Friending Adolescents on Social Networking Websites: A Feasible Research Tool.

OBJECTIVE: Social networking sites (SNSs) are increasingly used for research. This paper reports on two studies examining the feasibility of friending adolescents on SNSs for research purposes. METHODS: Study 1 took place on www.MySpace.com where public profiles belonging to 18-year-old adolescents received a friend request from an unknown physician. Study 2 took place on www.Facebook.com where college freshmen from two US universities, enrolled in an ongoing research study, received a friend request from a known researcher's profile. Acceptance and retention rates of friend requests were calculated for both studies. RESULTS: Study 1: 127 participants received a friend request; participants were 18 years-old, 62.2% male and 51.8% Caucasian. 49.6% accepted the friend request. After 9 months, 76% maintained the online friendship, 12.7% defriended the study profile and 11% deactivated their profile. Study 2: 338 participants received a friend request; participants were 18 years-old, 56.5% female and 75.1% Caucasian. 99.7% accepted the friend request. Over 12 months, 3.3% defriended the study profile and 4.1% deactivated their profile. These actions were often temporary; the overall 12-month friendship retention rate was 96.1%. CONCLUSION: Friending adolescents on SNSs is feasible and friending adolescents from a familiar profile may be more effective for maintaining online friendship with research participants over time.

"Just talk to me": communicating with college students about depression disclosures on Facebook.

PURPOSE: To determine acceptability, preferred communication medium, and other key considerations for intervention by friends, professors or resident advisors, and strangers in response to college students' references to depression on the social networking site Facebook. METHODS: Facebook profiles belonging to 18- to 19-year-old students (n = 60) at a large public university were evaluated for references to depression. In-person, structured interviews assessed how students would prefer to be approached by a friend, professor or resident advisor, or stranger if that person saw displays of depression on the student's Facebook page. We coded interview transcripts for approach acceptability, communication medium, and emerging themes. We used chi-square tests to assess differences between depression displayers and non-displayers. RESULTS: The sample was 60% female with a mean age of 18.5 years. All students were accepting of intervention approaches by friends. Most (93%) were accepting of an approach by known adults. Approximately half would accept an approach by a stranger, but this proportion was 26% lower among those who had displayed depression references on Facebook than among non-displayers (p = .072). In-person communication was preferred for approaches made by friends and adults. E-mail or using a student's friend as an intermediary was preferred if a stranger were to intervene. CONCLUSIONS: In-person communication from friends or trusted adults is the preferred means for raising concerns about a student's signs of depression displays on Facebook. Programs that encourage resident advisors and peers to respond in this manner and encourage treatment may represent a way to improve access to care for depression.

Hookah's new popularity among US college students: a pilot study of the characteristics of hookah smokers and their Facebook displays.

OBJECTIVES: (1) To confirm the prevalence of hookah use among US college students. (2) To identify substances commonly smoked in hookahs and other substance use characteristics of hookah smokers. (3) Given the powerful influence of Facebook and its potential role in promoting behaviours, to assess the prevalence of hookah references on Facebook profiles. DESIGN: Cross-sectional study. SETTING: Two large US universities; www.Facebook.com. PARTICIPANTS: 307 Facebook profiles were coded and 216 of these profile owners completed an online survey. On average, participants were 18.8 years old (SD=0.7), women (54%), Caucasian (70.4%) and approximately half were from each university. OUTCOME MEASURES: Lifetime and frequency of hookah use, substance smoked in hookah, cigarette and marijuana use, hookah references displayed on Facebook. RESULTS: 27.8% of participants endorsed hookah use; there were no significant differences between age, gender, race or university for hookah use. Hookah users reported smoking tobacco (78%), hash (12%) and both tobacco and marijuana/hash (10%) in their hookah. Compared with non-hookah smokers, hookah smokers were more likely to report using cigarettes (OR=3.41, 95%CI=1.2 to 9.64) and marijuana (OR=15.01, 95%CI=6.5 to 34.65). Hookah references were present on 5% of Facebook profiles. CONCLUSIONS: More than one quarter of college students smoke hookah. Most smoke tobacco in their hookah, and hookah smoking is associated with polysubstance use. Hookah may present new risks for nicotine addiction in this population.

