals, and/or clinics questions about reproductive health because of their lack of knowledge and limited researching techniques. One participant, Mel inda was comfortable asking her mother about reproductive health information because she was experienced and could give her accurate information: My mom, yeah, she is the only person I am comfortable withoh, or a gynecologist. My mom because she has gone through that and she knows what she is doing. Another participant, Isabel, liked asking a clinic, in particular Planned Parenthood, questions about reproductive health because she could trust the information without any hesitation. She said, I think P lanned Parenthood would be the best, because I dont know whats real on the Internet. Motivation The final theme that emerged from the analysis of in depth interviews and focus groups was that of Motivation. Motivation encompassed the two reasons for La tina adolescents, regardless of age, to search for reproductive health information. All seven focus groups and three in -depth interviews addressed surroundings and self -interest as motivation s for searching for reproductive or sexual health information wh ether online or through other venues.

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57 Surroundings Latina adolescents motivation for searching for reproductive health information was commonly caused by situations occurring in their surrounding s These included school assignments, friends, and magaz ine articles. Typically the older girls in the focus groups reported that they would look for sexual health information because of something that had happened to a friend. Cristina and Monica had similar situations in their surroundings that motivated them to search for sex related information online: Well, I have this friend, and this is a real I have a friend story, who was afraid she got pregnant because her boyfriend ejaculated kinda close to her. To calm her down I looked it up and you knowand I fo und out that there is a really little chance and I told her and took her to t he W eb site and I calmed her down. The Internet is a really good tool. I looked up information about STDs, bec ause I was interested about it (because of) something that happened to a friend. One participant, Stephanie was motivated to search for reproductive health information because of a sex education assignment and a magazine article she had read in a Seventeen magazine. Well, you always have sex ed ; you have to do a lot of research for projects, like STDs. That s how I got into the Seventeen W eb site. I read a sex article and they said for more information to go on to this site. Other participants, such as Cristina also had looked for sexual health information to suppl ement what they had read in magazine articles. If you want more and there is not enough details in the magazine you look for more information online. One in -depth interview, I003, confirmed that the Latina adolescents she dealt with mostly were motiv ated by friends, magazines, and school to search for reproductive health information: Mostly I would say their friends or magazines. Like teen magazines, they put stuff in the re all the time and there is a section of questions and answers. They go by

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58 inf ormation in magazines more because they are embarrassed to ask their parents or adults. Even though another educator, I005, also believed that magazines caused Latina adolescents to search for reproductive health information online, she assumed that if the information in the magazine w as comprehensive then girls would not look online for any further information because magazines were are easier cheaper, and popular: Yeah, a lot of the girls they like to read like Seventeen magazine and People magazin e. And they like to read the questionnaires and ask us if it is true. Is this what a guy likes ? Well dont go experimenting. We try to advise them. Magazines are what they use, because I think its easier, it s cheaper and it s right there and everyone d oes it because it s popular. So I think t hey would go to a magazine before they would go to the Internet. Even though many of the participants used magazines as a source for reproductive health information only one participant, Elena mentioned that sh e did so because of expense and ease. Most participants considered magazines as either a motivator to search for information online or as a supplement to information found online. Self -Interest The last component of the Motivation theme relates to the se lf -interest of Latina adolescents to search for reproductive health information that deals directly with their bodies and/or curiosity about the topic. In two separate focus groups two Latina adolescents, age 18, said they were considering becoming sexual ly active and used the Internet to search for relevant information. Gabriela explained why it was important for her to search for reproductive health information before considering having sex with her boyfriend: I mostly never really faced anything like t hat until I started dating my boyfriend and he wanted to start doing it, so I was like H old on -I need to learn more about this. Blanca had a similar response: Just basic things. How to prepare yourself for the first time.

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59 As mentioned earlier, Anna had already been sexually active and wanted to find more information about a sexually transmitted disease she was concerned she might have contracted. I had a question about my reproductive health and stuff like that. I wanted to know how much time it would take for the herpes disease to appear. All three quotes illustrated a desire for information relating to a personal situation or question. Curiosity was another aspect of self interest that motivated Latina adolescents to search for reproducti ve health information. In various focus groups, mainly in the younger groups of girls, the unknown provoked questions dealing with reproductive health. Participants would hear, read or see an issue dealing with reproductive health information that would motivate them to search online or ask parents, doctors or friends. For example Valeria was curious about something she had heard and used the Internet to get more information : I just used it because I was curious. What it was about, like what the effect o f, what something could have if they had like a disease. I was just curious of what could happen to somebody. Additionally, some of the educators were trying to incorporate the idea of self -interest into their curriculums. One educator, I001, mentioned e ncouraging the girls to seek trustworthy information relating to questions they may have about their sexual health: I am trying to, particularly the girls that you are interviewing [focus group participants] trying to help them develop self interest. T he themes of Convenience Credibility Motivation and Distrust will aid in answering the overarching question for this study: What role, if any, does the Internet play in Latina adolescents search for reproductive health information? Comprehensive analys is of interview and focus group transcripts also provided insightful information on how, when and why Latina

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60 adolescents use the Internet to gather reproductive health information. These questions will be answered in the following section. RQ 1: What rol e does if any, does the Internet play in Latina adolescents search es for reproductive health information? The role the Internet plays in Latina adolescents search for reproductive health information depends greatly on age. Of 23 participants, 16 had use d the Internet on multiple occasions to search for reproductive health informat ion. Only seven did not use the Internet or had only used the Internet once, usually for a class assignment, to search for reproductive health information. The 16 participants w ho used the Internet regularly were between the ages of 1718 and were primarily in 11th and 12th grade with the exception of three 16year -old girls who were also junior s in high school The remaining seven participants were between the ages of 1416 and were primarily in ninth and tenth grade. Of the 23 girls who participated in this study, 19 girls had taken a sex education class provided in school. In the first focus group, participants had taken part in a voluntary sexual education class provided at the local YMCA Most of the younger participants felt that these sexual education classes supplied enough information for them, and for this reason they did not need to search for more information online. However, older participants felt that even though a reasonable amount of information had been provided in sexual education classes it was not enough to answer questions they currently had; in some cases, they had forgotten the information they had once learned because they had taken the classes when they were in ninth grade. For example, Blanca said : I feel really uneducated about this stuff now because I dont really know any specific site. But I feel like it s nothing that has been enforced in my life, like nobody, my parents obviously, I feel like His panics dont get any, like they get the general review but it s so vague in my mind. I dont know where to go

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61 Surprisingly, this comment was made by an 18 -year -old in college who realized during the questions in the focus groups that she really had no i dea how to search for reproductive health information, a topic she was truly concerned about and interested in She was not the only participant who had this realization, but only the girls between the ages of 17 and 18 expressed this concern about their l ack of knowledge. Even though participants between the ages of 1416 had a difficult time even defining reproductive or sexual health, the common attitude was that they knew enough information for now and did not need the Internet for any further research. The following questions will go into much greater detail on what role the Internet plays in Latina adolescents search for reproductive health information. RQ 1A: To what extent do Latina adolescents use the Internet to gather reproductive health infor mation? The extent to which Latina adolescents use the Internet to search for reproductive health information is difficult to determine. All participants were asked how frequent ly they searched for reproductive health topics online and how thoroughly they searched for this type of information. Most participants struggled when answering this question and primarily guessed when they had searched or how often they would search for this type of subject matter. Only participants between the ages of 17 18 att empted to answer this question according to some specific criteria or reason. For example, Jessica only searched for information when she had a question or felt a change in her body: Whenever I have questions. Not every day. It all depends if I have ques tions, if I feel a change in me. Another participant, Emilia had an interesting answer about how often and in what depth she would research reproductive health information:

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62 Most likely, like if it was something for class or I was curious about somethin g or I heard something I was thinking about. I am a little nave, so if I hear something I look it up, like what she just said I didnt know [referring to a comment about pre ejaculation and pregnancy]. Like stuff like that I overheard I will look it up b ecause I dont want to tell them [referring to friends] that I dont know what that means. This desire to fit in with peers when discussing sex-related topics was only found among one focus group, #5, with 18 -year -old freshmen in college. This proactiv e method of searching for reproductive health information was not found at all among middle and high school participants. Girls in middle school primarily searched for information only if they had a class assignment or had seen something that was unusual. For example one participant, Jessica mentioned looking up information on teen pregnancy when she was younger because she had been transferred from an all -girl private school to a public school and had seen a pregnant girl her age for the first time. This shocked her and caused her to search for the information on teen pregnancy. Unlike younger participants, older girls typically looked for information that specifically dealt with their own body; topics included among others, STIs, HIV, contraceptives, teen pregnancy, losing their virginity, etc. Most of these girls would look for the information until they found an answer they were satisfied with. On average these searches reportedly took 30 minutes to one hour. Overall, participants did not look for i nformation more than three to five times a year, with younger girls averaging two to three times a year and older girls averaging three to five times a year. RQ 1B: What prompts Latina adolescents to search for reproductive health information on the Inter net? This question can be answered using the theme of Motivation as previously discussed. All participants in the focus groups, regardless of age, mentioned four reasons for

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63 researching reproductive health information. These were friends, self interest, cu riosity, and school. As previously examined, friends and school were grouped into the category of surroundings and personal curiosity and self interest were grouped into the category of self interest. Friends were the number one reason participants w ere motivated to search for reproductive health information, regardless of age. One participant, Lola was motivated to search for reproductive health information because of concern for a friend: A friend one time told me she had Chlamydia It was shockin g because you always hear that people get it but you never think it could happen to you. So then it s like really real. Whoa. So I asked my mom and around that time we went to go get a physical and I asked the doctor. Because she was a really really clos e friend and s h e was depressed. In a similar situation another participant, Maria also was motivated to search for information about sexual health to help a friend: Wellone of my friends start ed to have sex and she was scared about herpes I guess. And we went online looking for that. She was so scared that she had herpes. And also we went to Planned Parenthood clinic and got more information. The differences between the two situations are the age and venue for gathering information. In the first situation the participant was 16 years old and did not feel comfortable looking for information online and preferred to ask an adult, in particular her mother and doctor. In the second situation, the participant was 17 years old and preferred searching fo r information online because she felt embarrassed talking to an adult. Even though these girls seem very close in age, the girls were at very different levels due to the differences in grade and knowledge of sex -related information. This observation of mat urity and knowledge applies to all the participants in the focus group between the ages of 17 18, and the three 16 -year old participants that were in the older focus group However, participants between the ages of 14 1 6 were less

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64 mature and demonstrated a surprising lack of knowledge of even basic reproductive health information. Another factor that motivated participants to search for reproductive health information was school assignments and magazine articles. A handful of participants mentioned a maga zine article prompting them to search for additional information online. The most common magazines mentioned were Seventeen and People Even though Seventeen magazine was mentioned in numerous conversations, one participant indicated that she barely looked at the health articles in these magazines because it was usually nothing new. Her peers in the group seemed to agree by nodding their heads. The last category in the theme of Motivation was self interest. Self -interest encompassed the desire for Latina adolescents to search for reproductive health information that dealt directly with their own body and/or curiosity about the topic. Most of the participants who had personal questions of a sexual nature were usually older in age and had more knowledge of reproductive health than younger participants, but they still needed more information to answer the questions at hand. Only one educator reported that she was actively trying to encourage girls to be inquisitive and to search for further information bef ore believing everything they heard. RQ 1C: When Latina adolescents search for reproductive health information on the Internet, how do they decide what W eb sites to visit? Only participants in the focus groups with older girls, between the ages of 17 18, used the Internet to search for reproductive health information. Typically the participants mentioned Google as the main search engine for researching reproductive health topics, as well as any other topics not related to health or reproductive health. One participant, Cristina stated that she liked using Google because that is what they teach you in school, suggesting that she believed that if her teachers had taught her to

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65 use Google, it must be a trustworthy source. However, most participants mentioned using Google not because they had learned it in school, but because they had heard people, such as friends, tell them to Google it When they needed information. Nearly all the participants in this older age group used this phrase. When asked why they would Google it other than because they had heard it from friends, only a few participants explained that they believed that Google provided the most comprehensive search options that were easy to compare. As stated by Monica because like in Google you ca n type in stuff and a whole bunch of sites come up and you can compare what sites al l have the same thing. Even though other search engines, such as Ask.com, WebMD Yahoo! and Wikipedia were mentioned Google was still the most common answer. Only a few participants, mainly those who felt more comfortable speaking in Spanish, used Univision a Spanish news W eb site. Once the participants established what search engine they most commonly used, they were asked how they determined what W eb sites to visit. Most participants did not have an immediate answer to this question and often sat and pondered in silence until someone summoned up the courage to say they did not have a specific technique or reason for deciding what W eb sites to visit. Following this com ment most participants seemed more at ease and comfortable responding in a similar manner. This interaction occurred in all the focus groups with older participants. What is interesting to note is that even though the participants felt they did not have a specif ic technique for deciding what W eb sites to visit, in reality they did. All participants mostly stayed on the first page of the search and typically read two to three W eb sites that had the closest description to the question or word the participant had originally typed in the search engine As stated by Carmen I would read like the first line that comes up and decide what page to read. The y would typically click on the W eb sites closer to the top of the

