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Youth and online sexual health services : intersections of the social and the technical Davis, Wendy Marina 2012

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   YOUTH	
  AND	
  ONLINE	
  SEXUAL	
  HEALTH	
  SERVICES:	
  	
   INTERSECTIONS	
  OF	
  THE	
  SOCIAL	
  AND	
  THE	
  TECHNICAL	
   	
   by	
   	
   Wendy	
  Marina	
  Davis	
  	
   B.Sc.,	
  The	
  University	
  of	
  British	
  Columbia,	
  2008	
   	
    A	
  THESIS	
  SUBMITTED	
  IN	
  PARTIAL	
  FULFILLMENT	
  OF	
  THE	
   REQUIREMENTS	
  FOR	
  THE	
  DEGREE	
  OF	
   Master	
  of	
  Science	
   in	
   The	
  Faculty	
  of	
  Graduate	
  Studies	
  	
   (Health	
  Care	
  and	
  Epidemiology)	
   	
    THE	
  UNIVERSITY	
  OF	
  BRITISH	
  COLUMBIA	
  	
   (Vancouver)	
   	
   April	
  2012	
  	
   ©	
  Wendy	
  Marina	
  Davis,	
  2012	
    	
    Abstract	
   Background:	
   Sexually	
   transmitted	
   infections	
   (STIs)	
   remain	
   a	
   significant	
   public	
   health	
   concern,	
   especially	
   among	
   youth	
   (ages	
   15-­‐24),	
   who	
   account	
   for	
   an	
   increasingly	
  disproportionate	
  rate	
  of	
  infection.	
  Novel,	
  web-­‐based	
  interventions	
  are	
   being	
  developed	
  to	
  improve	
  sexual	
  health	
  outcomes	
  among	
  youth	
  (e.g.,	
  condom	
  use;	
   participation	
  in	
  testing).	
  To	
  date,	
  much	
  of	
  the	
  literature	
  in	
  this	
  area	
  employs	
  a	
  ‘read-­‐ only’	
   perspective	
   (e.g.,	
   examining	
   frequency	
   of	
   use;	
   topics	
   of	
   interest).	
   Some	
   research	
   also	
   has	
   begun	
   to	
   explore	
   ways	
   in	
   which	
   the	
   nexus	
   of	
   the	
   social	
   and	
   the	
   technical	
   aspects	
   of	
   web-­‐based	
   health	
   interventions	
   may	
   affect	
   experiences	
   with	
   online	
   STI/HIV	
   prevention	
   (e.g.,	
   how	
   youth	
   identify	
   salient,	
   credible	
   online	
   resources).	
  	
  For	
  many	
  young	
  people,	
  accessing	
  sexual	
  health	
  resources	
  (e.g.,	
  STI/HIV	
   testing;	
  counseling)	
  remains	
  a	
  stigmatized	
  activity,	
  and	
  it	
  is	
  unlikely	
  that	
  this	
  will	
  be	
   resolved	
   solely	
   through	
   the	
   web-­‐based	
   provision	
   of	
   these	
   services	
   (e.g.,	
   online	
   enactments	
   of	
   gendered	
   stereotypes;	
   traditional	
   ‘sex-­‐as-­‐risk’	
   discourses).	
   The	
   objectives	
   of	
   this	
   thesis	
   are	
   to	
   provide	
   an	
   in-­‐depth	
   analysis	
   of	
   young	
   people’s	
   (1)	
   perspectives	
  on	
  how	
  the	
  use	
  of	
  reverse	
  discourse	
  in	
  online	
  sexual	
  health	
  resources	
   affects	
   their	
   perceptions	
   of	
   these	
   resources;	
   and	
   (2)	
   descriptions	
   of	
   their	
   experiences	
  with	
  accessing	
  online	
  sexual	
  health	
  resources	
  and	
  their	
  perceptions	
  of	
   the	
   ways	
   in	
   which	
   gender	
   stereotypes	
   feature	
   in	
   those	
   experiences;	
   and	
   will	
  discuss	
   designing	
   (and	
   conducting	
   further	
   research	
   on)	
   online	
   sexual	
   health	
   resources	
   for	
   youth.	
   Results:	
  Youth’s	
   experiences	
   with	
   online	
   sexual	
   health	
   resources	
   are	
   heavily	
   influenced	
   by	
   ‘real	
   world’	
   youth	
   culture	
   (e.g.,	
   values;	
   beliefs;	
   practices).	
   These	
   analyses	
   provide	
   an	
   in-­‐depth	
   examination	
   of	
   the	
   ways	
   in	
   which	
   reverse	
   discourse	
    	
    	
    ii	
  	
    within	
   online	
   sexual	
   health	
   resource	
   contexts	
   can	
   negatively	
   affect	
   perceptions	
   of	
   these	
   resources,	
   as	
   well	
   as	
   illustrate	
   the	
   ways	
   in	
   which	
   gendered	
   stereotypes	
   regarding	
   sexual	
   health	
   help-­‐seeking	
   practices	
   extend	
   to	
   online	
   practices.	
   Discussion:	
   Intersections	
   of	
   the	
   social	
   and	
   technical	
   aspects	
   of	
   Internet-­‐based	
   sexual	
   health	
   resources	
   need	
   to	
   be	
   addressed	
   in	
   order	
   to	
   generate	
   more	
   equitable	
   opportunities	
  for	
  young	
  people	
  to	
  engage	
  with	
  sexual	
  health	
  resources.	
    	
    	
    	
    	
    iii	
  	
    Preface	
   The	
   research	
   in	
   this	
   thesis	
   was	
   conducted	
   according	
   to	
   the	
   guidelines	
   of	
   the	
   University	
  of	
  British	
  Columbia	
  Behavioural	
  Research	
  Ethics	
  Board.	
  UBC	
  BREB	
  H10-­‐ 01939	
  approved	
  interviews	
  and	
  focus	
  groups	
  of	
  human	
  subjects.	
  Data	
  were	
  drawn	
   from	
   an	
   ongoing	
   study	
   investigating	
   youth’s	
   perceptions	
   of	
   and	
   experiences	
   with	
   online	
   sexual	
   health	
   services	
   in	
   British	
   Columbia,	
   led	
   by	
   Dr.	
   Jean	
   Shoveller	
   (PhD,	
   UBC).	
   The	
   2-­‐year	
   study,	
   Online	
   STI	
   Testing	
   and	
   Youth,	
   is	
   funded	
   by	
   the	
   Canadian	
   Institutes	
  for	
  Health	
  Research.	
  Under	
  the	
  primary	
  supervision	
  of	
  Dr.	
  Jean	
  Shoveller	
   (PhD,	
  UBC)	
  and	
  co-­‐supervision	
  of	
  Drs.	
  John	
  Oliffe	
  (PhD,	
  Deakin	
  University)	
  and	
  Dr.	
   Mark	
   Gilbert	
   (MD,	
   University	
   of	
   Ottawa;	
   MHSc,	
   UBC),	
   Davis	
   conducted	
   the	
   following	
   research	
  activities:	
    1. Data	
   collection.	
   Davis	
   conducted	
   18	
   qualitative,	
   in-­‐depth	
   interviews	
   with	
   youth	
  (out	
  of	
  a	
  total	
  of	
  20	
  included	
  in	
  this	
  thesis)	
  and	
  facilitated	
  all	
  3	
  focus	
   groups	
  and	
  one	
  youth	
  roundtable	
  event.	
  	
    2. Data	
   analysis.	
   Data	
  analysis	
  was	
  primarily	
  conducted	
  by	
  Davis,	
  with	
  ongoing	
   research	
  team	
  consultation.	
  Feedback	
  from	
  Drs.	
  Shoveller,	
  Oliffe	
  and	
  Gilbert	
   were	
  subsequently	
  incorporated	
  into	
  the	
  thesis.	
  	
    3. Manuscript	
   preparation.	
   Each	
  manuscript	
  was	
  written	
  by	
  Davis;	
  theoretical	
   feedback	
   was	
   sought	
   from	
   Drs.	
   Shoveller,	
   Oliffe	
   and	
   Gilbert	
   and	
   incorporated	
   into	
  subsequent	
  and	
  finalized	
  versions.	
  	
    	
    	
    	
    iv	
  	
    A	
   version	
   of	
   Chapter	
   2	
   is	
   under	
   consideration	
   for	
   publication.	
   [Davis,	
   W.],	
   Shoveller,	
   J.A.,	
  Oliffe,	
  J.L,	
  &	
  Gilbert,	
  M.	
  ‘Sounds	
  like	
  the	
  person	
  you’re	
  drinking	
  with’:	
  Examining	
   youth’s	
   perspectives	
   on	
   the	
   use	
   of	
   reverse	
   discourse	
   in	
   web-­‐based	
   sexual	
   health	
   interventions.	
  Submitted	
  February	
  2012.	
    A version of Chapter 3 is under consideration for publication. [Davis,	
   W.],	
   Shoveller,	
   J.A.,	
   Oliffe,	
   J.L.,	
   &	
   Gilbert,	
   M.	
   Interrogating	
   gendered	
   stereotypes:	
   Young	
   people’s	
  descriptions	
  of	
  online	
  sexual	
  health	
  approaches.	
  Submitted	
  February	
  2012.	
  	
    	
    	
    	
    	
    v	
  	
    Table	
  of	
  contents	
  	
   Abstract	
  ..........................................................................................................................................................	
  ii	
   Preface	
  ...........................................................................................................................................................	
  iv	
   Table	
  of	
  contents	
  ......................................................................................................................................	
  vi	
   List	
  of	
  tables	
  ..............................................................................................................................................	
  viii	
   Acknowledgments	
  ....................................................................................................................................	
  ix	
   Dedication	
  ......................................................................................................................................................	
  x	
   Chapter	
  1.0	
  Introduction	
  ........................................................................................................................	
  1	
   1.1	
   Sexual	
  health	
  outcomes	
  among	
  Canadian	
  youth	
  .........................................................	
  1	
   1.2	
  	
  	
  	