Biofeedback therapy for pediatric headache: factors associated with response.

OBJECTIVES: The goal of this study was to measure the effect of biofeedback therapy on pediatric headache and to identify factors associated with response to biofeedback therapy. BACKGROUND: In the United States, 17% of children have frequent or severe headaches. Biofeedback therapy (BFT) appears to be an effective treatment for headaches in adults and is often recommended for children with headaches, but there are few data in the pediatric population. It is also not clear which patients are most likely to benefit from biofeedback therapy. METHODS: We examined the records of patients, aged 8 to 18 years old, who were referred to a pediatric BFT clinic for management of headache between 2004 and 2008. We extracted data regarding patient and headache characteristics, medication use, family history, and measures of depression, anxiety, and somatization. Chronic headache was defined as ≥4 headache days/week. Positive response to biofeedback was defined as a 50% reduction in number of headache days/week or hours/week, or ≥3-point decrease in severity (0-10 scale) between first and last visits. We analyzed the responder rate for those with episodic and chronic headaches and performed multivariable analysis to determine what factors were associated with headache response to biofeedback therapy. RESULTS: We analyzed records from 132 children who attended ≥2 biofeedback sessions. Median headache frequency dropped from 3.5 to 2 headache days/week between the first and last visits. The response rate was 58% overall; 48% for chronic headaches and 73% episodic headaches. In multivariate analysis, ability to raise hand temperature by >3°F at the last visit and use of selective serotonin reuptake inhibitors (SSRIs) were associated with a positive response, and preventive medication use was associated with nonresponse. Anxiety, depression, and somatization were not significantly associated with response to biofeedback therapy. CONCLUSIONS: Biofeedback therapy appears to be an effective treatment for children and adolescents with both episodic and chronic headaches. Further study is warranted to compare biofeedback with other treatments for chronic pediatric headache. Use of SSRIs appears to be associated with a positive response to biofeedback therapy, but the reasons for this relationship are unclear and merit further study.

A pilot evaluation of older adolescents' sexual reference displays on Facebook.

Many older adolescents display sexual references on their social networking site profiles; this study investigated whether these references were associated with self-reported sexual intention, sexual experience, or risky sexual behavior. Public Facebook profiles of undergraduate freshmen were identified within 1 large U.S. university Facebook network. Profile owners who displayed sexual references (Displayers) and did not display references (Non-Displayers) were invited to complete surveys. Surveys measured sexual intention, using the Postponing Sexual Intercourse (PSI) scale, and sexual experiences. A higher PSI score was inversely related to intention to initiate sexual intercourse. Of the 118 profiles that met inclusion criteria, 85 profile owners completed surveys. Profile owners were mostly female (56.5%) and Caucasian (67.1%). The mean PSI score for Displayers was 6.5 ± 1.6, and the mean PSI score for Non-Displayers was 10.2 ± 0.6 (p = .02). There were no differences between Displayers and Non-Displayers regarding lifetime prevalence of sexual behavior, number of sexual partners, or frequency of condom use. Display of sexual references on college freshmen's Facebook profiles was positively associated with reporting intention to initiate sexual intercourse. Facebook profiles may present an innovative cultural venue to identify adolescents who are considering sexual activity and may benefit from targeted educational messages.

Associations between displayed alcohol references on Facebook and problem drinking among college students.