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66 page because they believed that W eb sites o n the top of the page were the most common and popular ones and for that reason the most accurate. Anoth er factor that determined what W eb sites participants would choose to view was the appearance of the page. Seven features were commonly cited. These were colors, pictures and/or diagrams, logos, videos, personal stories, links, and subtopics in the margins. This will be furthered discussed in the following question. RQ 1D: What aspects of a W eb site containing reproductive health information are appe aling to Latina adolescents? As previously mentioned, seven features in a W eb site were appealing to participants when deciding what pages to view. These were colors, pictures and/or diagrams, logos, videos, personal stories, links, and subtopics in the ma rgins. Even though older participants were the ones who typically had searched for reproductive health information online, younger participants also had answers to this question. Virtually all participants mentioned the feature of personal stories and ho w it helped explain the question they were asking in a very personal and interesting manner. Anna explained why Web sites featuring personal stories are appealing: Maybe like something from another person. Like true stories. I dont like to read text ; I l ike to read things about people and stuff. Like Anna most girls did not enjoy reading lengthy amount s of text and preferred videos and diagrams and/or pictures that presented the same information in a more easily understood format. This sentiment was s hared by Michelle who also stated: Pictures, videos. The less reading you have to do the better. Another participant, Gabriella, went into more detail about why she prefers pictures to text: Like drawings show you whats going on, like explaining the pr ocess. In a ddition to pictures and/or diagrams, links and subtopics in the margins were highly regarded.

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67 Participants liked the ease of being able to click on a word or a subtopic in the margin for more detailed information. This helped them gather more information in a quick and straightforward method. Colors were only mentioned in the context of looking fancy and professional. According to the gi rls, W eb sites that were clean looking, had nice colors and nice fonts, and looked professional overall caused them to continue looking at the page. However, after getting pas t the look of the W eb site, it was the personal stories, diagrams and pictures that captured their extended attention. Lastly, logos of companies and/or organizations also attracted the girls attention but for reasons other than ease. Participants associated Web site domains such as .org .edu .gov and organization names such as John Hopkins Johnson & Johnson, etc. with stronger appeal because they were perceived to be credible. T his will be further discussed in the next question. RQ 1E: What criteria do Latina adolescents use to determine the credibility of a W eb site that contains reproductive health information? This question can also be answered by using the theme of Credibili ty as previously discussed. Latina adolescents in the focus groups #1, 2, 5 and 6 were asked how they decided what information was credible online because they actively used the Internet to search for reproductive health information. The three criteria th at were revealed for determining credibility were reliability, attractiveness, and status. Reliability encompassed three aspects, which were professional authority, organization trustworthiness, and consistency. Professional authority and organization tr ustworthiness are very similar aspects of reliability with a slight difference. Professional authority refers to the girls belief that information from certain types of individual s such as doctor s professor s researcher s scientist s, etc. would be cred ible no matter what organization they are a part of. On

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68 the other hand, organization trustworthiness relies on the institution s reputation, not the individual, for providing accurate and credible information. When asked what would cause th em to believe in formation on a W eb site, more than half of the participants immediately shouted doctor s name and/or hospital W eb sites. Consistency was also briefly mentioned when listing the reasons for believing information online. However, when asked what consis tency meant, most of the girls had a hard time defining the word in the context of credibility and just responded just look at the sites and see if they are all saying the same thing. As previously mentioned in RQ 1D logos of companies and/or organizat ions and domain names such as .org .edu .gov colors, pictures and creative layouts were consider ed attractive and added to the perceived credibility of a Web site. Multiple pa rticipants mentioned that if a W eb site looked too cheapy it was obviously not credible because credible organizations only produce fancy webpage s Lastly, the location of a W eb site on the search page results list was also a significant factor for credibility. This is categorized as status. If a word or question was put into a search engine, most likely Google the participants believed that those web pag es appearing at the top of the results list were clearly the most popular and accurate. The ir reasoning followed this progression: i f someone before you rese arches a topic an d clicks on a W eb site, and this same thing happens over and over again then that W eb site eventually moves to the top of the search page. The girls believed that if a webpage appeared high in the results list, it must be credible because people would not read the same pages over and over again if they were not accurate. N one of the girls indicated any understanding of the fact that organizations pay to be listed high in search results pages.

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69 All five of the educators interviewed confessed that they were concerned about the girls lack of knowledge when searching for credible information. Despite their concern, when asked what they were doing to help the teens with whom they worked to develop skills to search for credible information none of them had an a nswer or a future plan. RQ 1F: Do Latina adolescents discuss the information found on these W eb sites with peers, parents, siblings, medical professionals, etc. M ost of the Latina adolescents in these focus groups did discuss the information they found on W eb sites with mothers, friends, doctors, teachers, and sisters. Fathers were never mentioned when speaking about these interactions and it was typically younger girls who discussed with mothers and sisters the topics they had questions about or had resea rched online. One 15-year -old participant, Melinda liked to confirm the information she found by discussing it with her mother or friends: Whenever I get information I go to my mom or other friends that have looked it up too and ask them. Older girls typically talked to friends, doctors, such as gynecologists, and teachers, usually from Planned Parenthood or Life Management Life Management is a class required for students to graduate from high school, which discusses everything from sexual education to balancing a checkbook, with the sole purpose of giving both girls and boys the life management skills to have a successful life after high school graduation. O f 23 girls interviewed, 19 had taken this class or a similar class in the ninth grade. The edu cators who were interviewed also commented on the interactions they had with the participants. Four of the five educators interviewed recalled answering questions about reproductive health at the end of weekly classes. One educator, I002, mentioned the types of questions she typically gets especially after the girls begin warming up to her:

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70 Ill get questions about where to go. Probably more on the birth control tha n anything else and about the sexually transmitted infections. I get those a lot. They do nt ask too much in the beginning about the anatomy of their bodies and again it could be that they need to feel comfortable with me more and that can take some time. Unlike younger participants who followed up with friends to make sure the online infor mation they found was correct, older girls, such as Gabriela spoke with friends to provide the friends with information they may need in the future: For me if I can, I would like to inform it to my friends so that they dont have to go through the same thing too. Only five girls, all 17 or 18 years old, kept the information they found to themselves. When asked why they would not share the information they had found, none of them had an answer or reason for keeping it to themselves. Overall, discus sion with participants revealed that both younger and older Latina adolescents search ed for reproductive health information for themselves, a friend, or a class assignment. However, younger Latina adolescents did not use the Internet to search for reproduc tive health because they believed the information online was based on opinion and was too broad to answer personal questions. Instead, they would rather use parents and doctors as sources for information because most of them were not sexually active and we re not worried about their parents reaction to a question related to sex; the same was not true for the older participants. Unlike younger Latina adolescents, older Latina adolescents search ed for reproductive health information online because it is anon ymous, accessible, convenient, effortless, and it helped avoid confrontations with parents.

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71 CHAPTER 5 DISCUSSION The Internet has become a widely used source of information among adolescents between the ages of 1217. A larger proportion of Latino adolesc ents use the Internet in their daily lives, compared to non Hispanic whites and African Americans (Pew Internet & American Life Project 2005) According to Lenhart, et al., (2005), 89% of English-Speaking Latino adolescents reported spending free time onli ne Furthermore, about 53% of all female adolescents, regardless of ethnicity, search online for information on health topics such as sexual health (Lenhart, et al., 2005). In addition, U.S. Census Bureau statistics (2007) show a disproportionate increase in the Latino population due to the increasing number of unintended pregnancies among adolescents (Guttmacher Institute, 2006 ). Even if Latina adolescents are searching for reproductive health information online they still have the lowest use of contrace ptives and an increasing high school drop -out rate that usually leads to advanced sexual behaviors (Driscoll et al., 2001; Laird et al, 2006). In this new age of media, is the Latina adolescent population researching reproductive health information dur ing their spare time online? If so, how are they deciding what to deem believable? According to Ackard and Neumark -Sztainer, adolescents will search for reproductive health information at some point in time for themselves or a member of their social cir cle [or] to research subjects for school health classes (2001, p. 1475) The primary reasons adolescents reported for researching reproductive health information (Ackard & Neumark Sztainer, 2001) were also brought up by participants in this study. However age was an important factor in determining which of several scenarios would be most likely to motivate the participants to search for the information online. The data showed that 19 of the 23 participants had been

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72 required to take a class in sex educatio n in the ninth grade; typically girls between the ages of 1415 only searched for sexual health information online when a school project was assigned. On occasion, these younger girls would also do some research online about a sexual issue, before followin g up with an adult, either to help a friend or to find more information about something that had happened to a friend. Older girls also searched for information online to help a friend, but in contrast to younger girls, they would rarely follow up with an adult. It was the older girls who used the Internet solely for the purpose of answering questions for themselves or to follow up with something they had read in a magazine. Magazines are by far one of the most important sources from which adolescent girls obtain sexual health information (Walsh Childers, et al., 2002). As mentioned before, it was the older participants who read teen magazines, in particular Seventeen for tips on make up, nutrition, and celebrity gossip, but often stumbled across the healt h sections that occasionally dealt with sexual issues. Because these articles were frequently short and provided only basic information it often left older participants wanting to know more information, which caused them to follow up online. Even though s ome of the typical topics covered in teen magazines include having sex for the first time, STIs, and contraceptives (Walsh Childers, et al., 2002), which were all issues of interest to the older participants, not one participant felt the articles were help ful so they either followed up online or just disregarded the information. Surprisingly not one younger participant mentioned reading magazines for information or entertainment value. Instead they were more likely to use the TV or their cell phones as a l eisure activity. What is concerning about these various motivators is that Latina adolescents between the ages of 14 15 seem only to research information about sexual health when it is required for a school assignment despite the fact that the topic of sex is constantly surrounding them. Even

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73 though these Latinas are following up with adults when something happens to a friend, adults do not necessarily have the most accurate information. For example one participant, Alicia, had a question about STIs and whether HIV could be acquired through contact with a toilet seat. Her mother did not know. It is troubling that young Latinas are only motivated to seek reproductive health information when they know they will be held academically accountable. This lack of desire to be well informed about reproductive health seems to catch up with older Latina adolescents who are currently in a predicament and do not know how they could have prevented it or how to fix it. Some of the older participants had been concerned about having an STI, but did not remember anything from their past sex education courses and had tried frantically to find information online. T his frantic feeling could le a d girls to accept information that makes them feel better even though it may not be most accurate. Additionally, since the average age for adolescent girls to engage in sex for the first time is between the ages of 16 17, they are more likely to be influenced by the information found online to decide whether or not to have sex (Kaiser F amily Foundation, 2005). Because girls usually are only exposed to the most accurate information in the ninth grade, future situations such as those mentioned above c ould be minimized if parents took a more direct approach in speaking with adolescents throughout various stages of the life. However, many parents are reluctant to have conversations with their children about sex due to their cultural traditions and embarrassment, but realize it is important for their children to get the most accurate informati on (The National Campaign to Prevent Teen Pregnancy, 2001). If parents feel uncomfortable talking about the topic of reproductive health, educators from Planned Parenthood are available to meet one -onone with girls for educational lessons.

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74 When adolesce nts feel as though they are not receiving accurate or sufficient amount s of information about sex through school programs and parents, the media become their primary source of information about sex (Garner, et al., 1998). This is exactly what is occurring with the older participants in this study. As the girls age they have more questions about their bodies and how it relates to sex, but lack school programs and parental guidance. This, in turn, leads them to search for reproductive health information onli ne. However, this isnt the only reason older adolescents are using the Internet to search for reproductive health information. As expected for these older Latina adolescents, the appeal of using the Internet to gather information on a sensitive subject i nclude s the ability to ask questions anonymously, gain free access, find varying opinions, know who produced the information, search with convenience, and find people in similar situations (Rideout, 2002). In addition to all of these reasons, only a few ol der participants were comfortable divulging another incentive for researching reproductive health information online, which was the lack of confrontation with parents. Several times participants mentioned that even though they were sexually active, their p arents did not know this and for this reason the girls could not ask them any questions, however insignificant they might seem. Unlike the older participants, the younger participants did not feel comfortable searching for reproductive health informatio n online and preferred to ask parents, particularly mothers, and some teachers. In a 2001 study, younger girls in fifth and sixth grade s were more likely than girls attending eleventh and twelfth grade s to ask their mothers about information concerning hea lth issues ( Ackard & Neumark Sztainer) The difference between the participants in this study and those of the 2001 study is once again age. Older girls in ninth and tenth grade were still comfortable asking their mothers about reproductive health informat ion, but not eleventh or twelfth graders as in the 2001 study.