  Online	
  approaches	
  .....................................................................................................................	
  1	
   1.3	
   Intersections	
  of	
  the	
  social	
  and	
  the	
  technical	
  .................................................................	
  3	
   1.4	
   Reverse	
  discourse	
  .....................................................................................................................	
  5	
   1.5	
   Gendered	
  online	
  practices	
  .....................................................................................................	
  8	
   1.6	
   Thesis	
  objectives	
  and	
  overview	
  of	
  thesis	
  chapters	
  ...................................................	
  10	
   Chapter	
  2.0	
  ‘Sounds	
  like	
  the	
  person	
  you’re	
  drinking	
  with’:	
  examining	
  youth’s	
   perspectives	
  on	
  the	
  use	
  of	
  reverse	
  discourse	
  in	
  web-­‐based	
  sexual	
  health	
   interventions	
  .............................................................................................................................................	
  12	
   2.1	
  Introduction	
  ..................................................................................................................................	
  12	
   2.2	
  Methods	
  ...........................................................................................................................................	
  16	
   2.2.1	
  Recruitment	
  ..........................................................................................................................	
  16	
   2.2.2	
  Data	
  collection	
  and	
  analysis	
  ...........................................................................................	
  17	
   2.3	
  Results	
  ..............................................................................................................................................	
  19	
   2.3.1	
  Study	
  participants	
  ..............................................................................................................	
  19	
   2.3.2	
  Saliency	
  and	
  credibility	
  ....................................................................................................	
  22	
   2.3.3	
  Social	
  context	
  ........................................................................................................................	
  24	
   2.3.4	
  Reinforcing	
  stigma	
  .............................................................................................................	
  25	
   2.3.5	
  Potential	
  benefits	
  ................................................................................................................	
  27	
   2.4	
  Discussion	
  .......................................................................................................................................	
  28	
   Chapter	
  3.0	
  Interrogating	
  gendered	
  stereotypes:	
  young	
  people’s	
  descriptions	
  of	
   online	
  sexual	
  health	
  approaches	
  ......................................................................................................	
  34	
   3.1	
  Introduction	
  ..................................................................................................................................	
  34	
   3.1.1	
  Background	
  ...........................................................................................................................	
  34	
   3.1.2	
  Gender	
  and	
  online	
  health	
  activities	
  ............................................................................	
  35	
   3.1.3	
  Gendered	
  stereotypes	
  and	
  sexual	
  health	
  practices	
  .............................................	
  36	
   3.2	
  Methods	
  ...........................................................................................................................................	
  38	
   3.2.1	
  Recruitment	
  ..........................................................................................................................	
  38	
   3.2.2	
  Data	
  collection	
  .....................................................................................................................	
  39	
   3.2.3	
  Analysis	
  ...................................................................................................................................	
  40	
   3.3	
  Findings	
  ...........................................................................................................................................	
  41	
   3.3.1	
  Study	
  participants	
  ..............................................................................................................	
  41	
   3.3.2	
  Gendered	
  virtual	
  spaces	
  ..................................................................................................	
  41	
   3.3.3	
  Gendered	
  stereotypes	
  about	
  online	
  sexual	
  health	
  resource-­‐seeking	
  ..........	
  46	
   3.4	
  Discussion	
  .......................................................................................................................................	
  52	
   Chapter	
  4.0	
  Discussion	
  ..........................................................................................................................	
  59	
    	
    	
    vi	
  	
    4.1	
  Summary	
  of	
  findings	
  ..................................................................................................................	
  59	
   4.2	
  Implications	
  for	
  web-­‐based	
  sexual	
  health	
  interventions	
  ..........................................	
  61	
   4.3	
  Implications	
  for	
  future	
  research	
  ...........................................................................................	
  64	
   4.3	
  Strengths	
  and	
  limitations	
  ........................................................................................................	
  65	
   References	
  ..................................................................................................................................................	
  68	
   Appendices	
  .................................................................................................................................................	
  88	
   Appendix	
  1:	
  Interview	
  guide	
  for	
  youth	
  .....................................................................................	
  88	
   Appendix	
  2:	
  Focus	
  group	
  guide	
  for	
  youth	
  ................................................................................	
  96	
   	
    	
    	
    	
    	
    vii	
  	
    List	
  of	
  tables	
   	
   Table1.	
  Self-­‐identified	
  characteristics	
  of	
  youth............................................................................................19	
   Table	
  2.	
  Self-­‐reported	
  testing	
  history	
  of	
  youth.............................................................................................20	
   	
    	
    	
    	
    	
    viii	
  	
    Acknowledgments	
   	
    I	
  would	
  like	
  to	
  thank	
   all	
  of	
  the	
  youth	
  who	
  took	
  part	
  in	
  this	
  study.	
  I	
  would	
  also	
  like	
  to	
  especially	
   thank	
  Dr.	
  Jean	
  Shoveller	
  for	
  her	
  endless	
  encouragement,	
  guidance,	
  and	
  mentorship,	
  as	
  well	
  as	
   Drs.	
   John	
   Oliffe	
   and	
   Mark	
   Gilbert	
   for	
   their	
   valuable	
   input,	
   wisdom,	
   and	
   support.	
   I	
   would	
   also	
   like	
   to	
   thank	
   the	
   Youth	
   Sexual	
   Health	
   Team	
   staff	
   and	
   trainees	
   for	
   their	
   ongoing	
   training	
   support.	
  	
   Funding	
   for	
   this	
   study	
   was	
   provided	
   by	
   the	
   Canadian	
   Institutes	
   of	
   Health	
   Research	
   (Grant	
   number:	
  MOP-­‐106440).	
  My	
  financial	
  support	
  was	
  generously	
  provided	
  by	
  a	
  Frederick	
  Banting	
   and	
   Charles	
   Best	
   Canada	
   Graduate	
   Scholarship	
   from	
   CIHR,	
   by	
   a	
   Graduate	
   Entrance	
   Scholarship	
   from	
   the	
   Faculty	
   of	
   Graduate	
   Studies,	
   and	
   by	
   a	
   research	
   stipend	
   from	
   Dr.	
   Jean	
   Shoveller’s	
  Applied	
  Public	
  Health	
  Chair	
  in	
  Improving	
  Youth	
  Sexual	
  Health.	
    	
   	
    	
    	
    	
    ix	
  	
    Dedication	
   To	
  my	
  mom	
  and	
  my	
  dad  	
    	
   	
   	
    	
    	
    x	
  	
    	
    Chapter	
  1.0	
  Introduction	
   1.1 Sexual	
  health	
  outcomes	
  among	
  Canadian	
  youth	
   	
   Sexually	
   transmitted	
   infections	
   (STIs)	
   remain	
   a	
   significant	
   public	
   health	
   concern,	
   especially	
   among	
   youth	
   (ages	
   15-­‐24),	
   who	
   account	
   for	
   an	
   increasingly	
   disproportionate	
   rate	
   of	
   infection.	
   For	
   example,	
   rates	
   of	
   gonorrhea	
   among	
   Canadians	
   aged	
   15-­‐19	
   have	
   almost	
   doubled	
   in	
   the	
   past	
   decade	
   (rising	
   from	
   55.1	
   per	
   100	
  000	
  to	
  102.5	
  per	
  100	
  000	
  from	
  1999	
  to	
  2009),	
  while	
  rates	
  among	
  20-­‐24	
  year-­‐ olds	
  have	
  more	
  than	
  doubled	
  during	
  this	
  time	
  (from	
  66.6	
  per	
  100	
  000	
  to	
  145.2	
  per	
   100	
   000)	
   (PHAC,	
   2010a).	
   	
   A	
   similar	
   dramatic	
   increase	
   is	
   seen	
   in	
   chlamydia	
   rates	
   among	
  Canadian	
  youth	
  (ages	
  15-­‐24	
  years)	
  (PHAC,	
  2010b).	
  	
   	
   1.2	
  Online	
  approaches	
  	
   	
   There	
   are	
   compelling	
   public	
   health	
   reasons	
   to	
   develop	
   novel	
   intervention	
   approaches	
   to	
   improving	
   sexual	
   health	
   outcomes	
   among	
   youth	
   (e.g.,	
   increasing	
   condom	
   use;	
   decreasing	
   STI	
   prevalence;	
   improving	
   participation	
   in	
   testing),	
   and	
   web-­‐based	
   strategies	
   offer	
   promising	
   complements	
   to	
   human-­‐delivered	
   interventions.	
   The	
   Internet	
   is	
   a	
   medium	
   with	
   which	
   youth	
   are	
   familiar	
   and	
   receptive,	
   with	
   an	
   estimated	
   97%	
   of	
   Canadians	
   and	
   93%	
   of	
   Americans	
   (ages	
   12-­‐29)	
   being	
   Internet	
   users	
   (Fox,	
  Rainie,	
  Horrigan,	
  Lenhart,	
  &	
  Spooner,	
  2000;	
  Gray,	
  Klein,	
   Noyce,	
   Sesselberg,	
   &	
   Cantrill,	
   2005).	
   Additionally,	
   the	
   web	
   offers	
   a	
   degree	
   of	
   convenience	
   and	
   anonymity	
   for	
   locating	
   information	
   about	
   sensitive	
   health	
   topics	
   (e.g.,	
   STIs).	
   While	
   many	
   young	
   users	
   report	
   that	
   the	
   Internet	
   is	
   not	
   their	
   sole	
   source	
   	
    	
    1	
  	
    of	
   health	
   information	
   –	
   they	
   also	
   turn	
   to	
   family,	
   schools,	
   and	
   to	
   a	
   lesser	
   extent,	
   friends	
  –	
  it	
  is	
  often	
  the	
  first	
  place	
  they	
  look	
  (Hesse	
  et	
  al.,	
  2005).	
  Recent	
  years	
  have	
   seen	
   an	
   global	
   increase	
   in	
   the	
   number	
   of	
   online	
   sexual	
   health	
   interventions	
   for	
   youth,	
   including:	
   (a)	
   the	
   delivery	
   of	
   static	
   website	
   content	
   (e.g.,	
   www.avert.org);	
   (b)	
   interactive,	
   moderated	
   message	
   boards,	
   	
   (e.g.,	
   www.goaskalice.columbia.edu	
   or	
   www.scarleteen.com);	
   (c)	
   risk/knowledge	
   assessment	
   questionnaires	
   (JANCIN,	
   2009);	
   (d)	
   email/chat	
   outreach	
   (Harvey,	
   Churchill,	
   Crawford,	
   &	
   Brown,	
   2008);	
   (e)	
   online	
   partner	
   notification	
   (e.g.,	
   www.inspot.org);	
   and	
   (f)	
   online	
   STI/HIV	
   testing	
   (e.g.,	
  http://www.iwantthekit.org/).	
  Locally,	
  the	
  British	
  Columbia	
  Centre	
  for	
  Disease	
   Control	
   (BCCDC)	
   is	
   developing	
   an	
   online	
   sexual	
   health	
   service	
   program	
   (OSHSP),	
   including	
   web-­‐based	
   information	
   and	
   counseling	
   resources,	
   email	
   partner	
   notification,	
   as	
   well	
   as	
   online	
   STI/HIV	
   testing	
   service,	
   in	
   an	
   effort	
   to	
   increase	
   participation	
   in	
   testing	
   by	
   young	
   people	
   (and	
   other	
   population	
   subgroups)	
   and	
   to	
   decrease	
  the	
  spread	
  of	
  infection.	
   	
   While	
  young	
  people	
  frequently	
  seek	
  health	
  information	
  on	
  the	
  Internet	
  (Hesse	
  et	
  al.,	
   2005),	
  research	
  suggests	
  that	
  many	
  are	
  reluctant	
  to	
  completely	
  trust	
  online	
  health	
   information	
   (Gray	
   et	
   al.,	
   2005),	
   including	
   sexual	
   health	
   information	
   (Jones	
   &	
   Biddlecom,	
   2011).	
   Furthermore,	
   health	
   information-­‐seeking	
   is	
   a	
   complex	
   process,	
   wherein	
   youth	
   rely	
   upon	
   a	
   wide	
   range	
   of	
   online	
   sources	
   and	
   operationalize	
   a	
   unique	
  set	
  of	
  practices	
  for	
  identifying	
  salient,	
  credible,	
  and	
  high	
  quality	
  information	
   (Adams,	
   de	
   Bont,	
   &	
   Berg,	
   2006;	
   Borzekowski	
   &	
   Rickert,	
   2001;	
   Eysenbach,	
   2006;	
   Eysenbach	
   &	
   Köhler,	
   2002;	
   Gray	
   et	
   al.,	
   2005;	
   Hu,	
   2010;	
   Jones	
   &	
   Biddlecom,	
   2011;	
    	
    	
    2	
  	
    Laurent	
   &	
   Vickers,	
   2009).	
   Therefore,	
   in	
   order	
   to	
   best	
   design	
   online	
   sexual	
   health	
   services	
   to	
   meet	
   the	
   needs	
   of	
   youth,	
   and	
   to	
   not	
   exacerbate	
   barriers	
   associated	
   with	
   existing,	
   conventional	
   (i.e.,	
   face-­‐to-­‐face)	
   services	
   (Harvey,	
   Churchill,	
   Crawford,	
   &	
   Brown,	
   2008;	
   Shoveller	
   et	
   al.,	
   2009),	
   an	
   examination	
   of	
   youth’s	
   perspectives	
   and	
   experiences	
  with	
  accessing	
  online	
  sexual	
  health	
  resources	
  is	
  necessary.	
   	
