Using Media and Technology to Improve Sexual
Health Outcomes for Youth
Alwyn Cohall, M.D.
Professor of Clinical Public Health and Pediatrics, Mailman
School of Public Health, Morgan Stanley Children’s Hospital of
New York Presbyterian Hospital, Director, Harlem Health
Promotion Center and Project STAY
Sexual Health Information
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“Young people are sexually active…but sexually
illiterate”
 Faye Wattleton, former head of PPFA

In NYC, 25% of youth screened by our Mobile Health
Team in schools, juvenile justice programs and youth
agencies were involved in 1 or more unintended
pregnancies, yet less than half had ever heard of
Emergency Contraception
Typical scenario
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Rakheem is 18, and presents to a
primary care clinic for a college
physical
Waits , 45 minutes to an hour before
being seen
Health provider reviews college form,
asks a few questions about allergies,
past hx of medical problems etc.
Conducts brief physical, places a PPD
test, orders a blood count, cholesterol
level and urinalysis, and gives him a
follow-up appointment to return in 48
hours to get his PPD test read, obtain
his lab results and to complete his
college form
Rakheem misplaces his slip, and
misses his appointment. When he calls
to re-schedule, he is told that the next
available slot is in 2 weeks.
He eventually returns, waits another
45 minutes to be seen, collects his
paper work and sends the form off to
school
What’s wrong with this picture?
Got basic services
rendered…
 But multiple
opportunities missed
for health education,
targeted screening
and intervention

Current state of affairs
Clinicians often inadequately trained to
care for adolescents
 Have limited time
 Youth reluctant to bring up sensitive
issues without being asked
 Believe that providers have “X-ray vision”
and blood tests check for “everything”
 Opportunities are missed

Can media and technology make a
difference?
Potential roles for media and
technology
Taking advantage of “dead”
time to begin educational
process:
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Rakheem comes into a primary
care clinic, and while waiting
to see a provider, participates
in a workshop discussion
delivered by public health
students
Using Power-Point slides in the
waiting room, the students
review various sexual health
topics, such as anatomy STIs,
HIV, contraception and male
responsibility
Potential roles for media and
technology
Improving assessment
of assets and risks:
 ACASI (audio-assisted
computer self interview)
– Youth prefer being queried
by a computer and may be
more likely to reveal
sensitive information
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Screen:
 5 LTSP (all females), 3 in
last 6 months, 1 current
partner
 Hx unprotected sex with
new female partner
(female) 48 hrs ago
Potential roles for media and
technology
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Provider reviews riskassessment
Verifies information
Conducts physical exam
Places PPD, orders
standard tests, but in
addition, orders a urine
screen for Chlamydia and
Gonorrhea and blood
tests for syphilis and HIV
Potential roles for media and
technology
Providing health
information:
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While waiting for results of
rapid HIV test, Rakheem is
invited to view a video on the
computer which shows young
people in relationships dealing
with the consequences of
unprotected intercourse
In addition to demonstrating
the need for linkages to care,
it encourages youth to use
Emergency Contraception to
prevent unintended
pregnancies
Potential roles for media and
technology
30 minutes later, provider returns, HIV
test is negative
 Encourages him to contact his girlfriend
(also 18) and discuss the need for EC.
Given website (www.ec123.org) for more
information.
 Appointment made for follow-up in 48
hours to check PPD and complete college
forms
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Potential Roles for Media and
Technology
@the clinic 4 a chkup.
'Member when we
messed up on Sat? We
don't hv 2 w8t 2 see if u
get ur period. chk out
www.ec123.org 2 get
info abt Plan B. Hit me
back!
Potential roles for media and
technology
Girlfriend logs onto
www.ec123.org and
learns more about
emergency
contraception
 She goes to her local
pharmacy and obtains
product and takes
them immediately
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Potential roles for media and
technology
Appointment reminder
system:

48 hours later, Rakheem
gets a text message from
the clinic reminding him
of his appointment
Potential roles for media and
technology
When he returns, in
addition to getting his
form completed, he
learns that his urine
test for Chlamydia
was Positive
 Provider gives him
basic information
about Chlamydia,
along with a sample
of antibiotics for
himself and his
current partner
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Potential roles for media and
technology
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Additionally, she advises
him to contact his
previous partners
Rakheem wants to do the
right thing, but is
somewhat embarrassed
and concerned about
their reactions
He is advised to consider
using an anonymous
service called InSpot
which will alert them to
the need for testing and
will also provide listings
of clinics in their
communities
Potential roles for media and
technology
Provision of continued information after the
clinic visit has ended:
He is also encouraged to visit the web to
get more information about Chlamydia
 Rakheem views the websites but still has
questions about Chlamydia
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Potential roles for media and
technology
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Using a secure email
system (www.
RelayHealth.com),
he emails his
concerns to his
provider…
Potential roles for media and
technology
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…and receives a detailed response later that day which
reassures him
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“Thanks for your note, many young men (and
young women) with Chlamydia have no
symptoms. The treatment is very effective and
your chances of being a father (in the future!)
should be good. Just remember to use a condom
every time to prevent additional infections”
Potential roles for media and
technology
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His current girlfriend
makes an appointment to
the clinic after taking EC
and Zithromax
Her examination is
normal and she elects to
start OCP
Potential roles for media and
technology
Medication reminder
system:
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She receives an
automated text
message from the
clinic every
evening at 8pm to
remind her to take
the pills
REMEMBER!
Potential roles for media and
technology
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As a result of their
experiences,
Rakheem and his
girlfriend text friends
to check out the
website links, as well
as to make
appointments at the
clinic for services
Comparative Approaches
Standard
 Physical done
 College form completed
Enhanced
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Physical done
College form completed
Risk-assessment conducted
Additional screening tests
ordered
A potentially serious STI is
identified and treatment
provided (for index patient and
partner/s)
Potential pregnancy averted
Multiple opportunities for
health education utilized
Additional youth engaged in
care
Potential roles for media and
technology
Pipe-dream?
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All the elements in this altered scenario are available
But, need to connect the dots…
Several of our clinics at Columbia and NYP use
Powerpoint presentations and health education videos in
the waiting room
ACASI – used in research settings, can be used clinically
as well
Media can be used to initiate and reinforce health
information
Secure email
Text-message applications for health promotion
Conclusion
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Multiple applications for media
and technology
Has potential for improving
access to health information,
facilitating access to care,
strengthening client-provider
interactions, and enhancing
adherence to medication
It’s time that we examine
every possible resource to
provide youth with support
Contact Information
Alwyn T. Cohall, MD
 atc1@columbia.edu
 www.ec123.org
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