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75 When younger participants were asked why they did not like using the Internet and would rather speak to their mothers about reproductive health, various reasons came to light. Younger partic ipants mentioned that the information was too broad and opinion -based. When asked what they meant by broad and opinion -based they often responded that they could never find information pertinent to their bod ies because the information they found was ju st peoples opinions and not information from real doctors. The biggest difficulty for most adolescent s is being able to distinguish between facts and opinion (Gray, et al., 2002). Most of these younger participants faced this difficulty and lacked the knowledge of how to use a search engine to search for information, thus preventing them from finding re levant information on credible W eb sites. The last and most common reason younger participants gave for not using the Internet to search for reproductive health information was uncertainty. Content and quality of information are frequent concerns for adolescents not only when searching for health information but for all information found online (Rideout 2002; Gray, et al., 2002; Rietmeijer, et al., 2001). Man y of these girls were not sure how to determine if something was accurate or trustworthy ; for this reason they preferred to ask their mothers because she has gone through [it] and knows what she is doing. Also because most of the younger girls were not sexually active, they were not worried about their parents reaction to a sex related question, unlike the older participants. Although carefully designed Web sites maintained by legitimate health-focused organizations may serve as good sources of reproductive health information for teens, t he Internet offers a wealth of information with no screening for accuracy (Rideout, 2002). Most participants had a tough time expla ining how they determined if a W eb site was credible and/or accurate. Most individuals including most adolescents, usually explore only the first few links offered from a search engine, which may mean they are relying on sites promoted based on

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76 i ndirect measure s of popularity rather than informational credibility (Eysenbach & Kohler, 2002) The participants in this study used the same method to search for reproductive health information online as participants in Eysenbach and Kohler s study Participants would typically view the first few links of the search page or the links that had the m ost highlighted words similar to their question. As discussed in the results, the top links of a search engine were considered to be the most popular and for that reason the most accurate. Many of the girls believed that if the general au dience viewed information on a W eb site over and over again, the information had to be correct. Additionally, if the various W eb sites they had viewed had similar information, they believed the information was true because ther e was an agreement amongst the W eb sites. The p roblem with this idea is that even if multiple W eb sites provide the same information, the girls still are not looking to see if the information has been updated, comes from a reputable source or is correctly explained. The y could very easily read three W eb sites with similar information that were all last updated in 2000 or were from unqualified individuals. This was just one of the many incorrect ways these participants determined credibility. Participants also believed that information presented in an a ttractive manner had to be credible. Interestingly, the word attractive had different definitions for many of the participants. Some of the girls defined attractive as having a copyright symbol at the bottom of the page, easy links to navigate, and pic tures or diagrams to explain the information presented. Other participants defined attractive as having bold colors, nice font s and recognizable logos of companies. These definitions were completely different but all serve d the same purpose of determini ng credibility. The most shocking comment was that if a W eb site was not modern and nice to look at it was deemed unacceptable to view and untrustworthy Lastly, a company logo or reliable source quoted on a W eb site, such as a doctor or clinician, wa s considered trustworthy

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77 and for that matter credible. One reason these comments are so disturbing is because many sites that offer totally bogus information cite doctors, scientists, or researchers to back up their claims. Clearly, the criteria the se participants used to determine if information on a W eb site is accurate and credible is alarming. The Internet is a wonderful source of information that can be accessed in any location and in private, but at same time relying on online information can b e very unsafe if teens do not understand how to search for credible and accurate information Schools are not teaching a dolescents the skills they need to search for information on the Internet nor do they provide teenagers with the names of reputable W eb sites that could be used to gather information about specific topics. One clear example of this was a discussion between three participants, Alejandra, Melinda, and Melissa: (Alejandra) Yeah I would go to WebMD because thats like a doctor. (Melinda) You see I didnt even know about that site. Why dont they teach us that in school? (Melissa) I would go to WebMD before going to Google. (Melinda) See I didnt know about that, so I would have gone to Google. This is a prime example of the lack of kn owledge a dolescents have about credible W eb sites and how to search for trustworthy information via the Web. If students are expected to search for information using the Internet for projects and school assignments it is imperative that schools teach them correct procedures for de termining the credibility of a W eb site by using correct criteria, such as author qualifications an d credentials, sponsors of the W eb site, peer reviewed information, date of last update, among many others. Health agencies shoul d also take a more proactive approach when designing W eb sites for Latina adolescents. According to discussions among participants, question and answer

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78 services are the most appealing aspect of a W eb site. This allows adolescents to ask particular questions about their bodies and get accurate information from a qualified source. In 1996 the no t -for profit organization Campaign For Our Children Inc. (CFOC) created a W eb site for the use of individuals interested in receiving more information about sexual hea lth issues ( Flowers Coulson et al., 2000). Additionally, a question and answer service was implemented called Ask the Expert, which focused on answering any questions the public had regarding sexual intercourse, sexually transmitted infections and pregna ncy. A nswer s were usually provided within a 24-hour period and attempted to utilize empirically based information. This example illustrates the usefulness of an anonymous and available question and answer service. Additionally, participants are attracted to W eb sites that use simple language, detailed diagrams and other links that define words or phrases that may be new or confusing. Web sites should be free of clutter, easy to navigate and quick to rea d. Good examples of adolescent W eb sites focused on sexual health are thenationalcampaign.org, and advocatesforyouth.org. Since participants typically only view the first few Web sites of a Google search and use one -word searches, health a gencies should make sure their W eb sites appear when common words su ch as STIs HIV condoms sperm, ovaries virginity oral -sex sex among many others, are typed in the search. One serious problem adolescents may encounter when using the Internet to search for health information is pornography and unwanted sexual enco unters. According to a study conducted by t he Kaiser Family Foundation, 70% of adolescents between the ages of 1517 are unintenti onally exposed to pornographic W eb sites when searching for sexual health information (Rideout, 2002). Additionally, the ease of finding chat rooms, i nstant messaging services, and W eb sites to discuss sexual health topics facilitates unwanted sexual encounters. Fortunately,

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79 none of the participants in this study mentioned being exposed to pornography or unwanted sexual solicitation. Participants used Google when searching for W eb sites and Ask.com and Yahoo! Answers when asking questions in a forum. The main drawback of using a W eb site that has a question -forum format like Yahoo! Answer, is that there is no way of knowing who th e answers come from and what qualifications they may have to give advice. This is troublesome especially if the questions adolescents are asking are important for their health. The last concern to note is the language barrier these teens face when searc hing for reproductive health information online. Findings suggest that s econd or third generation Latinos are more likely to use ma instream media such as English W eb sites, pamphlets/brochures, and TV All the participants used media in English, as sugges ted, but many spoke Spanish with parents and Spanglish, a combination of English and Spanish, with friends. Throughout our discussion s, many of the girls had a difficult time explaining something in English and would revert back to Spanish. Even in some si tuations the girls would ask what a certain word meant in English. As suspected, the fact that secondor third -generation Latin a s are using more English media does not mean they necessarily understand the information. Even if Latina adolescents are search ing for reproductive health online, they may not understand the information being provided, due to the fact that it may be presented in an advanced level of English. Some participants, like the younger girls, did not like researching information online and preferred to ask parents instead. This means that many of the girls had to translate their question from English to Spanish and often los t the question in translation. An interesting observation was that every single participant was more comfortable speak ing in Spanglish than English or Spanish. This hybrid language, even though not accepted, may be the best way in the future to develop reproductive health W eb sites targeted to Latina adolescents who live in the United States.

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80 The findings of this study c an be projected against the construct of two theories to explain why Latina adolescents use the Internet to search for reproductive health information. Constructs of the Media Dependency and the Uses and Gratification theory may be applied to understand why Latina adolescents use the Internet to seek sensitive material. Media Dependency theory suggests that individuals depend on the media to meet certain needs and goals that are not being fulfilled. The more a medi um fulfills a persons need, the more the y depend on that specific medi um and the more important that medi um becomes to the individual. Additionally, dependency on media increases when individuals feel the necessity to deepen their understanding of a certain topic (DeFleur & Ball Rokeach, 1982). Older participants in this study were not receiving the desired information from other sources, such as parents and teachers, and because of that, they turned to the Internet to search for reproductive health information. Two key reasons for older Latina adolescents use of the Internet to search for reproductive health information were reve a led. The first reason was to deepen their understanding of topics with a sexual nature, as suggested by this theory, and the second reason was to avoid uncomfortable a dult confrontations. Contrary to Media Dependency theory 's predictions the Internet was not more important to participants because they had frequently depended on it for information. Instead, participants frequently used the Internet to search for sexua l health information in private to avoid parental altercations. For this reason Uses and Gratification theory can also be used to explain why Latina adolescents used the Internet to search for reproductive health information. The Uses and Gratifications t heory states that the individual has an active role in choosing media that will most closely gratify their needs. The needs for participants in this study were two -fold. One was to

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81 better understand a sexual -health topic, and the second was to quickly get information without drawing unwanted attention from parents. Even though there are many disadvantages associated with the Internet, as noted in this discussion, it also facilitates access to health information that individuals of all ages might find har der to obtain through a physician or parent because of lack of access, lack of confidence or embarrassment about asking questions related to sensitive topics such as sex. As found in this study, the Internet allows adolescents to search in an anonymous and timely manner for information on topics that would otherwise be ignored. The information provided from the Internet also can serve as a supplement to information previously obtained from another source of media, physician, or peer. Collaboration is need ed between parents, sexual health educators, schools and Web site creators in order to tackle the numerous issues surrounding Latina adolescents use of the Internet to search for reproductive health information. Together, Latina adolescents can learn how to use the Internet throughout their lives not only to search for information in dire situations but to keep themselves informed as their bodies and lives change day to -day. Limitations Because qualitative research was used as the method of collecting da ta, findings are only applicable to the participants of this research and are not to be generalized to the Latina adolescent population. This is a recognized limitation of qualitative research. Given that focus group participants for this study were recr uited from youth programs whose mission is to encourage adolescents to stay in school, practice abstinence, and be responsible and informed, along with other personal development characteristics, their media usage likely is not representative of other Lati na adolescents who may lack the guidance of an educator, have dropped out of school, or had an unintended pregnancy among other character

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82 differences. Even though these participants were all Hispanic and felt they shared a multitude of characteristics wi th their culture, they were very Americanized, which could greatly a ffect the choice of media search procedures or even whether to search for reproductive health information online. Additionally, it is difficult to truly know how Latina adolescents sear ched for reproductive health information using the Internet without actually watching the process unfold. Focus group participants easily could have been influenced by peers in the group to repeat or agree with a method of searching for health information online that was not necessarily the process they have actually used Recruitment efforts prevented data collection from focus groups of six or more participants as originally planned. Instead focus groups were conducted with 2 4 participants at a time, which could have affected the length and detail of conversation. It is impossible to know if the size of the group would have made a significant difference in the information gathered. Furthermore, the difficulty of recruiting younger participants becau se of the need for parental consent to talk about sensitive subject matter meant that the study included fewer Latina adolescents between the ages of 14 15, leaving mostly 16-year olds in the younger Latina adolescents focus groups This sample thus lacks two important age groups 14and 15 year olds and may provide only a limited amount of information on young Latina adolescents use of the Internet when searching for reproductive health information. Future Research There is no doubt that this research reveals that the Internet is becoming the newest way for females, in this case Latina adolescents, to learn about sexually related information. Because this is the first study that truly explores how, why, and when Latina adolescents use the Internet to gather sensitive information regarding reproductive health, we cannot conclude that this study

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83 alone has provided a sufficient understanding of all the intricacies of Latina adolescents use of the Internet. Exploring this topic further can aid in the devel opment of future campaigns, programs and W eb sites that are appealing to this specific culture and age group. More research needs to be done specifically within the context of age and sexual experience to better comprehend whether age or sexual experience is the determining factor for deciding whether to use the Internet to search for reproductive health information, and if there is a correlation between the two. Additionally, with such a large proportion of adolescents, regardless of race, who use the Internet in their daily lives, it is very possible that many cultur al groups are using the Internet to search for reproductive health information. It is therefore imperative to understand why and how African -Americans and nonHispanic whites use, or dont u se, the Internet to search for reproductive health information. This research may shed light on other tactics that could be used for the development of W eb sites and campaigns for adolescents including the Latina population. Research targeting Latinas a lone is not enough to make clear what interactions cause some Latina adolescents to speak with their mothers or other adults when they have questions while others use the Internet when researching questions of a sexual nature. Therefore, greater focus needs to highlight the mother -daughter relationship to reveal the attitudes and behaviors that cause Latinas to confide in or mistrust adults. As the National Campaign to Prevent Teen Pregnancy (2001) indicated, parents of Latina adolescents often felt uncomfo rtable talking about teen sex because of cultural and religious traditions or embarrassment, and these interactions greatly influenced whether Latina adolescents felt comfortable engaging in open communication with their parents. Additionally, it is also e ssential to conduct research with Latino adolescents. Sexual health is not solely the responsibility of females and is often shared, influenced and

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84 practiced due to the interactions and relationships young Latino females and males engage in. For this reas on, adolescent males should also be included as a main sample group for future research. Lastly, quantitative research should be conducted to find out how many Latina adolescents use the Internet as opposed to their parents to search for reproductive hea lth information, as well as to investigate what Web sites and search engines are commonly being used. By conducting quantitative research the data could possibly be generalized to the Latina adolescent population and further the understanding of this demog raphic and topic. As a reminder, 53% of Latina adolescents will become pregnant before the reach the age of 20, and will more than likely contract a sexually transmitted infec tion (Turner Foundation, 2007). For these reasons alone and many others that ha ve been revealed and discussed in this paper, reproductive health can have life -long consequences, and for this reason extensive research in this area is vital to help protect the younger generation of Latinas and secure their potential success in the Unit ed States .