   1.3 	
  Intersections	
  of	
  the	
  social	
  and	
  the	
  technical	
   	
   The	
  evolution	
  of	
  the	
  web	
  over	
  the	
  past	
  decade	
  has	
  reshaped	
  the	
  way	
  the	
  Internet	
  is	
   used.	
   No	
   longer	
   is	
   it	
   a	
   place	
   where	
   users	
   are	
   on	
   the	
   receiving	
   end	
   of	
   a	
   one-­‐way	
   information	
  flow	
  of	
  static,	
  “read-­‐only”	
  material.	
  Increasingly,	
  there	
  is	
  a	
  move	
  “from	
   publishing	
   to	
   participation…to	
   an	
   ongoing	
   and	
   interactive	
   process”	
   (Flew	
   &	
   Smith,	
   2011).	
   This	
   is	
   true	
   in	
   all	
   fields	
   with	
   an	
   online	
   presence,	
   including	
   the	
   rapidly	
   expanding	
   domain	
   of	
   web-­‐based	
   technologies	
   in	
   health	
   and	
   medicine.	
   In	
   order	
   to	
   better	
   understand	
   consumers’	
   online	
   health	
   practices	
   (and	
   thus	
   our	
   ability	
   to	
   influence	
  them),	
  we	
  must	
  (re)-­‐conceptualize	
  online	
  health	
  information-­‐seeking	
  as	
  a	
   set	
   of	
   “communication	
   processes	
   rather	
   than	
   information	
   dissemination	
   or	
   educational	
  processes”	
  (Cline	
  &	
  Haynes,	
  2001).	
  Unfortunately,	
  to	
  date,	
  much	
  of	
  the	
   literature	
  in	
  the	
  area	
  of	
  e-­‐health	
  has	
  failed	
  to	
  move	
  beyond	
  a	
  ‘read-­‐only’	
  perspective,	
   remaining	
   focused	
   on	
   the	
   Internet	
   as	
   a	
   “high-­‐tech	
   conveyor	
   in	
   the	
   rapid	
   diffusion	
   of	
   information	
  or	
  health	
  lessons”	
  (Hesse	
  et	
  al.,	
  2005).	
  In	
  particular,	
  research	
  describing	
   youth’s	
   use	
   of	
   the	
   Internet	
   as	
   a	
   sexual	
   health	
   resource	
   tends	
   to	
   focus	
   on	
   usage	
   patterns	
   (e.g.,	
   frequency	
   of	
   use;	
   topics	
   of	
   interest)	
   (Bull,	
   Phibbs,	
   Watson,	
   &	
    	
    	
    3	
  	
    McFarlane,	
   2007;	
   Jones,	
   Biddlecom,	
   &	
   Hebert,	
   2011;	
   Kanuga	
   &	
   Rosenfeld,	
   2004;	
   Suzuki	
  &	
  Calzo,	
  2004).	
   	
   Thus,	
   this	
   relatively	
   nascent	
   field	
   of	
   study	
   presents	
   new	
   opportunities	
   to	
   discover	
   what	
   makes	
   for	
   effective	
   interventions	
   to	
   improve	
   youth	
   sexual	
   health.	
   	
   Drawing	
   on	
   knowledge	
  developed	
  in	
  multiple	
  disciplines	
  (including	
  and	
  in	
  addition	
  to	
  health)	
  –	
   the	
  current	
  thesis	
  contributes	
  to	
  a	
  growing	
  body	
  of	
  theoretical	
  and	
  empirical	
  work	
   that	
   begins	
   to	
   illustrate	
   the	
   ways	
   in	
   which	
   the	
   virtual	
   world	
   is	
   situated	
   within	
   the	
   physical	
  and	
  social	
  world.	
  Cyberspace	
  is	
  both	
  a	
  	
  “psychological	
  and	
  social	
  domain”	
   (Ben-­‐Zeʼev	
  &	
  Ben-­‐Ze'ev,	
  2004),	
  wherein	
  youth’s	
  online	
  behaviours	
  are	
  governed	
  by	
   conventional	
   social	
   norms	
   and	
   expectations.	
   	
   Thus,	
   youth’s	
   online	
   experiences	
   are	
   heavily	
   influenced	
   by	
   ‘real	
   world’	
   youth	
   culture	
   (e.g.,	
   values;	
   beliefs;	
   practices);	
   social	
   behaviours	
   in	
   virtual	
   environments	
   may	
   not	
   be	
   identical	
   to	
   those	
   in	
   the	
   physical	
   world,	
   but	
   the	
   two	
   are	
   intricately	
   connected	
   (Suzuki	
   &	
   Calzo,	
   2004;	
   Yee,	
   Bailenson,	
   Urbanek,	
   Chang,	
   &	
   Merget,	
   2007).	
   New	
   work	
   related	
   to	
   other,	
   more	
   nuanced	
   aspects	
   of	
   the	
   ‘online	
   experience’	
   is	
   emerging	
   (Jones,	
   2011;	
   Selkie	
   &	
   Benson,	
  2011).	
  For	
  example,	
  it	
  is	
  now	
  argued	
  that	
  for	
  many	
  youth,	
  going	
  online	
  can	
   be	
   an	
   extension	
   of	
   their	
   ‘real-­‐world’	
   identities,	
   as	
   they	
   negotiate	
   online	
   constructions	
  of	
  important	
  social	
  cues	
  (e.g.,	
  gendered	
  stereotypes,	
  power	
  dynamics	
   within	
   relationships;	
   relations	
   to	
   peers)	
   (Macfarlane	
   &	
   McPherson,	
   2007;	
   Mazzarella,	
   2005).	
   A	
   small,	
   but	
   growing,	
   body	
   of	
   research	
   also	
   has	
   begun	
   to	
   explore	
   other	
  ways	
  in	
  which	
  the	
  nexus	
  of	
  the	
  social	
  and	
  the	
  technical	
  aspects	
  of	
  web-­‐based	
   health	
   interventions	
   affects	
   experiences	
   with	
   online	
   STI/HIV	
   prevention	
   (e.g.,	
   how	
    	
    	
    4	
  	
    website	
  attributes	
  may	
  affect	
  perceived	
  credibility;	
  how	
  youth	
  identify	
  salient	
  online	
   resources)	
   (Gray	
   et	
   al.,	
   2005;	
   Jones	
   et	
   al.,	
   2011;	
   Shoveller,	
   Knight,	
   &	
   Davis,	
   2011;	
   Simkins,	
  2007).	
   	
   While	
   several	
   studies	
   have	
   found	
   the	
   intersections	
   of	
   multiple	
   factors	
   (e.g.,	
   one’s	
   gender,	
   cultural	
   background,	
   sexual	
   identity)	
   are	
   important	
   influences	
   on	
   face-­‐to-­‐ face	
   communication	
   during	
   clinical	
   encounters	
   (Goldenberg,	
   Shoveller,	
   Ostry,	
   &	
   Koehoorn,	
   2008a;	
   Shoveller	
   et	
   al.,	
   2009;	
   Shoveller,	
   Knight,	
   Johnson,	
   Oliffe,	
   &	
   Goldenberg,	
  2010),	
  there	
  is	
  a	
  paucity	
  of	
  information	
  to	
  illuminate	
  how	
  these	
  forces	
   might	
   play	
   out	
   within	
   technology-­‐driven	
   sexual	
   health	
   services,	
   including	
   online	
   STI/HIV	
   testing.	
   For	
   many	
   young	
   people,	
   accessing	
   sexual	
   health	
   resources	
   (e.g.,	
   STI/HIV	
   testing;	
   sexual	
   health	
   counselling)	
   continues	
   to	
   be	
   a	
   stigmatized	
   activity	
   (Lichtenstein,	
  2003),	
  and	
  it	
  is	
  unlikely	
  that	
  this	
  will	
  be	
  fully	
  resolved	
  solely	
  through	
   the	
   web-­‐based	
   provision	
   of	
   these	
   services	
   (e.g.,	
   heteronormative	
   online	
   spaces;	
   online	
  enactments	
  of	
  gendered	
  stereotypes;	
  traditional	
  ‘sex	
  as	
  risk’	
  discourses).	
  	
   	
   1.4 	
  Reverse	
  discourse	
   	
   Framing	
   Internet	
   use	
   for	
   health	
   as	
   health	
  communication	
   invites	
   an	
   evidence	
   base	
   for	
  online	
  sexual	
  health	
  interventions	
  that	
  is	
  informed	
  by	
  social	
  theory.	
  Whether	
  and	
   how	
   positive	
   health	
   outcomes	
   are	
   facilitated	
   by	
   Internet	
   use	
   depends	
   not	
   only	
   on	
   messages	
  (i.e.,	
  content)	
  but	
  the	
  meanings	
  invoked	
  by	
  those	
  messages	
  for	
  users.	
  	
  In	
   constructing	
   messaging	
   for	
   online	
   sexual	
   health	
   interventions,	
   designers	
   have	
    	
    	
    5	
  	
    tended	
   to	
   rely	
   on	
   wisdom	
   from	
   conventional,	
   in-­‐person	
   programming,	
   which	
   suggests	
   that	
   youth	
   want	
   sexual	
   health	
   education	
   to	
   be	
   “empathetic,	
   non-­‐ judgmental,	
   and	
   able	
   to	
   create	
   a	
   'safe	
   environment'	
   in	
   order	
   to	
   facilitate	
   the	
   discussion	
   of	
   difficult	
   subjects”	
   (p.	
   33)	
   (Hilton,	
   2003),	
   and	
   to	
   use	
  relaxed	
   and	
   informal	
   methods	
   of	
   delivery	
   (Forrest	
   &	
   Strange,	
   2002;	
   Goldenberg,	
   Shoveller,	
   Koehoorn,	
   &	
   Ostry,	
   2008b;	
   Shoveller	
   et	
   al.,	
   2009).	
   With	
   this	
   in	
   mind,	
   some	
   web-­‐ based	
  sexual	
  health	
  promotion	
  efforts	
  utilize	
  reverse	
  discourse.	
   	
    Reverse	
  discourse	
  is	
  a	
  Foucauldian	
  concept,	
  developed	
  by	
  Foucault	
  only	
  in	
  limited	
   detail,	
  with	
  his	
  work	
  on	
  the	
  topic	
  being	
  contextualized	
  in	
  the	
  homosexual	
  civil	
  rights	
   movement.	
  However,	
  it	
  is	
  possible	
  to	
  consider	
  this	
  concept	
  in	
  the	
  broader	
  context	
  of	
   Foucault’s	
   discussions	
   relating	
   to	
   discourse,	
   power,	
   and	
   resistance,	
   wherein	
   the	
   marginalized	
   are	
   able	
   “to	
   speak”	
   on	
   their	
   “own	
   behalf,	
   to	
   demand	
   that	
   legitimacy	
   or	
   ‘naturality’	
   be	
   acknowledged,	
   often	
   in	
   the	
   same	
   vocabulary,	
   using	
   the	
   same	
   categories	
   by	
   which	
   it	
   was	
   medically	
   disqualified”	
   (p.	
   101)	
   (Foucault,	
   1978).	
   Reverse	
   discourse	
   is	
   a	
   fundamentally	
   subjective	
   and	
   social	
   phenomenon	
   wherein	
   dominant	
  notions	
  of	
  what	
  is	
  sacred	
  and	
  what	
  is	
  profane	
  are	
  contested,	
  in	
  an	
  attempt	
   to	
   disrupt	
   existing	
   power	
   structures.	
   This	
   lens	
   is	
   applied	
   in	
   examining	
   the	
   messaging	
   and	
   meanings	
   inherent	
   in	
   online	
   sexual	
   health	
   promotion	
   –	
   the	
   acknowledgement	
   and	
   rejection	
   of	
   shame	
   associated	
   with	
   some	
   sexual	
   behaviours	
   (e.g.,	
   having	
   sex	
   outside	
   of	
   a	
   monogamous	
   partnership)	
   and	
   efforts	
   to	
   challenge	
   those	
   actions	
   that	
   are	
   deemed	
   negative	
   (e.g.,	
   by	
   virtue	
   of	
   their	
   inherent	
   ‘risk’)	
   by	
   those	
  in	
  power.	
  In	
  theory,	
  this	
  serves	
  to	
  both	
  challenge	
  the	
  stigmatization	
  of	
  “risky”	
    	
    	
    6	
  	
    behaviours	
  and	
  increase	
  appeal	
  to	
  youth	
  (e.g.,	
  by	
  using	
  ‘their’	
  language).	
  It	
  is	
  argued	
   that	
   this	
   creates	
   an	
   empathetic	
   ‘information’	
   environment,	
   reducing	
   prejudice	
   against	
   ‘risky’	
   and/or	
   ‘immoral’	
   sexual	
   behaviours	
   (e.g.,	
   premarital	
   sex;	
   multiple	
   partners)	
  (Ingham,	
  2005;	
  Kehily,	
  2002).	
   	