OBJECTIVE: To examine the associations between displayed alcohol use and intoxication/problem drinking (I/PD) references on Facebook and self-reported problem drinking using a clinical scale. DESIGN: Content analysis and cross-sectional survey. SETTING: Facebook Web site (http://www.facebook.com/). PARTICIPANTS: The study included undergraduate students (age range, 18-20 years) at 2 state universities with public Facebook profiles. MAIN EXPOSURES: The profiles were categorized into 1 of 3 distinct categories: Nondisplayers, Alcohol Displayers, and I/PD Displayers. OUTCOME MEASURES: An online survey measured problem drinking using the Alcohol Use Disorders Identification Test (AUDIT) scale. Analyses examined associations between alcohol display category and (1) AUDIT problem drinking category using logistic regression, (2) AUDIT score using negative binomial regression, and (3) alcohol-related injury using the Fisher exact test. RESULTS: Among 307 profiles identified, 224 participants completed the survey (73% response rate). The average age was 18.8 years; 122 (54%) were female; 152 (68%) were white; and approximately 50% were from each university. Profile owners who displayed I/PD were more likely (odds ratio, 4.4; 95% CI, 2.0-9.4) to score in the problem drinking category of the AUDIT scale, had 64.0% (incidence rate ratio, 1.64; 95% CI, 1.27-11.0) higher AUDIT scores overall, and were more likely to report an alcohol-related injury in the past year (P = .002). CONCLUSIONS: Displayed references to I/PD were positively associated with AUDIT scores suggesting problem drinking as well as alcohol-related injury. Results suggest that clinical criteria for problem drinking can be applied to Facebook alcohol references.

Development of a researcher codebook for use in evaluating social networking site profiles.

INTRODUCTION: Social networking sites (SNSs) are immensely popular and allow for the display of personal information, including references to health behaviors. Evaluating displayed content on an SNS for research purposes requires a systematic approach and a precise data collection instrument. The purpose of this article is to describe one approach to the development of a research codebook so that others may develop and test their own codebooks for use in SNS research. METHODS: Our SNS research codebook began on the basis of health behavior theory and clinical criteria. Key elements in the codebook developmental process included an iterative team approach and an emphasis on confidentiality. RESULTS: Codebook successes include consistently high inter-rater reliability. Challenges include time investment in coder training and SNS server changes. CONCLUSION: We hope that this article will provide detailed information about one systematic approach to codebook development so that other researchers may use this structure to develop and test their own codebooks for use in SNS research.

An evaluation of the distribution of sexual references among "Top 8" MySpace friends.

To evaluate whether online friends of adolescents who display sexual references on a social networking site also display references. The method used was content analysis. The result of this study was that adolescents who displayed explicit sexual references were more likely to have online friends who displayed references. Thus, social networking sites present new opportunities to investigate adolescent sexual behavior.

A content analysis of displayed alcohol references on a social networking web site.

PURPOSE: Exposure to alcohol use in media is associated with adolescent alcohol use. Adolescents frequently display alcohol references on Internet media, such as social networking web sites. The purpose of this study was to conduct a theoretically based content analysis of older adolescents' displayed alcohol references on a social networking web site. METHODS: We evaluated 400 randomly selected public MySpace profiles of self-reported 17- to 20-year-olds from zip codes, representing urban, suburban, and rural communities in one Washington county. Content was evaluated for alcohol references, suggesting: (1) explicit versus figurative alcohol use, (2) alcohol-related motivations, associations, and consequences, including references that met CRAFFT problem drinking criteria. We compared profiles from four target zip codes for prevalence and frequency of alcohol display. RESULTS: Of 400 profiles, 225 (56.3%) contained 341 references to alcohol. Profile owners who displayed alcohol references were mostly male (54.2%) and white (70.7%). The most frequent reference category was explicit use (49.3%); the most commonly displayed alcohol use motivation was peer pressure (4.7%). Few references met CRAFFT problem drinking criteria (3.2%). There were no differences in prevalence or frequency of alcohol display among the four sociodemographic communities. CONCLUSIONS: Despite alcohol use being illegal and potentially stigmatizing in this population, explicit alcohol use is frequently referenced on adolescents' MySpace profiles across several sociodemographic communities. Motivations, associations, and consequences regarding alcohol use referenced on MySpace appear consistent with previous studies of adolescent alcohol use. These references may be a potent source of influence on adolescents, particularly given that they are created and displayed by peers.