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85 APPENDIX A QUESTION GUIDES FOCUS GROUP QUESTION GUIDE I. Introduction (10 minutes) Introduction of moderator and ground rules Hello! My name is Ilana Echevarria and I am a graduate student at the University of Florida. For my master's thesis, I am conducting research to understand what teenage girls like yourselves think about searching for health information online. I am also interested in learning how you decide what online sources to use. Although I can't really say that participating in this discussion will help you personally, the information I gather today will help in the future development of h ealth campaigns, programs, and W eb sites that are appealing to Latina adolescents. For this reason it is extremely important and valuable that everyone responds honestly. I want you to feel comfortable and share all experiences and thoughts on the topics we discuss. This is a safe environment, where there are no wrong answers, so I hope everyone will participate. I will not ask you to reveal any personal details concerning reproductive health, however for your protection and all participants, if someone reports being sexually abused I am required by law to report it. For the next hour, we will be covering an array of topics and it is important to remember that all comments are welcomed and valuable. Sometimes there will be opinions that some of you agree with and that some of you will not agree with. Everyones opinion and thoughts are equally important and valuable. Again, I encourage everyone to participate and to be open-minded. If at some point during our discussion you strongly disagree with someones answer, please share your thoughts in a respectful way. The point of this discussion today is to learn about your diverse thoughts, opinions and experiences. I am hoping to hear as many diverse answers as possible. Based on our conversation today, Ill be writing a report. To make sure everyone feels comfortable speaking their mind openly, I won't use any of your names in my report. Additi onally, no one else outside of this room today will know exactly what you said. I also ask that everyone respect the privacy of other group members by not discussing anything that anyone has said, after you've left this room today. It is possible that you may know someone who will be participating in a later focus group, and it is important that everyone enters the group with an open mind. While your information will be kept confidential in my study, I cannot guarantee the confidentiality of any partici pants comments outside of our discussion today. Nevertheless, you should treat this conversation as confidential and not discuss personal details outside of the group.

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86 Because everyones opinions are extremely important to me, and I want to make sure I do not miss anything, I'm going to videotape our session. Is everyone OK with this? [Pause] After I'm finished with the focus group, I'll transcribe it, which means I'll create a kind of written script of our discussion. I will not use any of your names in the transcript. To make sure we get the best recording, I ask that everyone speak as clearly as possible and only one person at a time. If you are referring to anyone else in the group -or, for that matter, any other person -please use only her fir st name, located on the name cards. These names are fake and I ask that if you know someones real first name in this group you refrain from using it. Also, the recordings and transcripts will be kept in password -protected files and will be deleted a t the conclusion of this study. Just as a reminder, this focus group is completely voluntary. You can leave at any time. Also, you don't have to answer any question you don't want to answer. Introduction of participants At this time I would like everyo ne to turn your name cards around so I can see them. OK, now I would like to start by going around the table and having everyone introduce herself, using your first (fake) name only, and share something about yourself, such as something you like to do or y our favorite book, movie, magazine or celebrity. II. Questions a. Media Use (15 minutes) What do you think of when I mention media? Define Media Walk me through a typical weekday or weekend -What type of media do you use? What media do you use most fre quently? How frequently? Why do you use these forms? What language are these mediums in? What language do you speak at home? What language do you speak with friends? What media does your family use? What type of media do you use? Of all the kinds of m edia, where you might be able to get information about something you were interested in, which one or ones give you the best, most believable or trustworthy information? Why are they credible?

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87 What about when searching for health information? What sources do you consider most credible? Why do you believe they are credible? What are the names of some specific sources that you use? b. Reproductive health information (20 minutes) If I use the phrase reproductive health, what does that mean to you? What kind s of topics would that include? What if I used the phrase sexual health what does that mean to you? If girls are struggling with the terms, will offer a short explanation of reproductive health and explain how sexual health is an interchangeable term. What kinds of reproductive health information are most important for girls your age to have? If you had questions about reproductive health, what sources would you use to try to get information? Which sources would you consider most trustworthy? Why? How likely would you be to look for reproductive health information online? Tell me your reasons. Tell me about a time when you used the Internet to search for reproductive health? What caused you or would cause to seek this type of information? How o ften do you use the Internet to gather reproductive health information? How would you compare the Internet to other sources you might use, such as ________________ (list other sources theyve mentioned)? c. Searching reproductive health information online (20 minutes) If you have ever used the Internet to look up reproductive health information, Id like for you to think about the most recent time you did that. If you havent, then maybe think about a reproductive health topic about which you might want mo re information.

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88 How did you or would you begin your search for reproductive health topics online? Did you/would you follow a specific process? Tell me about how you did or would go about your search. What type of sites did you visit when searching for he alth information/topics? Tell me your reasons for choosing these sites. What was especially attractive about these sites? What type of information did you receive on these sites? Was that the kind of information you were looking for? If not, what kinds of problems did you have with it? How trustworthy or believable was the information you found? After the search you did online, how satisfied were you that you had gotten the answers or information you needed? If you still needed more information, where do you go to get more information? d. Concluding Remarks (10 minutes) Tell me what, if anything, you did with or in response to the information you found online. Did you/Would you talk to anyone about the information you found online and if so, who would that be?

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89 IN DEPTH INTERVIEW QUESTION GUIDE I. Introduction (5 minutes) Introduction of interviewer Hello! My name is Ilana Echevarria and I am a graduate student at the University of Florida. For my master's thesis, I am conducting research to understa nd what Latina adolescents think and do as far as searching for health information online. I am also interested in learning how Latina adolescents decide what online sources to use. Although I can't really say that participating in this interview will help you personally, I hope that the information I gather today will help in the future development of health campaigns, programs, and W eb sites that are appealing to Latina adolescents. For this reason it is extremely important and valuable that you respond honestly. I want you to feel comfortable about sharing your experiences and thoughts on the topics we discuss. There are no wrong answers. I just want to hear what you believe about an array of topics related to your curriculum, how health is, or may be, incorporated into your curriculum, your interaction with Latina adolescents and how you believe Latina adolescents access health information, in particular reproductive health information Based on the interviews I'm doing with people such as yourself and on the focus groups I'm conducting with Latina girls, Ill be writing my thesis and one or more articles about my research. To make sure you feel comfortable speaking your mind openly, I will not use your name or other identifying information in anything I write about this research, nor will I discuss your answers with anyone else. I'm also going to be interviewing several other people who work with Latina girls, and I want each of my interviewees to answer based on his or her own experiences and beliefs, s o I'll also ask you not to talk about our conversation with anyone else until I'm finished conducting my research. Because your opinions are extremely important to me and I want to make sure I do not miss anything, I'm going to audiotape this interview. Is this OK with you? After I'm finished with the interview, I'll transcribe it, which means I'll create a kind of written script of our discussion. I will not use your name in the transcript. To make sure we get the best recording, I ask that you speak a s clearly as possible. Also, the recordings and transcripts will be kept in passwordprotected files and will be deleted at the conclusion of this study. Just as a reminder, this interview is completely voluntary. You can quit at any time, and you don't have to answer any question you don't want to answer. II. Questions a. Educators Role (15 minutes) Could you describe a normal day on the job? What are your main responsibilities? How old are the Latina girls you usually interact with?

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90 Describe for me, if you would the characteristics of the girls and their families -socioeconomic status, parental education levels, family structure? What barriers do you face when educating these Latina adolescents? How would you describe your relationships with the g irls? b. Curriculum (15 minutes) Could you describe for me, what your curriculum consists of throughout the year? How do the girls react to these topics? Which topics are more popular? Do you include health topics? If so, what type of topics do you disc uss? How do you choose what topics to discuss? What resources do you use to explain these topics? Could you define, as an educator, what reproductive health means to you? Do you cover reproductive health in your curriculum? Yes: If so, what topics? What resources do you use? What resources do you recommend for the girls to use? What types of questions are commonly asked? Could you tell me a time when a discussion occurred relating to reproductive health? What was the outcome? No: If not, could you tel l me your reasons for not including this topic in your curriculum? Have you tried to include reproductive health into the curriculum in the past? Why not? Have the girls ever asked questions or had comments relating to reproductive healt h? If so, could you elaborate? b. Internet Use (20 minutes) How do you, as an educator, use the Internet to prepare for your curriculum? As an educator, what makes certain sources more trustworthy or credible than others?

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91 Do the girls ever talk to you about information they've found through mass media sources, such as TV, radio, magazines or the Internet? Yes: If so, what types of media do the Latina adolescents you interact with use most often? What do they search? When you discuss information they gather from the media, what sources do they believe to be credible? Could you give some examples? No: If not, what medium do you think the girls use on a daily basis? Do you think demographic characteristics, such as income or family structure, affect which media sourc es the girls are likely to use as information sources? Could you elaborate? Yes: If you include reproductive health in your curriculum, what online sources, if any, do you use? How did you decide what sources to use? Did the girls seem receptive to this i nformation? No: If you do not include reproductive health in your curriculum, but do include other health topics in your curriculum, what online sources, if any, do you use? How did you decide what sources to use? Do the girls ever bring up health topics they heard of? If yes, where did they get the information? Could you describe what those interactions have been like? Other than media sources, where else do they get health information?

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92 APPENDIX B FOCUS GROUP TRANSCRI PT II. Questions a. Media Use (15 minutes) Mod : What do you think of when I mention media? Define Media Mod : Walk me through a typical weekday or weekend -What type of media do you use? CRISTINA : Well I guess since this is my senior year I am not using the computer as often as I was, whi ch is bad because I am taking two classes online and I am a little bit behind and I find I dont have the time to use the computer. Not like years before. So I am not on that often. JESSICA : Well it is the same thing as her, its my senior year and its c razy you like My Space, Facebook everyone is in it. I have an account in those, but I dont have the time. CRISTINA : I dont have time for those JESSICA : Exactly I dont have time for those. I get home do my homework if I work, I work. I use the phone I talk, time is really tight. STEPHANIE: Well I am not a senior yet; I am a junior so I do use My Space a lot. Im a My Space addict, I use the computer a lot, the phone also text messaging, the radio also I guess is a media type. I listen to it every mo r ning when my mom drops me off at school. I use magazines a lot. Whenever I go to the store I ask my mom for a Seventeen magazine. Even though I am not Seventeen I really like that magazines its just really informative. JESSICA : Every time I go to Wal -Ma rt with my mom, or I do groceries I am reading magazines in the store. I just need to read. I read everything. I got some magazines about Prom and how to get ready. It all depends on the day. Texting that is my number one thing. I would get out of school a nd talk on the phone. Before I used to talk on the phone. Now I have so many things in my head that I do texting. CRISTINA : The only time I read magazines is at the gym. I dont really buy them. I had a subscription last year, but I dont have time for that anymore since I am preparing for college. I listen to my Zoom a lot. Mod : What media do you use most frequently? How frequently? CRISTINA : TV JESSICA : Radio STEPHANIE: Between the computer and the TV

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93 Mod : Why do you use these forms? CRISTINA : TV...ummthe television you get a variety of everything. If youre interested in cooking there is a cooking channel, discovery channel, and animal channel. You get to learn a lot from the TV. Sometimes my teachers will assign an assignment to watch certain shows and write reports on them, and the news because I like keeping informed with current events. JESSICA : Since I have a tight schedule I dont have time watching TV. I love radio I listen to my Ipod. When I take a shower I listen to the music. I need to have music on every time, all the time. STEPHANIE: I agree with her, when I am cleaning my room I have the radio on. With the TV and the Computer I dont know its just there. So I guess I will go and use it. Mod : Where is your computer? STEPHANIE: Its a laptop, so in my room. Mod : What language are these mediums in? JESSICA : I used to watch a lot of Spanish TV, but now more English TV, I dont know why. I speak French because I was living over there for a year I love listening to French music o r watch French movies. STEPHANIE: Both English and Spanish and I am taking German, this is my second year taking German, so I watch German movies to understand. CRISTINA : Usually I watch shows in English, but sometimes I watch novelas with my mom. JE SSICA : I dont have time for novelas. Because you watch one day and you get caught up. I give up. STEPHANIE: Yeah I watch novelas. CRISTINA : Cuidado con tu Corazon. I was really into Rebelde JESSICA : Rebelde es CRISTINA : Its like a pop sensation in Mexico and they broke up pretty fast and they have a show. STEPHANIE: Since I am Mexican there are tons of novelas. Since I was living in Mexico for a while there are lots of novela. Its all the same thing, so I dont watch as often anymore because y ou know whats going to happen. There is a bad person and whats going to happen in the end. JESSICA : In my house we dont watch novelas.