   Previous	
   work	
   in	
   the	
   fields	
   of	
   Political	
   Science	
   (Serafim,	
   2006),	
   Sociology	
   (Kingfisher,	
   1996),	
   Literature	
   (Da	
   Silva,	
   1998),	
   and	
   Comedy	
   Studies	
   (Weaver,	
   2010)	
  	
   has	
   examined	
   the	
   use	
   of	
   reverse	
   discourse	
   as	
   a	
   deliberate	
   methodology.	
   A	
   recent	
   analysis	
  of	
  InSPOT	
  (see	
  inspot.org,	
  an	
  anonymous	
  online	
  partner	
  notification	
  service	
   for	
   sexually	
   transmitted	
   infections)	
   describes	
   the	
   use	
   of	
   several	
   forms	
   of	
   reverse	
   discourse	
  (Simkins,	
  2007).	
  Another	
  study	
  examined	
  the	
  use	
  of	
  reverse	
  discourse	
  in	
   sexual	
   health	
   promotion	
   messaging,	
   wherein	
   it	
   was	
   used	
   as	
   an	
   analytical	
   lens	
   through	
   which	
   to	
   examine	
   HIV/AIDS	
   messaging	
   in	
   the	
   1980-­‐90s	
   (Simkins,	
   2007).	
   However,	
   little	
   is	
   known	
   about	
   the	
   effects	
   of	
   reverse	
   discourse	
   in	
   online	
   sexual	
   health	
   interventions,	
   nor	
   do	
   we	
   understand	
   its	
   potential	
   value	
   as	
   a	
   strategy	
   of	
   resistance.	
  Given	
  the	
  sensitive	
  and	
  easily	
  stigmatized	
  nature	
  of	
  sexual	
  health	
  seeking	
   practices,	
   it	
   is	
   important	
   to	
   explore	
   and	
   understand	
   youth’s	
   perspectives	
   on	
   the	
   use	
   of	
   reverse	
   discourse	
   in	
   online	
   sexual	
   health	
   promotion	
   messaging.	
   Furthermore,	
   perceived	
   meanings	
   of	
   reverse	
   discourse	
   are	
   heavily	
   influenced	
   by	
   other	
   features	
   of	
   youth’s	
  social	
  environments	
  (e.g.,	
  gendered	
  stereotypes)	
  –	
  a	
  reality	
  that	
  is	
  likely	
  to	
   profoundly	
  impact	
  online	
  sexual	
  health	
  practices.	
   	
   	
    	
    	
    7	
  	
    1.5 	
  Gendered	
  online	
  practices	
   	
   An	
   abundance	
   of	
   evidence	
   demonstrates	
   that	
   online	
   habits	
   and	
   experiences	
   vary	
   considerably	
   by	
   gender	
   (McMahan	
   &	
   Hovland,	
   2009;	
   Richard,	
   Chebat,	
   &	
   Yang,	
   2010).	
   Within	
   the	
   health	
   realm,	
   there	
   is	
   evidence	
   that	
   health	
   information-­‐seeking	
   patterns	
   and	
   practices	
   among	
   men	
   and	
   women	
   are	
   substantially	
   different	
   (Seale,	
   Ziebland,	
  &	
  Charteris-­‐Black,	
  2006).	
  For	
  example,	
  results	
  from	
  recent	
  Pew	
  Internet	
  &	
   American	
   Life	
   Project	
   studies	
   show	
   that	
   women	
   are	
   significantly	
   more	
   likely	
   than	
   men	
   to	
   go	
   online	
   to	
   search	
   for	
   health	
   information,	
   and	
   are	
   more	
   likely	
   to	
   hold	
   positive	
   beliefs	
   concerning	
   the	
   beneficial	
   effects	
   of	
   Internet	
   health	
   information-­‐ seeking	
   (Rice,	
   2006).	
   When	
   conducting	
   Internet	
   searches,	
   women	
   are	
   more	
   likely	
   than	
  men	
   to	
   focus	
   on	
   an	
   illness	
   or	
  its	
  symptoms,	
  while	
  men	
  tend	
  to	
  focus	
  on	
  disease	
   prognosis	
   and	
   treatment	
   (Fox,	
   Rainie,	
   Horrigan,	
   Lenhart,	
   &	
   Spooner,	
   2002).	
   Compared	
   to	
   women,	
   men	
   are	
   less	
   concerned	
   with	
   the	
   perceived	
   credibility	
   of	
   online	
  health	
  information.	
  	
  	
   	
   Men	
   and	
   women	
   also	
   have	
   distinct	
   and	
   unique	
   preferences	
   and	
   perceptions	
   when	
   it	
   comes	
   to	
   accessing	
   and	
   navigating	
   websites.	
   Much	
   of	
   what	
   is	
   known	
   about	
   the	
   different	
  ways	
  in	
  which	
  men	
  and	
  women	
  experience	
  the	
  online	
  world	
  originates	
  in	
   the	
   literature	
   in	
   the	
   field	
   of	
   e-­‐commerce.	
   	
   Research	
   in	
   this	
   area	
   examines	
   the	
   differences	
   between	
   men	
   and	
   women’s	
   online	
   practices,	
   revealing	
   gender-­‐based	
   dissimilarities	
   in	
   preferences,	
   satisfaction,	
   and	
   ease	
   of	
   website	
   use,	
   depending	
   on	
   aesthetics	
   and	
   content	
   (both	
   linguistic	
   and	
   visual).	
   A	
   combination	
   of	
   cues	
   (e.g.,	
   colours,	
   layout,	
   tone	
   of	
   written	
   content)	
   renders	
   online	
   spaces	
   inherently	
    	
    	
    8	
  	
    “gendered”	
  (e.g.,	
  website	
  features	
  ‘mirror’	
  the	
  gender	
  of	
  the	
  web	
  designer)	
  (de	
  Cabo,	
   Gimeno,	
  &	
  Martínez,	
  2011;	
  Moss	
  &	
  Gunn,	
  2006).	
   	
   Features	
   of	
   social	
   context	
   (e.g.,	
   gendered	
   stereotypes;	
   stigma)	
   are	
   known	
   to	
   exert	
   considerable	
   influence	
   on	
   experiences	
   with	
   conventional	
   sexual	
   health	
   service	
   provision	
   (e.g.,	
   STI	
   testing;	
   sexual	
   health	
   counseling).	
   A	
   growing	
   body	
   of	
   work	
   examines	
  the	
  complex	
  relationships	
  between	
  gender,	
  identity,	
  and	
  social	
  structures	
   and	
   considers	
   how	
   the	
   stigmatizing	
   effects	
   of	
   gendered	
   stereotypes	
   shape	
   youth’s	
   experiences	
   with	
   sexual	
   health	
   services.	
   For	
   example,	
   pervasive	
   social	
   norms	
   that	
   place	
  high	
  value	
  on	
  young	
  women’s	
  sexual	
  ‘morality’	
  (e.g.,	
  limiting	
  their	
  number	
  of	
   sexual	
  partners;	
  staying	
  ‘clean’)	
  may	
  lead	
  women	
  to	
  fear	
  being	
  labeled	
  negatively	
  for	
   accessing	
   testing,	
   or	
   for	
   testing	
   positive	
   for	
   an	
   STI	
   (Goldenberg,	
   Shoveller,	
   Koehoorn,	
   &	
   Ostry,	
   2008b;	
   Nwokolo,	
   McOwan,	
   &	
   Hennebry,	
   2002;	
   Shafer	
   et	
   al.,	
   2002).	
   In	
   fact,	
   some	
   women	
   cite	
   fear	
   of	
   rejection	
   or	
   blame	
   from	
   their	
   partner(s),	
   family,	
  or	
  health	
  care	
  provider	
  as	
  a	
  reason	
  to	
  avoid	
  testing	
  (Sheahan,	
  Coons,	
  Seabolt,	
   Churchill,	
  &	
  Dale,	
  1994).	
  Meanwhile,	
  dominant	
  ideals	
  of	
  masculinity	
  simultaneously	
   glorify	
  men’s	
  sexual	
  promiscuity	
  (i.e.,	
  men	
  having	
  multiple	
  partners)	
  and	
  reinforce	
   attitudes	
  and	
  beliefs	
  that	
  discourage	
  men’s	
  use	
  of	
  health	
  care	
  services	
  (e.g.,	
  denial	
  of	
   illness	
   in	
   favour	
   of	
   self-­‐monitoring	
   and	
   self-­‐treatment	
   of	
   symptoms)	
   (Courtenay,	
   2004;	
   Lee	
   &	
   Owens,	
   2002;	
   Robertson,	
   2007).	
   Within	
   heterosexual	
   relationships,	
   women	
   are	
   often	
   seen	
   as	
   the	
   caretakers	
   of	
   sexual	
   health	
   (Darroch,	
   Myers,	
   &	
   Cassell,	
   2003),	
   effectively	
   shaping	
   expectations	
   and	
   burdening	
   women	
   with	
   primary	
   responsibility	
   for	
   safe-­‐sex	
   practices	
   (e.g.,	
   advocating	
   for	
   condom	
   use;	
   procuring	
   oral	
    	
    	
    9	
  	
    contraceptives;	
  being	
  tested	
  for	
  STI/HIV)	
  (Oliffe	
  et	
  al.,	
  in	
  press).	
  Overall,	
  this	
  social	
   milieu	
   contributes	
   to	
   an	
   environment	
   that	
   fundamentally	
   genders	
   young	
   people’s	
   experiences	
   with	
   conventional,	
   in-­‐person	
   sexual	
   health	
   services,	
   a	
   reality	
   that	
   potentially	
  is	
  extended	
  to	
  web-­‐based	
  services.	
   	
   1.6 Thesis	
  objectives	
  and	
  overview	
  of	
  thesis	
  chapters	
   	
   The	
  current	
  thesis	
  aims	
  to	
  provide	
  an	
  in-­‐depth	
  analysis	
  of	
  young	
  people’s:	
   (1)  Perspectives	
   on	
   how	
   the	
   use	
   of	
   reverse	
   discourse	
   in	
   online	
   sexual	
    health	
  resources	
  affects	
  their	
  perceptions	
  of	
  these	
  resources	
  (Chapter	
  2);	
   (2)  Descriptions	
  of	
  their	
  experiences	
  with	
  accessing	
  online	
  sexual	
  health	
    resources	
   and	
   their	
   perceptions	
   of	
   the	
   ways	
   in	
   which	
   gender	
   stereotypes	
   feature	
  in	
  those	
  experiences	
  (Chapter	
  3).	
   	