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94 Mod : What language do you speak at home? What language do you speak with friends? CRISTINA : English. I wish my mom would speak more Spanish with us. I am not all the way fluent. I am fluent but with more difficult words I am not able to understand. Thats at home. But the only practice I get is in Mexico when I go visit my family. They dont speak English so I need t o speak in Spanish. JESSICA : I think kind of both. But more Spanish at home, since I have English at school. My mom says, You better love speaking Spanish. STEPHANIE: I speak more English, but my mom also gets mad so she tells wants me not to forget. So I speak Spansglish. Mod : How about when you speak with friends? JESSICA : Spanglish. It depends on the friends. Because I used to have more Spanish friends in middle and stuff like that. Like now I have more English speaking friends. STEPHANIE: Wit h my friends here, English. I dont know why but I dont feel comfortable speaking Spanish with anyone else. Like here people will ask me things in Spanish and I will answer them but I dont feel comfortable. I dont know. I just speak English. JESSICA : I speak English so that I wont get other peoples accent. CRISTINA : Its not that II have Spanish friends. But I dont really speak Spanish with them, maybe because I am not as confident with speaking Spanish, and if I have a few grammar problems they wil l point it out. I dont want to speak Spanish anymore. Mod : What media does your family use? CRISTINA : My mom uses the computer a lot because what she is doing now she is watching the soap operas on you tube. Soap opera here come later. For example in Me xico a soap opera could be done and here it is almost over. So my mom uses the computer to watch Soap Operas on Youtube. And also EBay. I got her into EBay. That was my thing last year. I used to use EBay a lot but sadly I do not have time for it anymore. JESSICA : My mom uses more the computer. To find out whats going around the world in Columbia. STEPHANIE: Well my dad uses everything, the computer, the newspaper and my mom uses the computer and the television also. Mod : Of all the kinds of media, w here you might be able to get information about something you were interested in, which one or ones give you the best, most believable or trustworthy information? Why are they credible?

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95 CRISTINA : I would go definitely to the computer. Like Google it. Beca use that is what they teach you in school anyway. They take you to the computer and they teach how to look for something specific. JESSICA : The computer, its better to go to a person who knows what it really is. But if you dont have that person or you w ant more information before you go to that person computer is the best thing. STEPHANIE: Sometimes I use the computer, but now people can have their own account in Google or Wikipedia so sometimes it is not always right. Not just go with the first thing, but keep on researching. Like someone who knows to be really sure. JESSICA : Look for more and more and see which one you agree with. STEPHANIE: Yeah anything on the computer c an be a lie, if I find if they W eb site is credible enough like a government seal or somethin g official or like a companies W eb site. JESSICA : Like a comp anies logo you trust. For some W eb site its how it looks too. Like if it looks to cheapy come on. If they didnt put time into it and its just like click here, I dont really tr ust this one. Anyone can do it. The ones that are really fancy or creative. I look for colors. STEPHANIE: I agree with her. Mod : What about when searching for health information? What sources do you consider most credible? Why do you believe they are cr edible? JESSICA : Well first I talk to my mom a lot. She is my best friend; she is not even like my mom she is like my sister. She is really open-mind so we talk a lot. I am really not ashamed to ask her about anything even if sex or anything. But if not I will go to the Internet I will search there. There is a really good one that sends you messages and tips. Its called Nosotras.com. They send you stories about other girls. CRISTINA : Basically in schools we learn everything we need. So I really dont hav e questions, but if I did I would use Google. I would Google that. I would look at health pages of hospitals and doctors that have WebPages. JESSICA : Being a Latina is really different. I wasnt born here so its really different. In Columbia you have yo ur own doctor its not like here when you only go to the doctor when you are sick because its so expensive. Over there everyone needs to have their own doctor and school is so important because they teach you everything. My school was only girls it was ba sically everything for us. Companies would come and explain things. But now being here, you have to have the need to search. Its not like people come to you and tell you need to do this and this.

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96 STEPHANIE: Usually I read Seventeen magazine. They have a health section that is really interesting. They usually have opinion pieces and questions that teenagers may have and dont feel comfortable asking. Usually I can ask my mom or my science teacher. JESSICA : Yeah really good magazines are good; I like readi ng stories about other girls. You learn through other peoples stories. Mod : What are the names of some specific sources that you use? STEPHANIE: I watch the English news and Spanish news and Univision W eb site. JESSICA : It all depends what you are l ooking for I just Google it. There is a W eb site that sends me tips, but I dont remember the name of it. CRISTINA : There is a show that doctor Oz is a host of. And he sometimes talks about sex and its good because it comes from a credible source like a doctor. JESSICA : There is a show on MTV called Sex with mom and dad. CRISTINA : Its a show with a doctor that sits down with the parents and the child and discusses sex. It gets awkward sometimes. JESSICA : Its funny to see how people react and how people have these problems with their moms. Because I really dont have, I have experienced, my mom we trust and stuff. b. Reproductive health information (20 minutes) Mod : What kinds of reproductive health information are most important for girls your age to have? CRISTINA : Contraceptives, how to be safe about it. In middle school, well going from middle school to high school and seeing older people being pregnant and having classes with them really shocked me, and its really sad something should have been done to prevent that. I think thats the first thing. JESSICA : For me it really shocked me coming from Columbia from an all girls private school to all boys and girls. In middle school I seen this girl who was pregnant, in middle school she was only 15 years old, that just helped me so mush so that I wouldnt do that, but at the same time I wanted to learn more it helped me so much because I did not want to be in the same position as her. So how to protect yourself. STEPHANIE: I kind of agree with that. Its weird because they know how to use a condom and all that, but they say I already know that so I dont need to learn that. Mod : If you had questions about reproductive health, what sources would you use to try to get information?

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97 CRISTINA : I would rely on the computer if not a health teacher you can ask someone but in private. So if the computer doesnt have the answers you can always talk to someone. JESSICA : Like if the computer, you just have a question or type the word and read about it But magazine is good, but its not like when you are asking the questions. Because I know that not everyone has someone to talk to, because they might feel like the question is stupid. STEPHANIE: Its not hard to me to talk to me about my mom, I just wont be straightforward, Ill drop hints and then ask the questions. JESSICA : I remember in middle school I was so embarrassed to talk to my mom, but I knew she would have a perfect answer for me, so I would say Mami I have a question for my friend, just for my friend Mod : Which sources would you consider most trustworthy? Why? CRISTINA : A doctor JESSICA : doctor STEPHANIE: doctor Mod : How likely would you be to look for reproductive health information online? Tell me your reasons. CRISTINA : A 100% likely online you can read testimonials, tips on how to get aid, what the doctors said about it, a lot of information. JESSICA : Yeah to get information, so when you go to the doctor you are prepared. STEPHANIE: Yeah well I have three siblings and the y are little and I do not want them to hear my conversation, so I will also go online so I can have my privacy. Mod : Tell me about a time when you used the Internet to search for reproductive health? CRISTINA : Well I have this friend, and this is a real I have a friend story, who was afraid she got pregnant because her boyfriend ejaculated kinda of close to her. To calm her down I looked it up and you knowand I found out that there is a really little chance and I told her and took her to the W eb site an d I calm her down. The Internet is a really good tool JESSICA : Just basic things. How to prepare yourself for the first time. STEPHANIE: Well you always have sex Ed; you have to do a lot of research for projects. Like STDs. Mod : How often do you use the Internet to gather reproductive health information?

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98 CRISTINA : Like twice a year. JESSICA : Whenever I have questions. Not every day. It all depends. If I have questions, if I feel a change in me. STEPHANIE: Once in a while Mod : How would you compar e the Internet to other sources you might use, such as ________________ (list other sources theyve mentioned)? JESSICA : Like in the computer you type the question so its more specific. You can find other peoples question. Its more personal. CRISTINA : The answers are instant, instead of waiting for the next episode to come up. STEPHANIE: Yeah the same thing with magazines. You just read this and now you have to wait to the next edition. Mod : After reading a magazine or watching a TV show do you guys follow -up on the computer? JESSICA : If there is something that is really interesting I just go on to learn more. CRISTINA : If you want more and there are not enough details in the magazine you look for more information online. STEPHANIE: That s how I got into the Seventeen W eb site I read a sex article and they said for more information to go on the site. JESSICA : I go on Youtubeits like the same time like TV. I put in a question and videos come up about it. CRISTINA : Thats true I look at music vi deos or how to do. I guess if its on the radio, it gives me more reason to look it up. Because I cant see it. So I can see a visual. STEPHANIE: I watch Oprah and it has a doctor sometimes CRISTINA : Doctor Oz? STEPHANIE: And then he has a W eb site that you can go too for more information. c. Searching reproductive health information online (20 minutes) Mod : If you have ever used the Internet to look up reproductive health information, Id like for you to think about the most recent time you did that. If you havent, then maybe think about a reproductive health topic about which you might want more information. How did you or would you begin your search for reproductive health topics online?

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99 CRISTINA : I went to specifics, I guess in sex Ed you take it in midd le school I dont remember any W eb site that they gave us. So I just typed in the question. I had to kind of edit it to fit the W eb site. I Googled it. JESSICA : Google STEPHANIE: Google Mod : Did you/would you follow a specific process? Tell m e about how you did or would go about your search. CRISTINA : The most popular on the top, read the bottom credits. JESSICA : The first one I see. I read them. I just stay in the first page. STEPHANIE: I like to read the first one; I like to look at the m all. The farthest I will go is page three. CRISTINA : Until I find my answer I keep searching. Mod : How do you decide what is correct information? JESSICA : I compare the sites. I look at the all of them and see if they are all the same. I really dont know the information, so I dont know what is right. CRISTINA : I think we use our judgment, if its credible or truthful. JESSICA : And how it looks. CRISTINA : Or if you open a nother W eb site and its the same thing, then you know what it was true. Mod : What type of sites did you visit when searching for health -information/topics? CRISTINA : I just remember health sites, no doctor or hospital sites. JESSICA : The same thing. STEPHANIE: Also Planned Parenthood. Mod : Tell me your reasons for choos ing these sites. CRISTINA : After comparing. I pull up multiple tabs and if I find one that is pretty good I will keep it open and compare it. Mod : What was especially attractive about these sites?

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100 JESSICA : Its like they are talking to you. Its for teen agers and they are talking to us. If they have stories STEPHANIE: I dont like having big words. CRISTINA : I dont mind the big words; if it has big words it is more credible. I also like pictures. JESSICA : Oh yeah me too. If its too much text, I loo k at something else. Mod : What type of information did you receive on these sites? JESSICA : When I was looking at one specific thing, I found other stuff. STEPHANIE: In Seventeen it was a topic about sex Ed and then it had information on breast cance r and how to check yourself. CRISTINA : They always have other links that you can check other stuff. Mod : Was that the kind of information you were looking for? If not, what kinds of problems did you have with it? CRISTINA : I had to a couple of sites until I found what I was looking for. Maybe if the question is really specific it wont be on the Internet and then it doesnt become your question anymore and then you really need to talk to someone else. JESSICA : You had to edit it a lot. Mod : How tru stworthy or believable was the information you found? CRISTINA : Everything. Since we have a background with sex Ed, we kind of have a head start. JESSICA : It has to be logical. Mod : Did you all have sex Ed? CRISTINA : Its basically a requirement unles s your mom signs you out. I was in seventh grade and in high school you are required to take a class called management skills. The topics we cover are STDs, contraceptives, and a pregnancy video. I actually I took it in sixth, eight and ninth. CRISTINA : W hen you get to middle school they tell you over and over again and use protection. CRISTINA : Middle school I had speakers [nurses] but in high school its your teacher.