   Chapter	
   2	
   focuses	
   on	
   the	
   use	
   of	
   reverse	
   discourse	
   as	
   it	
   relates	
   to	
   perceived	
   saliency/credibility	
   of	
   sexual	
   health	
   information	
   resources	
   and	
   hypothesizes	
   how	
   the	
   use	
   of	
   reverse	
   discourse	
   techniques	
   may	
   dispel	
   or	
   reproduce	
   existing	
   conceptualizations	
   of	
   youth	
   sexual	
   behaviour	
   as	
   inherently	
   risky	
   and/or	
   immoral.	
   Chapter	
  3	
  examines	
  the	
  ways	
  in	
  which	
  online	
  sexual	
  health	
  information	
  seeking	
  may	
   be	
   a	
   gendered	
   experience	
   and	
   includes	
   young	
   people’s	
   descriptions	
   of	
   the	
   ways	
   in	
   which	
   they	
   view	
   masculinities	
   and	
   femininities	
   as	
   featuring	
   in	
   those	
   experiences.	
   Chapter	
   4	
   includes	
   a	
   discussion	
   of	
   the	
   potential	
   implications	
   that	
   the	
   empirical	
    	
    	
    10	
  	
    findings	
   presented	
   in	
   Chapters	
   2	
   and	
   3	
   may	
   have	
   for	
   designing	
   (and	
   conducting	
   further	
  research	
  on)	
  online	
  sexual	
  health	
  resources	
  for	
  youth.	
    	
    	
    	
    11	
  	
    Chapter	
  2.0	
  ‘Sounds	
  like	
  the	
  person	
  you’re	
  drinking	
  with’:	
   examining	
  youth’s	
  perspectives	
  on	
  the	
  use	
  of	
  reverse	
  discourse	
  in	
   web-­‐based	
  sexual	
  health	
  interventions1	
   2.1	
  Introduction	
   	
   There	
  is	
  a	
  strong	
  public	
  health	
  impetus	
  to	
  develop	
  new	
  strategies	
  to	
  promote	
  sexual	
   health	
   among	
   youth	
   (<25)	
   (CATIE,	
   2011;	
   Moses	
   &	
   Elliott,	
   2002;	
   White,	
   Kelly,	
   Oliver,	
   &	
   Brotman,	
   2007),	
   and	
   Internet-­‐based	
   approaches	
   are	
   being	
   developed	
   to	
   complement	
   conventional	
   (e.g.,	
   clinic-­‐based;	
   school-­‐based)	
   services	
   (Bailey,	
   2010;	
   Levine,	
   2011;	
   Lim	
   et	
   al.,	
   2012;	
   Rietmeijer	
   &	
   McFarlane,	
   2009;	
   Rosenberger,	
   Reece,	
   Novak,	
   &	
   Mayer,	
   2011;	
   Shoveller	
   et	
   al.,	
   2011).	
   As	
   a	
   result,	
   increasing	
   attention	
   is	
   turning	
  towards	
  the	
  use	
  of	
  the	
  Internet	
  to	
  reach	
  populations	
  at	
  high	
  risk	
  for	
  STI/HIV	
   infection	
   	
   (e.g.,	
   youth	
   ages	
   15-­‐24;	
   men	
   who	
   have	
   sex	
   with	
   men).	
   This	
   emergent	
   field	
   of	
   study	
   presents	
   new	
   opportunities	
   to	
   re-­‐conceptualize	
   what	
   makes	
   for	
   effective	
   interventions	
   to	
   address	
   the	
   prevention	
   and	
   treatment	
   of	
   STIs	
   and	
   to	
   draw	
   on	
   theoretical	
   constructs	
   developed	
   in	
   disciplines	
   other	
   than	
   health	
   to	
   better	
   understand	
  what	
  online	
  approaches	
  might	
  be	
  more	
  (or	
  less)	
  effective.	
  	
   	
   An	
   important	
   body	
   of	
   literature	
   to	
   be	
   drawn	
   on	
   in	
   the	
   current	
   thesis	
   pertains	
   to	
   the	
   evidence	
   describing	
   various	
   aspects	
   of	
   adolescents’	
   use	
   of	
   the	
   Internet	
   for	
   sexual	
   health	
   information	
   (Borzekowski	
   &	
   Rickert,	
   2001;	
   Gray	
   et	
   al.,	
   2005;	
   Jones	
   &	
   	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
   1	
  A	
  version	
  of	
  this	
  chapter	
  is	
  under	
  review	
  for	
  publication.	
  Davis,	
  W.,	
  Shoveller,	
  J.A.,	
  Oliffe,	
    J.L,	
  &	
  Gilbert,	
  M.	
  ‘Sounds	
  like	
  the	
  person	
  you’re	
  drinking	
  with’:	
  Examining	
  youth’s	
   perspectives	
  on	
  the	
  use	
  of	
  reverse	
  discourse	
  in	
  web-­‐based	
  sexual	
  health	
  interventions.	
   Submitted	
  February	
  2012.	
    	
    	
    	
    12	
  	
    Biddlecom,	
   2011;	
   Kanuga	
   &	
   Rosenfeld,	
   2004).	
   In	
   general,	
   much	
   of	
   the	
   research	
   in	
   this	
   realm	
   focuses	
   on	
   usage	
   patterns	
   (e.g.,	
   frequency	
   of	
   use;	
   topics	
   of	
   interest);	
   however,	
   new	
   work	
   related	
   to	
   other,	
   more	
   nuanced	
   aspects	
   of	
   the	
   ‘online	
   experience’	
  is	
  emerging	
  (Gray	
  et	
  al.,	
  2005;	
  Jones	
  &	
  Biddlecom,	
  2011).	
  	
  For	
  example,	
   it	
   is	
   now	
   argued	
   that	
   for	
   many	
   youth,	
   going	
   online	
   is	
   an	
   experience	
   beyond	
   mere	
   information-­‐seeking;	
  instead,	
  it	
  can	
  be	
  an	
  extension	
  of	
  young	
  people’s	
  identities,	
  as	
   they	
   negotiate	
   online	
   constructions	
   of	
   important	
   social	
   cues	
   (e.g.,	
   gendered	
   stereotypes;	
  power	
  dynamics	
  within	
  relationships;	
  relations	
  to	
  peers)	
  (Macfarlane	
  &	
   McPherson,	
  2007;	
  Mazzarella,	
  2005).	
  A	
  small,	
  but	
  growing,	
  body	
  of	
  research	
  also	
  has	
   begun	
   to	
   explore	
   other	
   ways	
   in	
   which	
   the	
   nexus	
   of	
   the	
   social	
   and	
   the	
   technical	
   aspects	
   of	
   web-­‐based	
   health	
   interventions	
   affects	
   experiences	
   with	
   online	
   sexual	
   health	
  promotion	
  (e.g.,	
  how	
  features	
  of	
  a	
  website	
  affects	
  perceived	
  credibility;	
  how	
   youth	
   identify	
   salient	
   online	
   resources)	
   (Gray	
   et	
   al.,	
   2005;	
   Jones	
   et	
   al.,	
   2011;	
   Simkins,	
  2007).	
  	
   	
   Previous	
   research	
   has	
   shown	
   that	
   several	
   factors	
   appear	
   to	
   be	
   related	
   to	
   the	
   perceived	
   credibility	
   and	
   saliency	
   of	
   sexual	
   health	
   information	
   and	
   resources.	
   For	
   example,	
   many	
   youth	
   want	
   sexual	
   health	
   education	
   to	
   be	
   ‘empathetic,	
   non-­‐ judgmental,	
   and	
   able	
   to	
   create	
   a	
   'safe	
   environment'	
   in	
   order	
   to	
   facilitate	
   the	
   discussion	
   of	
   difficult	
   subjects’	
   (Hilton,	
   2003),	
   and	
   to	
   use	
  relaxed	
   and	
   informal	
   methods	
  of	
  delivery	
  (Audrey,	
  Holliday,	
  &	
  Campbell,	
  2006;	
  Measor,	
  2004;	
  Mellanby,	
   2001;	
  Williams	
  &	
  Bonner,	
  2006).	
  	
  Much	
  of	
  the	
  work	
  in	
  this	
  area	
  has	
  focused	
  on	
  the	
   provision	
   of	
   peer-­‐led	
   health	
   promotion	
   and	
   education	
   (Audrey	
   et	
   al.,	
   2006),	
   as	
   an	
    	
    	
    13	
  	
    alternative	
   to	
   adult-­‐led	
   instruction.	
   Proponents	
   of	
   this	
   approach	
   cite	
   several	
   advantages	
   over	
   more	
   conventional,	
   adult-­‐led	
   approaches,	
   including	
   increased	
   credibility,	
   empowerment,	
   acceptability,	
   and	
   success	
   associated	
   with	
   peer-­‐led	
   delivery	
   (summarized	
   (Turner,	
   1999).	
   Such	
   strategies	
   reportedly	
   draw	
   on	
   several	
   important	
   theoretical	
   models	
   (e.g.,	
   Social	
   Learning	
   Theory;	
   Social	
   Influences	
   Theory)	
  to	
  inform	
  peer-­‐education	
  initiatives	
  (Kirby,	
  1994;	
  Wilton	
  &	
  Keeble,	
  1995).	
   Within	
   these	
   interventions,	
   it	
   is	
   suggested	
   that	
   learning	
   and/or	
   behaviour	
   change	
   is	
   enhanced	
  when	
  the	
  supplier	
  of	
  sexual	
  health	
  information	
  is	
  perceived	
  to	
  share	
  key	
   characteristics	
   with	
   the	
   recipient(s)	
   (e.g.,	
   behaviour;	
   experience;	
   social	
   status;	
   cultural	
  background)(Harden,	
  Oakley,	
  &	
  Oliver,	
  2001).	
  	