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101 CRISTINA : In sixth grade I had one lady come in she was a nurse she brought a condo m to be fun, she told the guys that condoms are for everybody to use it. Then she blew it up and put it over her head. STEPHANIE: In middle school we went to a clinic. Mod : After the search you did online, how satisfied were you that you had gotten the answers or information you needed? CRISTINA : Yeah JESSICA : Yeah Mod : If you still needed more information, where do you go to get more information? CRISTINA : Friends, someone you have a lot of confidence in, or a teacher. Not dad. d. Concluding Rema rks (10 minutes) Mod : Tell me what, if anything, you did with or in response to the information you found online. Did you/Would you talk to anyone about the information you found online, and if so, who would that be? CRISTINA : I talked it over with my fr iend. I would never keep anything in. I dont tell my parents I just feel more comfortable with my friends. STEPHANIE: I did the same I told my friends. I have a boyfriend, so my mom talks to me to be careful. My dad just brought it. CRISTINA : My mom t rusts me a lot. She doesnt tell me to be careful, nothing like that. JESSICA : I told my friends.

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102 APPENDIX C INTERVIEW TRANSCRIPT II. Questions a. Educators Role (15 minutes) Mod : Could you describe a normal day on the job? What are your main responsibilities? I002: I am basically a sexuality educator, so the main bulk of my job is going out into the community and doing classes on everything from basic puberty to anatomy, birth control, sexual decision -making, and sexually transmitted infections. Anything that has to do with sexuality. I mostly work with teenagers; I work a lot with alternative schools I do some classes in high schools, occasionally I will be called to do a college class. I also work with parents at least ten times a year. Ill do all d ay training where we talk about talking to their kids about sexuality. Sometimes different programs will ask me to come in and do training for their staff. So every day is varied and I see thousands of people every year and umm its just a huge variety of topics but the main bulk of whom I talk to are teenagers. Mod : How do interact with the Latino community? I002: In Sarasota there is, I am not even sure what the population is, but there are always a percentage of Latino kids in every class that I do. Sp ecifically through this project that I have been working on for the last three yearsumm starting last spring, I started doing classes with the Yachievers through this project where the teens attend eight classes, and then they get paid at the end of eigh t weeks for attending all the classes and I have doneumm three classes now with teens that are all bilingual and have done two parental classes. And Ill be startingthese have all been high school students and I will be starting the first or second week in January with a group of middle school kids that are part of this Latino after school group through the Y. Latinos are always part of classes I do, it might be a smaller percentage but I have been doing these classes specifically within the Latino commun ity and when I do the parent classesumm they are done in Spanish with me saying what I can, because my Spanish is certainly not excellent. Mod : How many students would you say you have per class? I002: Umm it varies. Through this project that I have been doing just with the Hispanic community we have had 20 kids and 20 parents. Umm when I am doing another class it depends, for example, tomorrow I am going to be at one of the local high schools and will be doing four different classes and each one has between 30 36 students. I also work at PACE Center for girls were I do eight series workshops. Usually out of the 10 girls that attend the class, half of them are Latina. So umm, they have a high percentage of Latinas at there school. I work with them by doing 5 series of classes a year. The classes there are very small, but at least half of them are Latinas. Mod : How many girls or boys do you interact with in the Yachievers program?

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103 I002: Pretty even, it depends umm, the first class I did there was by far more girls. The last class it was straight down the middle. Sometimes they will bring friends and it will be 24 or 23 students. It depends, its pretty even. But PACE center is an all girls school. Other programs in the schools its pretty even. I als o do a class at a place called Character House, which is a place for girls that are incarcerated and pregnant that are under 18. So thats all girls, so usually in a class of 15 there are 4 Latinas there. Mod : The Yachievers program is it a voluntary program? Do they have to sign some sort of contract? I002: In the class that I do, they have to come to all eight classes to get paid. Now sometimes friends will come and they will come for a class or two. But they sign a contract at the beginning saying they will come to all eight classes and the classes are an hour and a half. Sometimes we do it twice a week; sometimes we do it once a weekummbut they are eight one hour and a half classes andummthey have to come to all the classes unless they have a p arental excuse they can miss one. So thats the deal that we tell them at the very beginning. They get paid a $100. And they each get a book at the end [a sexuality book complied by Planned Parenthood]. It seems to be a very well receptive program. They te ll their friends about it and it is very easy to get the kids for it. And the same with the parent class, the word is out in the community and ummthere is usually a waiting list for people who want to get in it. We have been trying to do this middle school. But some of the middle -schoolers get out very late in the afternoon. And they will have to do this at night. Thats has been a little more complicated but we will be starting that in January. Mod : How old are the Latina girls you usually interact with ? I002: 14 18 years old for the high -school students and 12 13 years old for the middle -school students. Sometimes I found that some of the Hispanic kids will start a lower level [grade] then if they were in their native country because of the language d ifference, because they come here with no English. So sometimes you will have girls in middle school that have gotten pregnant and married. And they were 16 years old. And I have had that happen too, because they have been older. Mod : Describe for me, if you would the characteristics of the girls and their families -socioeconomic status, parental education levels, family structure? I002: The girls that I have worked with, the kids that are in this program tend to be more educated. Certainly when I ha ve met with their parents a lot of the parents of the kids have been in my parent class. The girls tend to be more educated are usually very very familiar with English and some of them are fully bilingual. They tend to be very comfortable with each other t alking about sex, but not so much asking questions, especially in front of the boys. I think if the boys and the girls were separate the boys would ask more questions and the girls would ask more questions, hard to tell. They are more comfortable coming an d talking to me about anything private afterwards, which is the same with boys. I have had several times when kids have come up to me in the parking lot or they have come early, they dont want to ask questions in front of the girls. I dont see much diffe rence between the Hispanic kids and the other group that I work

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104 with. They are generally more respectful, they are more appreciative...umm...they seem to have close family ties. The kids that I have through the Hispanic achievers program, these are kids that the goal of the program is to get them into college, get them into a career. So these kids tend to be kids that are going to stay in school, that have goals. I know the first group that I taught last spring...umm...they had a breakfast to honor them and all the people the worked with the black achievers as well, because its a program that the Y has too. And I went to it and these kids were getting wonderful scholarships, many many of the kids in my class were getting scholarships and going up to college So umm, this last class I had, not so much. Especially some of the boys were pretty tough and...ummI dont want to say anything about any gang association or anything like that, but they were not, some of them were not at the same level as the kids I ha ve had in the past. They were less likely to participate in class or less respectful, they werethey wouldnt talk to me in English and Isometimes afterwards I spoke to one of the kids and he said ohh noo they speak English. So I think they were giving me a hard time for whatever reason, I dont know. They didnt realize how much I understood what they were saying. I could get the gist of it. So that was a more challenging group. But the girls I have found to be very very delightful in class, they just d ont ask a lot of questions. Makes it harder, still kind of shy about it. Its not what I am guessing is part of their culture. When I have talked to their parents it is typically nothing that they have discussed at home, certainly the parents havent. So a lot of them come in with very little basic knowledge about anything, about birth control, about their own anatomy, about STDs. But that is not anything different that I see in other groups. Mod : What barriers do you face when educating these Latina ado lescents? I002: That I dont speak Spanish. What I did do last semester and I hope to do again is we have a Hispanic clinic women that worked in the clinic who was bilingual and she came in and talked to the kids in Spanish and what the clinic services we re. That was fantastic. They seemed to open more up to her and be more comfortable. Some of them I think are uncomfortable speaking in English and umm that is the biggest barrier for me. Its not being bilingual, I am tryingwe get through it and I think that they do learn a lot. At the end when I evaluate themand evaluation, they fill out an evaluation sheet a couple of times during the eight weeks of What did you learn? and What do you want more information about? I do have pamphlets; a lot of the kid s take pamphlets for information. I had a girl and her boyfriend come into you clinic last week. That always makes me feel wonderful. Like it was a big success. Mod : How do the parents react to the topics you discuss with the girls in the sessions? I002: They are so glad that their kids are getting this information. They really want their kids to get it. The really really care about their kids and ummthey say, I dont know this, and hopefully when they take the class and their kids take the class they w ill have something to talk about together. I dont know how many parents come up to me either before or after when they are dropping their kids off and they will thank me. They have been very very supportive. They want their kids in these classes. They wan t to take the parent classes themselves. The classes with the parents have been fantastic. They have been so well received and it has been absolutely wonderful. We are just getting started; we still have a couple more years on this grant. I cant do as man y classes as they would like because we have to use the grant for other groups as well.

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105 b. Curriculum (15 minutes) Mod : Could you describe for me, what your curriculum consists of throughout the year? I002: I always start with anatomy because people of any age do not know their anatomy, do not know their reproductive anatomy. So I talk about starting with puberty, what are the changes that happen to the male and female body. What needs to be in place for pregnancy to happen? How are sexually transmitted diseases spread? We start with a simple thing, were we have big pieces of paper around the room and have the words on the top such as vagina penis breast testicles I stick elbow in there to see what happens, and then I have them write as many di fferent words as they can in English, Spanish, slang, whatever for each of these words, just to get the comfortable enough with saying each of the words or just to say the words and we have a good laugh and they get that out. And then I say then why is the re nothing for elbow? Why dont they make up funny words for that? And then we go from there, umm...and then we say you can call it whatever you want outside, but in here we are going to try and use the medical name, the real word. And then we go through a nd do a whole anatomy lesson, with a lot of emphasis on preventing infections, just about pre -ejaculate how that can have enough sperm to cause pregnancy, how infections can be in there. Stuff like that. So that they really get a good basis, so when I am t alking about birth control, they will get what I am talking about. When I talk about skin to -skin infections they get what I am talking about, when I talk about using a condom they have that basis. That to me is probably the most important lesson. Ummand then they get some understanding that they can ask me questions about all of these words. It really gets them off to a good start. Then I go into something that I call sexual decision making. I ask them to tell me Why do teens decide to have sex? Why do they decide to wait? And we put a long list up on the board. And then I have an activity where they have little scenarios, where they read; I make a big chart on the board about deciding to wait and deciding to have sex. If you decide to have sex, do you plan ahead? Or does it just happen. If it just happens, you could have a pregnancy you could have an infection, so I have this big chart on the board and then I have this pictures with scenarios on them and I have them read them. And this gives me the oppo rtunity to evaluate how well they speak English, because often time I dont really know. That really helps me with that so I can see where we are. Umm...and then I do an activity where I have them in groups and I have them define the word sex and define th e word abstinence, because so often when people are talking about sex they have different definitions. And when people are talking about abstinence, what do they really mean. I do the same thing with the parents too and I get some very interesting definiti ons. So what I am trying to get out of this, is when I am talking about sex I am talking about oral, anal, vaginal intercourse because that is how infections can be spread. And from the point of abstinence, you can have whatever definition you want, as lon g as you know what your definition is and your able to be assertive enough and say, this is my limit. This is what I am willing to do and not willing to do. And then we talk about How do you tell someone that this is your limit? How do you communicate? so thats the whole lesson. Then I do a lesson where I show a video of two teenagers giving birth and that always gets their attention. I have a belly they can try on that simulates being nine months pregnant. We talk a lot about that. We talk about wha t is the youngest person you know who has had a baby? What does