  	
   	
   In	
  some	
  instances,	
  this	
  thinking	
  appears	
  to	
  have	
  been	
  extended	
  and	
  applied	
  within	
   some	
   web-­‐based	
   sexual	
   health	
   promotion	
   efforts,	
   primarily	
   via	
   the	
   use	
   of	
   reverse	
   discourse	
  (Foucault,	
  1978).	
  Reverse	
  discourse	
  –	
  the	
  acknowledgement	
  and	
  rejection	
   of	
   shame	
   associated	
   with	
   stigmatized	
   concepts	
   –	
   is	
   intended	
   both	
   to	
   challenge	
   negative	
  judgments	
  of	
  ‘risky’	
  behaviours	
  (e.g.,	
  having	
  sex	
  outside	
  of	
  a	
  monogamous	
   partnership)	
   and	
   to	
   appeal	
   to	
   youth	
   (e.g.,	
   by	
   using	
   ‘their’	
   language).	
   Reverse	
   discourse	
   is	
   a	
   Foucauldian	
   concept,	
   originally	
   developed	
   in	
   the	
   context	
   of	
   the	
   homosexual	
   civil	
   rights	
   movement	
   (Foucault,	
   1978).	
   However,	
   in	
   the	
   current	
   analysis,	
   reverse	
   discourse	
   is	
   considered	
   within	
   the	
   broader	
   context	
   of	
   Foucault’s	
   discussions	
   relating	
   to	
   discourse,	
   power,	
   and	
   resistance,	
   wherein	
   the	
   marginalized	
   are	
  able	
  ‘to	
  speak’	
  on	
  their	
  ‘own	
  behalf,	
  to	
  demand	
  that	
  legitimacy	
  or	
  ‘naturality’	
  be	
   acknowledged,	
  often	
  in	
  the	
  same	
  vocabulary,	
  using	
  the	
  same	
  categories	
  by	
  which	
  it	
    	
    	
    14	
  	
    was	
  medically	
  disqualified’	
  (p.	
  101).	
  Reverse	
  discourse	
  is	
  a	
  fundamentally	
  subjective	
   and	
   social	
   phenomenon	
   wherein	
   dominant	
   notions	
   of	
   what	
   is	
   sacred	
   and	
   what	
   is	
   profane	
  are	
  contested,	
  in	
  an	
  attempt	
  to	
  disrupt	
  existing	
  power	
  structures.	
  This	
  lens	
   is	
   applied	
   in	
   examining	
   the	
   messaging	
   and	
   meanings	
   inherent	
   in	
   online	
   sexual	
   health	
  promotion.	
  In	
  particular,	
  the	
  analysis	
  will	
  focus	
  on	
  the	
  acknowledgement	
  and	
   rejection	
   of	
   shame	
   associated	
   with	
   behaviours	
   (e.g.,	
   having	
   sex	
   outside	
   of	
   a	
   monogamous	
   partnership)	
   that	
   are	
   stereotypically	
   deemed	
   to	
   be	
   negative	
   (e.g.,	
   by	
   virtue	
   of	
   their	
   inherent	
   ‘risk’)	
   by	
   ‘experts’	
   (i.e.,	
   those	
   in	
   power).	
   These	
   messages	
   are	
   delivered	
   using	
   the	
   same	
   language	
   and	
   concepts	
   that	
   are	
   traditionally	
   associated	
   with	
  ‘unsafe’	
  sexual	
  practices	
  (e.g.,	
  having	
  multiple	
  sexual	
  partners	
  is	
  referred	
  to	
  as	
   ‘casual	
  sex’).	
  	
   	
   Several	
   studies	
   have	
   found	
   the	
   intersections	
   of	
   multiple	
   factors	
   (e.g.,	
   one’s	
   gender,	
   cultural	
   background,	
   sexual	
   identity)	
   are	
   important	
   influences	
   on	
   face-­‐to-­‐face	
   communication	
   during	
   clinical	
   encounters	
   (Goldenberg,	
   Shoveller,	
   Ostry,	
   &	
   Koehoorn,	
   2008a;	
   Goldenberg,	
   Shoveller,	
   Koehoorn,	
   &	
   Ostry,	
   2008b;	
   Lichtenstein,	
   2004;	
  Lichtenstein	
  &	
  Bachmann,	
  2005;	
  Shoveller	
  et	
  al.,	
  2009;	
  Shoveller	
  et	
  al.,	
  2010);	
   however,	
  there	
  is	
  a	
  paucity	
  of	
  information	
  to	
  illuminate	
  how	
  these	
  forces	
  might	
  play	
   out	
  within	
  online	
  sexual	
  health	
  services.	
  While	
  the	
  provision	
  of	
  web-­‐based	
  services	
   offers	
   advantages	
   (e.g.,	
   anonymity;	
   convenience)	
   (Shoveller	
   et	
   al.,	
   2011),	
   it	
   is	
   unrealistic	
   to	
   assume	
   that	
   stigma	
   associated	
   with	
   the	
   utilization	
   of	
   sexual	
   health	
   services	
   will	
   be	
   completely	
   dispelled	
   through	
   this	
   approach	
   (e.g.,	
   heteronormative	
   online	
  spaces;	
  online	
  enactments	
  of	
  gendered	
  stereotypes).	
    	
    	
    15	
  	
    	
   Many	
   young	
   people	
   report	
   that	
   the	
   Internet	
   is	
   the	
   first	
   place	
   they	
   look	
   for	
   health	
   information	
   (Hesse	
   et	
   al.,	
   2005).	
   Thus,	
   it	
   is	
   important	
   to	
   understand	
   and	
   respond	
   to	
   youth’s	
   perspectives	
   about	
   online	
   resources,	
   particularly	
   their	
   perceived	
   salience	
   and	
   credibility.	
   To	
   identify	
   and	
   mitigate	
   the	
   possibility	
   of	
   the	
   new	
   online	
   sexual	
   health	
   interventions	
   to	
   unintentionally	
   reinforce	
   stigma	
   associated	
   with	
   STI/HIV,	
   or	
   to	
  exacerbate	
  existing	
  barriers	
  to	
  service	
  access	
  for	
  vulnerable	
  subgroups	
  of	
  youth,	
   we	
   need	
   to	
   understand	
   youth’s	
   perspectives.	
   Without	
   accounting	
   for	
   these	
   perspectives,	
  intervention	
  planners	
  risk	
  repeating	
  many	
  of	
  the	
  problems	
  associated	
   with	
  conventional	
  services	
  (i.e.,	
  face-­‐to-­‐face	
  services)	
  (Harvey	
  et	
  al.,	
  2008).	
  Thus,	
  the	
   current	
  chapter	
  sought	
  to	
  examine	
  and	
  understand	
  youth’s	
  perspectives	
  on	
  the	
  use	
   of	
   reverse	
   discourse	
   in	
   web-­‐based	
   sexual	
   health	
   promotion	
   initiatives,	
   and	
   to	
   understand	
  how	
  it	
  may	
  affect	
  young	
  people’s	
  experiences	
  accessing	
  these	
  resources.	
   	
   2.2	
  Methods	
   2.2.1	
  Recruitment	
   A	
   purposive	
   sampling	
   strategy	
   was	
   employed	
   (Shadish	
   &	
   Cook,	
   2002)	
   to	
   select	
   a	
   wide	
   range	
   of	
   participants	
   (ages	
   of	
   15-­‐24),	
   deliberately	
   selecting	
   youth	
   who,	
   by	
   virtue	
   of	
   their	
   social	
   contexts,	
   could	
   share	
   insights	
   into	
   the	
   needs	
   of	
   a	
   variety	
   of	
   youth.	
  Recruitment	
  efforts	
  included	
  posters	
  at	
  various	
  ‘youth	
  hang-­‐outs’	
  (e.g.,	
  drop-­‐ in	
   centres,	
   community	
   colleges),	
   as	
   well	
   as	
   targeted	
   online	
   advertisements	
   (e.g.,	
   Craigslist,	
  Facebook).	
  	
  Efforts	
  were	
  made	
  to	
  recruit	
  in	
  spaces	
  (online	
  and	
  otherwise)	
   populated	
   by	
   vulnerable	
   youth,	
   such	
   as	
   multicultural	
   youth	
   centres,	
   low-­‐threshold	
   	
    	
    16	
  	
    service	
   centres	
   for	
   street-­‐involved	
   youth,	
   and	
   list-­‐serves	
   for	
   queer	
   youth.	
   Youth	
   contacted	
   our	
   office	
   by	
   phone	
   or	
   email,	
   and	
   were	
   screened	
   for	
   eligibility	
   (e.g.,	
   previously	
  sexually	
  active,	
  lived	
  in	
  the	
  study	
  area,	
  fluent	
  in	
  English,	
  had	
  considered	
   or	
   had	
   undergone	
   STI	
   testing).	
   	
   As	
   the	
   study	
   progressed,	
   sampling	
   needs	
   were	
   discussed	
  by	
  team	
  members	
  and	
  adjusted	
  according	
  to	
  emergent	
  findings.	
   	
   2.2.2	
  Data	
  collection	
  and	
  analysis	
   Data	
   were	
   collected	
   using	
   in-­‐depth,	
   individual	
   interviews	
   with	
   20	
   youth	
   participants,	
   as	
   well	
   as	
   focus	
   groups	
   (3	
   groups	
   with	
   4	
   participants	
   per	
   group).	
   Interview	
   and	
   focus	
   group	
   guides	
   were	
   developed	
   and	
   pilot	
   tested	
   by	
   members	
   of	
   the	
  research	
  team.	
  Informed	
  consent	
  was	
  obtained	
  from	
  all	
  participants,	
  who	
  were	
   asked	
   to	
   also	
   complete	
   a	
   brief	
   socio-­‐demographic	
   questionnaire.	
   Ethics	
   approval	
   was	
  obtained	
  from	
  the	
  University	
  of	
  British	
  Columbia	
  Behavioural	
  Research	
  Ethics	
   Board.	
  Upon	
  completion	
  of	
  an	
  interview	
  or	
  focus	
  group,	
  participants	
  received	
  a	
  $25	
   cash	
   honorarium.	
   All	
   interviews	
   and	
   focus	
   groups	
   were	
   audio-­‐	
   or	
   video-­‐recorded,	
   transcribed	
   (with	
   all	
   identifying	
   information	
   removed),	
   and	
   transcripts	
   were	
   checked	
   for	
   accuracy.	
   	
   Transcripts	
   were	
   coded	
   and	
   date	
   organized	
   using	
   NVivo	
   8	
   qualitative	
   analysis	
   software.	
   Constant	
   comparative	
   techniques	
   informed	
   the	
   analysis	
  (Corbin,	
  1998),	
  and	
  emergent	
  findings	
  were	
  used	
  by	
  the	
  research	
  team	
  to	
   iteratively	
   revise	
   the	
   interview	
   and	
   focus	
   group	
   guides.	
   	
   In	
   addition,	
   a	
   five-­‐hour	
   Youth	
   Roundtable	
   event	
   (composed	
   of	
   13	
   youth,	
   3	
   of	
   whom	
   had	
   taken	
   part	
   in	
   an	
   interview	
  or	
  a	
  focus	
  group)	
  gave	
  the	
  opportunity	
  to	
  verify,	
  correct,	
  and	
  conceptually	
   advance	
   emergent	
   and	
   evolving	
   findings	
   through	
   workshop	
   and	
   group	
   activities.	
   	
    	
    17	
  	
    Youth	
   were	
   compensated	
   for	
   their	
   participation	
   with	
   an	
   $80	
   honorarium.	
   The	
   materials	
   (e.g.,	
   transcripts	
   of	
   audio-­‐recordings;	
   paper	
   results	
   of	
   group	
   activities)	
   resulting	
   from	
   this	
   event	
   were	
   included	
   in	
   the	
   analysis,	
   and	
   were	
   used	
   to	
   vet	
   and	
   advance	
  thematic	
  results.	
  	
   	
   North	
   American,	
   English-­‐language	
   sexual	
   health	
   websites	
   (n=15)	
   were	
   reviewed	
   during	
   qualitative	
   in-­‐depth	
   interviews	
   and	
   focus	
   groups	
   with	
   youth	
   participants.	
   Youth	
   were	
   asked	
   to	
   share	
   their	
   perspectives	
   on	
   written	
   (e.g.,	
   clinical	
   versus	
   colloquial	
   language)	
   and	
   visual	
   (e.g.,	
   medicalized	
   images;	
   sexualized	
   images)	
   presentations	
  of	
  sexual	
  health	
  information	
  on	
  the	
  websites,	
  taken	
  in	
  isolation.	
  Text	
   and	
  image	
  sample	
  selection	
  included	
  a	
  variety	
  of	
  styles,	
  and	
  included	
  samples	
  that	
   could	
   potentially	
   be	
   interpreted	
   as	
   reverse	
   discourse	
   by	
   study	
   participants.	
   Selection	
   of	
   these	
   examples	
   was	
   informed	
   by	
   an	
   understanding	
   of	
   the	
   concept	
   of	
   reverse	
   discourse	
   in	
   the	
   context	
   of	
   contemporary	
   sexual	
   health	
   messaging	
   (e.g.,	
   identifying	
   examples	
   of	
   slang,	
   colloquialism,	
   and	
   vernacular),	
   and	
   by	
   previous	
   analyses	
   of	
   enactments	
   of	
   reverse	
   discourse	
   in	
   sexual	
   health	
   messaging	
   (Myrick,	
   1996).	
  Interviews	
  were	
  semi-­‐structured	
  and	
  used	
  open-­‐ended	
  questions,	
  providing	
   participants	
   with	
   opportunities	
   to	
   discuss	
   the	
   ways	
   in	
   which	
   various	
   online	
   representations	
   could	
   affect	
   their	
   experiences	
   accessing	
   online	
   sexual	
   health	
   services.	
   Interviews	
   were	
   conducted	
   in	
   a	
   research	
   office,	
   or	
   in	
   private	
   space	
   made	
   available	
   for	
   use	
   by	
   community	
   partners	
   (e.g.,	
   drop-­‐in	
   service	
   meeting	
   room),	
   and	
   each	
  lasted	
  approximately	
  1-­‐1.5	
  hours.	
  	
   	
    	
    	
    18	
  	
    2.3	
  Results	
  	
   2.3.1	
  Study	
  participants	
   In	
  total,	
  interviews	
  and	
  focus	
  groups	
  were	
  conducted	
  with	
  12	
  male,	
  19	
  female,	
  and	
  1	
   transgendered	
   youth	
   (mean	
   age:	
   20	
   years).	
   	
   Table	
   1	
   shows	
   participants’	
   self-­‐ identified	
  socio-­‐demographic	
  characteristics,	
  and	
  Table	
  2	
  summarizes	
  participants’	
   previous	
  STI/HIV	
  testing	
  history.	
   	
   Table	
  1:	
  Participants’	
  self-­‐reported	
  socio-­‐demographic	
  characteristics	
   Age	
  Group	
  	
   15	
  -­‐	
  19	
  years	
   20	
  -­‐	
  24	
  years	
   Gender	
   Female	
   Male	
   Transgender	
  (F)	
   Ethnicity	
  (self-­‐identified)	
   Aboriginal	
   East	
  Asian/Southeast	
  Asian	
   Euro-­‐Canadian	
   South	
  Asian	
   Other	
   Country	
  of	
  Birth	
   Canada	
   Other	
   Length	
  of	
  Stay	
  in	
  Vancouver	
   <	
  1	
  year	
   1	
  -­‐	
  5	
  years	
   6	
  -­‐	
  10	
  years	
   11	
  -­‐	
  15	
  years	
   >15	
  years/Entire	
  life	
   Living	
  Arrangement	
   Alone	
   University	
  Residence	
   With	
  Friends/Roommates	
  	
   With	
  Partner/Spouse	
   With	
  Parents/Family	
   Shelter/Transition	
  House/Street	
   Other	
    	
  n	
  (%)*	
   15	
  (47)	
   17	
  (53)	
   	
  	
   19	
  (59)	
   12	
  (38)	
   1	
  (3)	
   	
  	
   4	
  (13)	
   6	
  (19)	
   19	
  (59)	
   1	
  (3)	
   2	
  (6)	
   	
  	
   22	
  (69)	
   10	
  (31)	
   	
  	
   4	
  (13)	
   9	
  (28)	
   3	
  (9)	
   3	
  (9)	
   13	
  (41)	
   	
  	
   2	
  (6)	
   5	
  (16)	
   6	
  (19)	
   2	
  (6)	
   12	
  (38)	
   3	
  (9)	
   2	
  (6)	
    	
    	
    	
    19	
  	
    Table	
  1	
  (continued):	
  Participants’	
  self-­‐reported	
  socio-­‐demographic	
  characteristics	
   Sexual	
  Orientation	
   Bisexual	
   Lesbian	
   Gay	
   Straight	
   Two-­‐Spirit	
   Other	
   Current	
  Sexual	
  Activity	
   Not	
  currently	
  sexually	
  active	
   With	
  one	
  partner	
   With	
  more	
  than	
  one	
  partner	
    	
  	
   1	
  (3)	
   1	
  (3)	
   4	
  (13)	
   23	
  (72)	
   1	
  (3)	
   2	
  (6)	
   	
  	
   7	
  (22)	
   22	
  (69)	
   3	
  (9)	
    	
   Table	
  2:	
  Participants’	
  self-­‐reported	
  STI	
  testing	
  history	
   Tested	
  Previously	
   No	
   Yes	
   Last	
  Tested	
  (n=22)	
   Within	
  1	
  month	
   Within	
  6	
  months	
   Within	
  1	
  year	
   1	
  year	
  or	
  more	
    	
  n	
  (%)*	
   10	
  (31)	
   22	
  (39)	
   	
  	
   5	
  (16)	
   10	
  (31)	
   3	
  (9)	
   4	
  (13)	
    *	
  Percentages	
  may	
  not	
  add	
  up	
  to	
  1	
  due	
  to	
  rounding.	
   	
   In	
   reviewing	
   the	
   sample	
   of	
   sexual	
   health	
   websites,	
   youth	
   identified	
   a	
   variety	
   of	
   potentially	
   problematic	
   phrases	
   and	
   images.	
   	
   While	
   there	
   was	
   not	
   absolute	
   agreement	
   among	
   participants	
   as	
   to	
   precisely	
   which	
   language	
   or	
   imagery	
   had	
   a	
   negative	
   impact	
   on	
   their	
   impressions	
   of	
   the	
   websites,	
   most	
   participants	
   identified	
   more	
   explicit	
   or	
   colloquial	
   language	
   (e.g.,	
   ‘no-­‐strings	
   sex’,	
   ‘screw	
   around’,	
   ‘fuck	
   friend’)	
   as	
   an	
   enactment	
   of	
   reverse	
   discourse.	
   	
   In	
   general,	
   compared	
   to	
   their	
   reactions	
   to	
   text	
   samples,	
   participants	
   had	
   less	
   intense	
   opinions	
   about	
   images,	
   although	
  some	
  found	
  more	
  ‘sexy’	
  images	
  (e.g.,	
  a	
  photo	
  of	
  two	
  youth	
  kissing)	
  to	
  be	
  an	
   enactment	
  of	
  reverse	
  discourse.	
    	
    	
    20	
  	
    	
   When	
   asked	
   to	
   consider	
   online	
   sexual	
   health	
   resource	
   designers’	
   motivations	
   for	
   utilizing	
   textual	
   and	
   image-­‐based	
   enactments	
   of	
   reverse	
   discourse,	
   nearly	
   all	
   participants	
  perceived	
  an	
  intention	
  by	
  the	
  designer	
  to:	
  (i)	
  catch	
  the	
  user’s	
  attention	
   by	
  using	
  words	
  or	
  images	
  that	
  are	
  more	
  striking	
  or	
  explicit;	
  (ii)	
  align	
  content	
  with	
   dominant	
   portrayals	
   of	
   youth	
   culture;	
   or	
   (iii)	
   anticipate	
   and	
   pre-­‐empt	
   youth’s	
   discomfort	
   or	
   embarrassment	
   with	
   the	
   sensitive	
   nature	
   of	
   the	
   topic,	
   and	
   to	
   mitigate	
   this	
  discomfort	
  through	
  the	
  overt	
  use	
  of	
  colloquial	
  language	
  and/or	
  explicit	
  images.	
  	
   One	
   youth,	
   Justin	
   theorized	
   that	
   these	
   techniques	
   were	
   used	
   on	
   sexual	
   health	
   websites	
   ‘because	
   a	
   lot	
   of	
   people	
   would	
   relate	
   to	
   that	
   language	
   and	
   sort	
   of	
   use	
   it	
   already.	
   So	
   it’s	
   common,	
   so	
   they	
   would	
   know	
   what	
   it	
   means.’	
   Often,	
   youth’s	
   initial	
   responses	
  to	
  reverse	
  discourse	
  presentations	
  focused	
  on	
  the	
  perceived	
  intentions	
  of	
   the	
  website	
  designers.	
  	
  Implicit	
  in	
  many	
  of	
  these	
  reflections	
  was	
  a	
  perceived	
  lack	
  of	
   authenticity.	
  As	
  one	
  young	
  woman,	
  Coral,	
  told	
  us:	
  	
  ‘It	
  seems	
  like	
  they	
  are	
  trying	
  to	
  like	
   fit	
  in.	
  I	
  know	
  it	
  sounds	
  ridiculous,	
  but	
  like	
  fit	
  in	
  with	
  the	
  reader’.	
  Like	
   many	
   youth	
   in	
   the	
   study,	
   Coral	
   sensed	
   that	
   website	
   designers	
   were	
   attempting	
   to	
   resonate	
   with	
   youth	
   by	
   using	
   ‘their	
   language’.	
   	
   Ultimately,	
   these	
   efforts	
   had	
   the	
   opposite	
   effect:	
   youth	
   sensed	
   that	
   the	
   authors	
   of	
   this	
   content	
   were	
   not,	
   in	
   fact,	
   their	
   peers,	
   but	
   were	
   instead	
   ‘outsiders’	
   (i.e.,	
   sexual	
   health	
   intervention	
   designers).	
   	
   Instead	
   of	
   seeming	
   authentic,	
   inauthenticity	
   emerged,	
   as	
   youth	
   perceived	
   the	
   ‘youthful’	
   messaging	
   style	
   as	
  feigned.	
  	
   	
   	
   	
    	
    21	
  	
    2.3.2	
  Saliency	
  and	
  credibility	
   More	
  explicit	
  content	
  elicited	
  negative	
  responses	
  from	
  youth	
  in	
  terms	
  of	
  perceived	
   appeal,	
   trust,	
   and	
   quality	
   of	
   these	
   websites.	
   Youth	
   explained	
   that	
   when	
   sifting	
   through	
  the	
  abundance	
  of	
  sexual	
  health	
  information	
  on	
  the	
  Internet,	
  they	
  undertake	
   a	
  complex	
  process	
  of	
  identifying	
  information	
  that	
  is	
  personally	
  salient,	
  or	
  relevant	
  to	
   their	
   needs.	
   	
   For	
   many	
   youth	
   participants,	
   reverse	
   discourse	
   detracted	
   from	
   this	
   saliency.	
   	
   For	
   example,	
   many	
   youth	
   valued	
   a	
   professional,	
   straightforward	
   approach	
   to	
  the	
  delivery	
  of	
  sexual	
  health	
  content.	
  As	
  Sarah	
  explained:	
   	
   Like,	
   when	
   you	
   are	
   looking	
   for	
   an	
   answer	
   you	
   want	
   someone	
   who	
   sounds	
   like	
   they	
   know	
   what	
   they	
   are	
   talking	
   about,	
   not	
   somebody	
   that	
   sounds	
   like	
   the	
  person	
  you	
  are	
  drinking	
  with.	
   	
   While	
  acknowledging	
  that	
  particular	
  words	
  or	
  phrases	
  might	
  catch	
  youth’s	
  attention	
   or	
  be	
  seen	
  as	
  humorous,	
  most	
  participants	
  suggested	
  that	
  they	
  would	
  not	
  perceive	
   information	
  presented	
  in	
  this	
  way	
  to	
  be	
  ‘worth’	
  processing.	
  For	
  many	
  participants,	
   delivering	
   sexual	
   health	
   information	
   without	
   an	
   appropriate	
   level	
   of	
   seriousness	
   effectively	
  rendered	
  the	
  message	
  as	
  being	
  without	
  value.	
  As	
  one	
  youth	
  described:	
  “It	
   will	
   make	
   you	
   laugh.	
   But	
   at	
   the	
   same	
   time,	
   like	
   you	
   are	
   probably	
   not	
   gonna	
   remember	
   anything	
  you	
  read	
  from	
  it,	
  because	
  it	
  doesn’t	
  go	
  into	
  your	
  brain	
  as	
  something	
  serious.”	
  	