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106 somebody do if they pregnant at the age of 11,12,13,13? Ummhow would it affect your life? What makes it hard? Why does it make it harder? We talk all about teen pregnancy. I do a lesson abo ut the different birth controls. I make charts around the room with each one attached on the paper and write What do you know about this form of birth control? And what questions do you have? And they really dont know much, unless they have been on a fo rm of birth control themselvesummthey reallyhavent heard about themdont know much about them. The guys even less than the girls. So I talk a lot about that, I talk a lot about the services in the health department, the services at Planned Parenthood where they can go, what it cost. That they dont need parental consent. They dont realize that they can access these services without parental consent. They just, they just dont know that. That they can get free condoms. Ummso luckily where this class i s held a half a mile from both Planned Parenthood and the health department. So they are located in the perfect place to be able to walk to these places where many of them dont even know they can access these things. Many of the kids really do want to be responsible umm...most of the kids in these classes are older, they are juniors and seniors, and a large percentage are sexually active, but they really dont know what to do, or where to go. Then we do a whole class on using condoms a whole class just o n using condoms. They work in groups and they have these cards that have prompts of twenty-some steps and they work them in groups and put them in order. So we talk about everything from the very beginning, of about talking to your partner, to where do you get them, where do you store them. We do a whole thing where we blow up condoms and we put baby oil on them and we watch them explode. Which they always enjoy! I hear the most amazing things from pizza grease, toothpaste, all these bizarre things, Pam, t hats what I just, heardspray Pam that teenagers use as lubrication. We talk about that. Where do you get them? So I do a whole hour and a half on condoms and how to use them correctly. Unfortunately I cannot give them it there, but they can go and get th em for free at our clinic or the health department. Then we do a whole class on sexually transmitted infections. I have a very dear friend who has lived wit HIV for her 22 years and she will come in and talk to them about her life and answer any question s they have. That usually is very impactful. And that kind of covers it. If there is time I will do something on Facts and Myths, I throw stuff like that as we go along. Umm that pretty much takes up the whole eight weeks. OhhI do another piece on, toward the beginning, whats normal and whats not normal? Whether, I have all these little strips that say is it normal for an adolescent male to have this? Or is it something they need to go to a clinic for? And the third category is if you are not sure, if you want me to talk about it, I put it in that category. So we go through that with the males and females right at the beginning so they get a better idea of whats normal. Mod : What topics seem to be the most popular? I002: Talking about condoms, the love that, and wearing the emphacy belly, they really like that. When they walk around and pick up stuff and watch the birthing video. UmmI try to make everything interactive and have them work together as much as possible. Ohh...there is another little piece that I do when I do the abstinence piece. Where I have one be the partner that wants

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107 to have sex and one that wants to wait, and I put a chocolate kiss in front of the person that wants to wait and the person that wants to have sex has to convince the other person to give them the kiss and ummif they can convince them, then that person gets the kiss, if not the other person who was trying to wait keeps it. So that gets some interesting dialogue going. How do youI want them to talk. Ummand to get them words and to get that power to say if I am not doing it on my terms I am not doing it. Mod : How do the girls usually react to all these topics? I002: They seem great. Them seemummreally interested. I always try to bring pamphlets on the different topics. They take them. At the end they get a book called Sex, Puberty and All That Stuff. It kind of goes through everything that we went through in the class. So they seem attentive. They seem interested, but ummthere is always a lot of flirting in the class so I kind of gotta toits hard to keep a lid on it. Umm...because you got a lot of hormones in there. There usually are one or two couples that are draped all over each other. That can be a little distracting. But you know positive. They may not ask a lot of questions but they are paying attention. I really feel that they are learning and that they want to learn. Sometimes I will have kids that are very arrogant; they think they know everything and that we have nothing to teach them. But that is not the ca se here. They are like I didnt know that. Mod : What type of questions do you get often? I002: Ill get questions about where to go. Probably more on the birth control then anything else and about the sexually transmitted infections. Those get them a lot. They dont ask too much on the beginning about the anatomy and again it could be that they need to feel comfortable with me more and that can take some time. Mod : What topics are the girls less familiar with when they attend the workshops? I002: Basically their basic anatomy and where to access services. They just dont know. They dont know the law; they dont know where they can go. This information is just not out there. For anybody, but ummmany of our clients hear it from a friend. I used to be in all the high schools and I used to do tons and tons and tons of classes. And I am not allowed anymore even though I am slowing getting back in. I was thrilled when I got invited to a big high school for the next two days Im going in. But they are no t getting this information anymore. They dont even know whats there for them. Mod : What type of resources do you use? I002: Umm.a lot of it I made up. I have been doing this for sixteen years. I always love to make up curriculums. UmmStreet Wise is excellent stuff. Any of the Planned Parenthood stuff, like Peggy Brick. We all think the same way even before I started working for Planned Parenthood. This is how I have always taught. I always make everything very interactive. I try to use all of the sen ses; I try and mix it up. UmmI dont do a lot of games for this group, some other groups we do more. A lot of the stuff, I dont even know I pulled it from places so many years ago. Ummmor I just make it up, or I got it from somebody. And we have an educ ation

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108 team of eight educators and ummwe all make up stuff. We find something or we think of a new way to do something, we share it. Its a great organization and we help each other. Mod : What resources do you recommend for the girls to use if they want more information? I002: I give them pamphlets ummI probablyI am not sure how many of these kids have access to a computer. But probably something I should do is give them more resources so that they can go online. But that is probably something that I havent done enough of. I dont knowI assume Teenwire.com in Spanish. Although most of themI only had one girl who wanted a book in Spanish the other are comfortable reading and talking in English. She had just recently arrived from Cuba, so her best fri end sat and translated everything for her, she had almost no English. Mod : What change, if any, do you see in the girls throughout the entirety of the series? I002: They get a comfort level in talking the talk and learning the words and talking to each other and I purposefully try to have them work in groups of boys. One of the things I am trying to do is to get them comfortable talking to guys about it. I just think they feel empowered with their bodies. They start to understand how it works they real ize that they can be in control of their fertility and that they have the right to say I dont want to do this and if they do they can say we need to go get tested. They get a lot of power of feeling good about themselves. I am sure there are plenty that s till cant say it, cant talk and cant say I dont want to do this but I think this is a good step in that way. And I think as more and more of these classes are done, even though we do have a large Hispanic population a lot of them know each other, especially if they are in the same school. It starts a dialogue in their community and they get more confident. Mod : What information seems to stick with them after the series? I002: We recently had a Hispanic festival and we had a booth there and some of the girls from my other class were coming up and asking me questions about the birth control they were using. And some of them come back to the class and some of them are in the YMCA visiting and I will see them in there. Ummits mostly about there birth controlummor something for their friends, questions like that. Sometimes they come from another country and they have birth control there. I have had girls that were from Columbia who were using the patch and they want to continueummso I get questions like that. c. Internet Use (15 minutes) Mod : How do you, as an educator, use the Internet to prepare for your curriculum? I002: If I am doing something particularly in a college level or I do HIV updates for clinic staff, Ill go online and look for that. All of the educators send stuff to each other all the time. If we see a new article. So I am on the Internet every day, several times a day. Whoever finds anything; we send it out to all of us. Im getting stuff all the time. Or if I am asked, for exam ple on a college level, where things need to be more in -depth I need to make sure I get everything more detailed

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109 than on the high school level. Ill go online and Illwell I know college students that dont know anything either. They dont know it. Mod : Do the girls ever talk to you about information they've found through mass media sources, such as TV, radio, magazines or the Internet? I002: Not much. I think they get most of their information from their friends. I think its more in African -American culture where they will say, well my mother told me this, my aunt told me this. Or my sister told me this. I havent found this much in this population. And usually it is something that is not true. Sometimes I hear some stuff that is true. Usually it is a friend. I am not seeing a lot of independent research. I would be surprise if they were going to books to gather information. Again I dont know what percent of these kids have a computer in their home. Mod : Do you think this demographic is more receptiv e to printed information like your pamphlets or are they more receptive to going online? I002: Well I dont hand pamphlets out. I just put them out and if they want more information they can get it here. The girls tend to take them more than the boys, wh ich is not surprising. That is typical. I dont know, just from my own kids, we have four kids, and they do everything online. But, again they are taking the pamphlets. d. Planned Parenthood Education (15 minutes) Mod : What types of issues are commonly seen in your clinics with the Latina population? I002: It is usually birth control and STDs and they are usually very shy about asking for things. They need to feel a level of trust and luckily we have wonderful counselors here. One is fully bilingual and one is quite bilingual, she has lived in Peru for I dont know how many months and she is able to carry on a conversation with them. But even if they are not bilingual they are shy and they are not used to talking about things. So the main things people c ome here for are birth control and STD testing. Ummwhat I have seenwe do abortions here once a week and when I used to be a counselor, not anymore, but when I wasummmany of the people who came in for an abortion were not at all bilingual and really did nt know much about birth control or their partner didnt want them to use it. Ummdifferent level of education. People that have not been able to learn English, just trying to learn English and survive. Mod : What are the topics that Latinas often receiv e incorrect information about? I002: Probably about birth control, about condoms. Yeah that they [condoms] dont work. I think the main thing that I am gathering is that it is just not talked about at all! They dont really get misinformation from home, they dont get any information. I dont know. I guess I just havent had the chance for them to talk to me that much about that. Mod : Why has Planned Parenthood stopped talking to schools in the area?

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110 I002: Well what happened is, this was about five y ears agoumma parent came before the school board whose daughter happened to be 16 and pregnant and had never been in my class. The parent was furious when she found out, through one of her daughters friends, that Planned Parenthood was allowed in the sc hool. So this is right when we had a superintended, and this whole big movement was started as all these people were called upon to the school board meetings and many of them were older, many of them were pulled together through their churches. Most of the m did not have children in the school and they gave unbelievable misinformation about what we have done in the classes. It was very bizarre because I went to these meetings and nobody knew whom I was, because none of them had been in my classes and didnt know what I was talking about. It was countered by teachers, professionals, people who had taught with me whose classes I had been doing for years and years and years. But at the time the makeup of the school board was such that is was just the perfect tim e to umm.limit was going on here and just having teachers or the health department nurses teach. There was this huge massive school board meeting but there were enough people on the school board that were against Planned Parenthood and they really only wa nted abstinence information. Many of the places that I had taught for 10, 12 years ummtheir principals just didnt want to take a chance of being targeted. We have been talking to summer schools. Last year we did three different summer schools and last year at the end of the school year I did do one high school. And there is one teacher at one of the high schools who has had us in for the last couple of years during the school year. And I got a phone call this morning from a teacher who had been one of t he teachers during summer school who said I want you to come to my class during the school year. I said great but then I didnt hear from her and she probably asked her principal and he probably said I dont want to take the chance but I am going in tomorrow. Summer school were they take it used to be called Life management and now they combine like management and PE into a class they call HOPE. Thats the only place if the teacher decides to do it, is the only place where they get sexuality inform ation. They have nurses that go to the schools, but they typically had a lot of schools, and the normally dont have time to teach them. I think its mostly administration. There is a man from the health department that goes around and does some classes f or the health department and he does classes on sexually transmitted infections. Umm my friend that has HIV does, she is part of a Speakers Bureau and she goes around and talks to some of the classes. But they are not getting information on birth control or emergency contraceptives, which I think is really critical for them to have. I still do private schools, I still do alternative schools. They just arent getting it. Mod : Within the 5 -year period, have you seen an increase in your clinics of anythin g? I002: I know our Chlamydia and gonorrhea rates countywide are up. How can the increase not be a lack of education. Its only speculation. I know I am part of an HIV network and someone from the health department epidemiologist came in and was given us the statistics of gonorrhea and Chlamydia and they have gone way up. Thats a co -factor for HIV. And if they go up, I am sure other stuff goes up as well. Part of it is that the kids do not know where to get tested. They

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111 dont have symptoms so they dont k now. They are not even getting the message to go in and get tested. The dont even know the infections. If they are not even willing to get testedis one of the biggest messages that we giveagain and again and again. Go in and get tested, find out. We al ways find a way and we are not hitting the numbers they way we want and should be.

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112 APPENDIX D PARTICIPANT LIST Individual Interviews ID Number Gender Ethnicity I001 F Mexican I002 F American I003 F Puerto Rican I004 F Mexican I005 F Puerto Rican Focus Group #1 ID Number Age Ethnicity MARIA 17 Mexican ELENA 17 Argentinean ANNA 17 Mexican MICHELLE 16 Argentinean Focus Group #2 ID Number Age Ethnicity CRISTINA 18 Mexican JESSICA 18 Columbian STEPHANIE 16 Mexican Focus Group #3 ID Num ber Age Ethnicity LOLA 16 Ecuadorian VERONICA 16 Ecuadorian VALERIA 16 Ecuadorian CARMEN 16 Puerto Rican Focus Group #4 ID Number Age Ethnicity MELINDA 15 Puerto Rican MELISSA 15 Puerto Rican ALEJANDRA 16 Puerto Rican ALICIA 16 Cuban

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113 Fo cus Group #5 ID Number Age Ethnicity BLANCA 18 Cuban EMILIA 18 Cuban GABRIELA 18 El Salvador Focus Group #6 ID Number Age Ethnicity ISABEL 17 Puerto Rican MARIBEL 17 Chilean MONICA 16 Puerto Rican Focus Group #7 ID Number Age Ethnicity NO EMI 15 Argentinean SARA 14 Argentinean

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114 LIST OF REFERENCES Ackard, D. M., & Neuma rk -Sztainer, D. (2001). Health care information sources for adolescents: age and gender differences on use, concerns and n eeds. Journal of Adolescent Health, 29, 170176. Allen, M., Svetaz, M. V, Hardeman, R. & Resnick, D. (2008). What research tells us about Latino parenting practices and their relationship to youth sexual behavior The National Campaign to Prevent Teen and Unplanned Pregnancy. Washington, D.C. Babbie, E. (2004). The practice of social research Belmont, CA: Wadsworth Publishing. Benedek, E. P., & Brown, C. F. (1999). No excuse: televised pornography harms children. Harvard Review Psychiatry, 7 (4 ), 236240. Bloor, M., Frankland, J., Thomas, M., & Robso n, K. (2001). Focus groups in social research. Thousand Oaks, CA: Sage Publications. Borzekowski, D. L. G., & Rickert, V. I. (2001). Adolesce nts, the Internet, and health: i ssues of access and content. Applied Developmental Psychology 22, 49 59. Ce nters for Disease Control and Prevention. (n.d.). Ret rieved October 2007, from http://cdc.gov Brown, J. D. & Steele, J. R. (1995). Adolescent room culture: studying media in the context of everyday life. Journal of Youth and Adolescence 24(5), 551576. Brown, J. D., Steele, J. R., & Walsh -Childers, K. (Eds.) (2002). Sexual teens and sexual media: investigating medias influence on adolescent sexuality Mahwah, New Jersey: Lawrence Erlbaum Associated. Brown, J. D., L'Engle, K., Pardun, C., Guo, G ., Kenneavy, K., & Jackson, C. (2006). Sexy media matters: exposure to sexual content in music, movies, television, and magazines predicts black and white adolescents' sexual behavior. Pediatrics 117(4 ), 10181027. Centers for Disease Control and Prev ention (2005). MMWR: Youth Risk Behavior Surveillance Washington, D.C.: U.S. Cheong, P. H. (2007). Health communication resources for uninsured and insured Hispanics. Health Communication, 21(2), 153163. Cope -Farrar, K. M., & Kunkel, D. (2002). Sex ual messages in teens favorite primetime television programs. In Brown, J. D., Steele, J. R., & Walsh Childers, K. (Eds.), Sexual teens and sexual media: investigating medias influence on adolescent sexuality (59 78). Mahwah, New Jersey: Lawrence Erl baum Associated.

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116 Gilliam, M. L., Warden, M., Goldstein, C., & Tapia, B. (2004). Concern about contraceptives side effects among young Latinas: a focus group approach. Contraception, 70(4), 299305. Glaser, B., and Strauss, A (1967). The discovery of grounded theory: strategies for qualitative research Chicago: Aldine Publishing Company. Gray, N. J., Klein, J. D., Cantrill, J. A., & Noyce, P. R. (2002). Adolescent girls' use of the Internet for health information: Issue be yond access. Journal of Medical Systems 26(6 ), 545553. Gray, N. J., Klein, J. D., Noyce, P. R., Sesselberg, T. S., & Cantrill, J. A. (2005). Health information -see king behaviour in adolescence: t he place of the Internet. Social Science & Medicine 60, 1 4671478. Greenberg, B. S., Siemick, M., Dorfman, S., Heeter, C., Stanley, C., Soderman, A., & et al., (1993). Sex content in R rated films viewed by adolescents. In B. S. Greenberg, J. D. Brown, & N. L. Buerkel Rothfuss (Eds.). Media, sex and the adolesc ent (p. 45 58). Cresskill, NJ: Hampton Press. Gross, E. F. (2004). Adolescent Internet use: what we expect, what teens report. Applied Developmental Psychology 25, 633649. Guttmacher Institute. (2006). U.S. teenage pregnancy statistics: National and state trends and trends by race and ethnicity. Hines, A. M., & Caetano, R. (1998). Alcohol and AIDS related se xual behavior among Hispanics: a cculturation and gender differences. AIDS Education Prevention, 10, 533547. Hovell, M., Sipan, C., Blumberg, E ., Atkins, C., Hopstetter, C. R., & Kreitner, S. (1994). Family influences on Latino and Anglo adolescents sexual behavior. Journal of Marriage and the Family 56, 973986. Huston, A. C., Wartella, E., Donnerstein, E. (1998). Measuring the effects of s exual content in the media: a report to the Kaiser Family Foundation. Jick, T.D. (1979). Mixing qualitative and quantitative methods: triangulation in action. Administrative Science Quarterly, 24 602611. Johnson, M. A., Gotthoffer, A. R., & Lauffer, K. A. (1999). The sexual and reproductive health content of African American and Latino magazines. The Howard Journal of Communication, 10, 169187. Jourard, S. (1964). The Transparent Self New York: Van Nostrand.

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117 Kaplan, E. B., & Cole, L (2003). "I want to read stuff on boys": White, Latina, and Black girls reading seventeen magazines and encountering adolescence. Adolescence, 38 (149), 141159. Kanuga, M., & Rosenfeld, W. D. (2004). Adolescent sexuality and the Internet: the good, the bad and the URL. Journal of Pediatric Adolescent Gynecology 17, 117 124. Kerns, J., Westhoff, C., Morroni, C., & Murphy, P.A. (2003). Partner influence on early discontinuation of the pill in a predominantly Hispanic population. Perspectives on Sexual and Reproductive Health 35(6), 256260. Knodel, J., Havanon, N., & Pramualratana, A. (1987). Fertility transition in Thailand: A qualitative analysis. Population and Development Review, 10, 297328. Krishnan, S. P. (1996). Health educati on at family plann ing clinics: s trategies for improving information about contraception and sexually transmitted diseases for low income women. Health Communication, 8(4), 353366. Krueger, R. A., & Casey, M. A. (2000). Focus groups: a practical guide for applied research. (3rd ed.). Thousand Oaks: Sage Publications, Inc. Krueger, R., & Morgan, D. (1997). The focus group kit, volumes 1-6 Thousand Oaks: Sage Publications, Inc. Kvale, S. (1996). Interviews: An introduction to qualitative re s earch interviewing Thousand Oaks, CA: Sage Publications. Laird, J., DeBell, M., & Chapman, C.D. (2006). Dropout rates in the United States: 2004. (NCES 2007024). US Department of Education, Washington, D.C. National Center for Education Statistics. Levy, J. A., & Strombeck, R. (2002). Health benefits and risks of the Internet Journal of Medical Systems, 26( 6) 495510. Lenhart, A., Madden, M., & Hitlin, P. (2005). Teens and technology: Youth are leading the transition to a fully wired and mobile nation. Pew Internet & American Life Project. Washington, D.C. Lindlof, T. R., and Taylor, B. (2002). Qualitative communication research methods Thousand Oaks, CA: Sage Publications. Lindlof, T. R. (1995). Qualitative communication research methods Thousand Oaks, CA: Sage Publicat ions. Llagas, C. & Snyder, T. D. (2003). Status and trends and in the education of Hispanics. National Center for Education Statistics to Prevent Teen Pregnancy. Washington, D.C.

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118 Lowry, D. T., & Shidler, J.A. (1993). Prime time TV portrayals of sex, saf e sex and AIDS: a longitudinal analysis. Journalism Quarterly 70, 628637. Manlove, J. (1998). The influence of high school dropout and school disengagement on the risk of school age pregnancy. Journal of Research on Adolescence 8 ( 2 ), 187220. Marin, G. (1989). AIDS Prevention among Hispanics: needs, risk behaviors, and cultural values. Public Health Reports, 104(5), 411415. Marshall, C. & R ossman, G.B. (1999). Designing qualitative research (3rd Ed.). London: Sage Publications Inc. Marvin, G., Sa bogal, F., Marin, B. V., Otero -Sabogal, R., & Perez-Stable, E. J. (1987). Development of a shot acculturation scale for Hispanics. Hispanic Journal of Behavioral Sciences 9, 182205. Minnis, A., & Padian, N. (2001). Reproductive health differences among Latina American and US born young women. Journal of Urban Health, 78(4 ), 627637. Moran, K. C. (2003). A reception analysis: Latina teenagers talk about telenovelas. Global Media Journal 2 (2 ). Morgan, D. (1988 ). Focus groups as qualitative research. T housand Oaks, CA: Sage Publications. Morgan, D. (1997). Focus groups as qualitative research. Thousand Oaks, CA: Sage Publications. Morse, J. (1994). Critical issues in qualitative research methods Thousand Oaks, CA: Sage Publications. O Brien, K.J. (1 993). Using focus groups to develop health surveys: an example from research on social relationships and AIDS preventive behavior. Health Education Quarterly, 20, 361372. Pardun, C., L'Engle, K., & Brown, J. (2005). Linking exposure to outcomes: early a dolescents' consumption of sexual content in six media. Mass Communication & Society 8 (2 ), 7 91. Planned Parenthood Planned Parenthood of Greater Miami, Palm Beach and Treasure Coast, Inc. (n.d.). Retrieved August 3, 2008, from http://www.plannedparenthood.org/gmpbtc/la promesa 1323.htm Quayle, E., & Taylor, M. (2001). Child seduction and self representation on the Internet. CyberPsychology & Behavior 4 (5 ), 597608.

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120 Unger, J. B. (2007). Acculturation and attitudes about contraceptive use among Latina women. Health Care For Women International 21(3 ), 235249. U.S. Census Bureau. (2000). Health insurance coverage: 2000. Washington, D.C.: U.S. Department of Commerce. U.S. Census Bureau (2007) Nations population one -third minority (U.S. Census Bureau News CB06 72). Washington, DC: U.S Department of Commerce. Vanoss, M. B., Coyle, K. K., Gomez, C. A., Carvajal, S. C., & Kirby, D.B. (2000). Older boyfriends and girlfriends increase risk of sexual initiation in young adolescents. Journal of Adolescent Health 27(6), 409418. Ventura S. J., Mosher, W. D., Curtin, S. C., Abma, J. C., & Henshaw, S. (2001). Trends in pregnancy rates for the United States, 197697: an update. National Vital Statistics Reports, 49(4), 1 9. Vexler, E. J. (2007). Voices heard: Latino adults and teens speak up about teen pregnancy The National Campaign to Prevent Teen and Unplanned Pregnancy. Washington, D.C. Villarruel, A. M. (1998) Cultural influences on the sexual attitudes, beliefs and norms of young Latina adolescents. Journal of Society Pediat ric Nurses 3 69 81. Walsh Childers, K. Gotthoffer, A., & Greenberg, B. S. From just the facts to downright salacious: teens and womens magazine coverage of sex and sexual health. (2002). In Brown, J. D., Steele, J. R., & Walsh -Childers, K. (Eds.), Sexual teens and sexual media: investigating medias influence on adolescent sexuality (153172). Mahwah, New Jersey: Lawrence Erlbaum Associated. Ward, L.M., Gorvine, B., & Cytron Walker, A. Would that really happen? Adolescents perceptions of sexual r elationships according to prime time television. (2002). In Brown, J. D., Steele, J. R., & Walsh Childers, K. (Eds.), Sexual teens and sexual media: Investigating medias influence on adolescent sexuality (95 124). Mahwah, New Jersey: Lawrence Erlbaum A ssociated. World Health Organization. (1998). Progress in human reproduction research. (UNDP/UNFPA/WHO/ No. 45). Washington, DC: U.S. Government Printing Office. Zillmann, D. (2000). Influence of unrestrained access to erotica on adolescents and young adults dispositions toward sexuality. Journal of Adolescent Health, 27, 41 44.

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121 BIOGRAPHICAL SKETCH Ilana Echevarria earned her Bachelor of Science degree in 2007 from the University of Florida in Gainesville, Florida. She majored in public relations. Ms. Echevarria began graduate studies at the University of Florida, College of Journalism and Mass Communication in the fall of 2007. She focused her studies on health communication. In August 2007 Ms. Echevarria received an assistantship from the Career Reso urce Center at the University of Florida. During this assistantship she provided individual career advice to students on the three experiential education programs: externships, internships, and cooperative education, conducted outreach presentations on a v ariety of career topics to classes and student organizations, and served as a liaison between the College of Journalism and Communications, the Career Resource Center, students and employers. In addition to her assistantship and course work, Ms. Echevarri a worked on a grant with the Malcolm Randall VA Medical Center aiding in the development of a 10 -minute script for an educational video targeting veterans with atrial fibrillation. In the summer of 2008 Ms. Echevarria accepted an internship with Planned P arenthood of North Central Florida. Her duties included, but were not limited to, developing and presenting educational sexual health programs to schools, community centers, and non -profit organizations, developing client educational sexual health material s, and managing and counseling 30 adolescent clients on sexual health. Ms. Echevarria receive d her Master of Arts in Mass Communication in May 2009. She plans to work in corporate health communication and possibly pursue an additional m asters degree in Pu blic Health.