  	
   	
   Youth	
   often	
   suggested	
   that	
   there	
   is	
   a	
   ‘time	
   and	
   a	
   place’	
   for	
   sexual	
   topics	
   to	
   be	
   discussed	
  in	
  a	
  casual	
  or	
  humorous	
  way,	
  but	
  that	
  the	
  use	
  of	
  reverse	
  discourse	
  in	
  an	
    	
    	
    22	
  	
    online	
  sexual	
  health	
  resource	
  was	
  not	
  necessarily	
  the	
  most	
  appropriate	
  or	
  effective	
   means	
   of	
   health	
   communication.	
   	
   Some	
   youth	
   were	
   more	
   direct;	
   they	
   said	
   that	
   reverse	
  discourses	
  that	
  challenge	
  conventional	
  norms	
  about	
  youth	
  sexual	
  behaviour	
   are	
   inappropriate	
   in	
   an	
   online	
   context	
   –	
   many	
   preferring	
   instead	
   to	
   discuss	
   such	
   things	
  with	
  friends.	
  As	
  Sarah	
  explained:	
   	
   They	
  are	
  trying	
  really	
  hard	
  to	
  sound	
  sort	
  of	
  like	
  the	
  friend	
  you	
  would	
  talk	
   to.	
  If	
  you	
  are	
  gonna	
  go	
  online,	
  I	
  mean	
  that’s	
  why	
  you	
  have	
  friends.	
  Like	
  if	
   you	
  were	
  gonna	
  talk	
  to	
  your	
  friend,	
  you	
  talk	
  to	
  your	
  friend,	
  you	
  wouldn’t	
  go	
   to	
  a	
  website,	
  you	
  know	
  what	
  I	
  mean?	
  	
   	
   Furthermore,	
   the	
   use	
   of	
   reverse	
   discourse	
   often	
   had	
   a	
   detrimental	
   impact	
   on	
   the	
   perceived	
   credibility	
   of	
   a	
   website.	
   	
   Youth	
   made	
   clear	
   that	
   they	
   valued	
   a	
   professional	
   approach	
  to	
  online	
  sexual	
  health	
  information	
  provision,	
  and	
  that	
  reverse	
  discourse	
   negated	
  this.	
  	
  For	
  example,	
  Elisa	
  explained:	
  	
   	
   If	
  I	
  was	
  reading	
  this	
  on	
  a	
  website	
  I	
  would	
  probably	
  leave	
  the	
  website	
  right	
   away	
  because	
  it	
  doesn’t	
  seem	
  like	
  it’s	
  something	
  that	
  a	
  very	
  credible	
  source	
   would	
   use	
   at	
   all.	
   Like	
   the	
   ‘f’	
   word,	
   ‘heavy	
   love	
   stuff’,	
   like	
   once	
   again	
   that	
   doesn’t	
   seem	
   very	
   serious	
   at	
   all.	
   Like,	
   I	
   know	
   what	
   it	
   means	
   but	
   not	
   something	
  that	
  I	
  would	
  probably	
  continue	
  reading.	
   	
    	
    	
    23	
  	
    Participants	
   particularly	
   objected	
   to	
   the	
   use	
   of	
   reverse	
   discourse	
   enacted	
   as	
   slang	
   within	
  sexual	
  health	
  websites.	
  One	
  young	
  woman,	
  Bridgette	
  expressed	
  that	
  the	
  way	
   a	
   websites	
   “talks”	
   has	
   significant	
   effect	
   on	
   how	
   well	
   she	
   trusts	
   it	
   as	
   a	
   source	
   of	
   information,	
  and	
  that	
  the	
  use	
  of	
  a	
  colloquialism	
  detracts	
  from	
  the	
  trustworthiness	
  of	
   online	
   sexual	
   health	
   messaging.	
   	
   For	
   example,	
   in	
   response	
   to	
   the	
   use	
   of	
   the	
   word	
   “cum”,	
  she	
  exclaimed	
  that	
  the	
  website	
  was	
  “not	
  too	
  trustworthy.	
  I	
  don’t	
  know	
  it	
  just	
   sounds	
  silly.	
  To	
  me	
  anyhow,	
  it	
  just	
  seems	
  like	
  some	
  teens	
  talking.”	
   	
   2.3.3	
  Social	
  context	
   Many	
  participants	
  acknowledged	
  that	
  enactments	
  of	
  reverse	
  discourse	
  on	
  a	
  sexual	
   health	
  website	
  could	
  potentially	
  be	
  a	
  deterrent	
  for	
  some	
  youth,	
  depending	
  on	
  their	
   current	
   social	
   context	
   (e.g.,	
   living	
   situation;	
   sexual	
   identity	
   disclosure	
   status.)	
   For	
   example,	
   Vidia	
   suggested	
   that,	
   for	
   youth	
   from	
   more	
   conservative	
   or	
   religious	
   backgrounds,	
  enactments	
  of	
  reverse	
  discourse	
  in	
  this	
  area	
  could	
  be	
  off-­‐putting.	
  She	
   explained	
   that,	
   for	
   these	
   youth	
   sexualized	
   images	
   on	
   sexual	
   health	
   websites	
   (e.g.,	
   images	
  of	
  youth	
  kissing):	
  “could	
   be	
   somewhat	
   offensive.	
   Like	
   they	
   wanna	
   learn	
   about	
   sex	
  but	
  they	
  don’t	
  wanna	
  see	
  people	
  going	
  at	
  it.	
  Like	
  they	
  didn’t	
  search	
  for	
  porn	
  or	
  like	
   sexy	
   movies,	
   they	
   searched	
   for	
   facts.”	
   As	
  a	
  young	
  woman	
  who	
  identified	
  as	
  a	
  lesbian,	
   Vidia	
  acknowledged	
  that	
  for	
  many	
  youth,	
  engaging	
  in	
  same-­‐sex	
  sexual	
  interactions	
   can	
  be	
  laced	
  with	
  stigma	
  and	
  shame,	
  making	
  it	
  even	
  more	
  difficult	
  to	
  seek	
  relevant	
   sexual	
   health	
   resources.	
   	
   She	
   asserted	
   that	
   this	
   might	
   motivate	
   some	
   youth	
   (e.g.,	
   some	
   LGBT	
   youth)	
   to	
   visit	
   websites	
   that	
   were	
   absent	
   of	
   any	
   risqué	
   content.	
   She	
   suggested	
   that,	
   to	
   avoid	
   creating	
   additional	
   barriers	
   for	
   these	
   youth,	
   online	
   sexual	
   	
    	
    24	
  	
    health	
  resources	
  should	
  avoid	
  “big	
  pictures	
  of	
  people	
  making	
  out,	
  or	
  having	
  the	
  words	
   ‘sex’	
  super,	
  super	
  big.	
  Basically	
  don’t	
  make	
  it	
  super	
  crude	
  or	
  risqué,	
  or	
  intimidating.”	
  	
   	
   In	
  addition,	
  the	
  use	
  of	
  reverse	
  discourse	
  also	
  appeared	
  to	
  be	
  differentially	
  perceived	
   by	
  youth	
  depending	
  on	
  their	
  cultural	
  or	
  ethnic	
  background.	
  Participants	
  stressed	
  the	
   importance	
  of	
  youth’s	
  relationships	
  with	
  cultural	
  norms	
  as	
  being	
  influences	
  in	
  how	
   reverse	
   discourse	
   would	
   be	
   perceived.	
   For	
   example,	
   for	
   a	
   youth	
   who	
   is	
   unfamiliar	
   with	
  contemporary	
  lingo,	
  slang,	
  or	
  idioms	
  associated	
  with	
  sexual	
  health	
  topics,	
  the	
   more	
  nuanced	
  aspects	
  of	
  this	
  language	
  could	
  be	
  ‘lost’	
  in	
  an	
  online	
  context	
  that	
  used	
   frequent	
  examples	
  of	
  reverse	
  discourse	
  and/or	
  employed	
  slang	
  or	
  colloquialisms.	
  As	
   one	
  woman,	
  Ramona,	
  explained:	
  	
   	
   You	
  need	
  to	
  be	
  fluent	
  in	
  English,	
  and	
  kind	
  of	
  be	
  born	
  in	
  the	
  Western	
  world	
   to	
   understand	
   that.	
   And	
   I	
   think	
   that	
   a	
   lot	
   of	
   my	
   immigrant	
   friends	
   would	
   not.	
   	
   2.3.4	
  Reinforcing	
  stigma	
   Many	
   youth	
   reacted	
   negatively	
   to	
   seeing	
   youth	
   sexual	
   behavior	
   presented	
   in	
   what	
   they	
   perceived	
   to	
   be	
   a	
   callous	
   or	
   crude	
   manner,	
   and	
   tended	
   to	
   have	
   negative	
   associations	
   with	
   such	
   depictions.	
   For	
   example,	
   upon	
   reviewing	
   website	
   content	
   that	
  discussed	
  the	
  implications	
  of	
  casual	
  sex,	
  using	
  the	
  colloquial	
  terms	
  ‘fuck	
  buddy’,	
   one	
   youth,	
   Jane,	
   told	
   us:	
   “It’s	
   so	
   offensive.	
   I	
   think	
   it’s	
   like	
   you’re	
   just	
   a	
   ‘fuck	
   buddy’,	
    	
    	
    25	
  	
    you’re	
  nothing	
  else	
  to	
  that	
  person.	
  There	
  are	
  so	
  many	
  other	
  ways	
  you	
  could	
  describe	
   it.”	
  	
   	
   Some	
  participants	
  expressed	
  that	
  casual	
  depictions	
  of	
  youth	
  sexual	
  behavior	
  do	
  not	
   align	
   with	
   their	
   own	
   personal	
   conceptualization	
   of	
   sex.	
   In	
   response	
   to	
   one	
   website’s	
   references	
   to	
   ‘recreational	
   sex’,	
   Olivia	
   explained	
   that:	
   “It’s	
   not	
   a	
   good	
   message	
   [to	
   send].	
   It’s	
   more	
   serious.	
   You	
   shouldn’t	
   be	
   viewing	
   it	
   this	
   way.”	
   Many	
   other	
   youth	
   agreed	
   that,	
   to	
   them,	
   sex	
   was	
   a	
   serious	
   topic,	
   and	
   deserved	
   to	
   be	
   discussed	
   in	
   a	
   respectful	
  way.	
  One	
  young	
  man,	
  Trevor,	
  told	
  us:	
  “I	
  don't	
  think	
  [these	
  terms]	
  should	
  be	
   included	
   in	
   a	
   site	
   talking	
   about	
   something	
   so	
   serious.	
   It’s	
   funny,	
   now,	
   to	
   talk	
   about	
   these	
  sites	
  [in	
  this	
  interview],	
  but	
  like,	
  if	
  you	
  were	
  actually	
  looking	
  for	
  information…’”	
  	
   	
   Some	
  youth	
  commented	
  that	
  rather	
  than	
  dispelling	
  the	
  stigma	
  associated	
  with	
  youth	
   sexual	
   behavior,	
   the	
   use	
   of	
   reverse	
   discourse	
   had	
   the	
   potential	
   to	
   exacerbate	
   conceptions	
  of	
  youth	
  sexual	
  behavior	
  as	
  inherently	
  risky	
  or	
  immoral.	
  	
  Enactments	
  of	
   reverse	
   discourse	
   that	
   endeavor	
   to	
   dispel	
   shame	
   associated	
   with	
   stigmatized	
   concepts	
   sometimes	
   invoked	
   a	
   boomerang	
   effect,	
   serving	
   to	
   re-­‐stigmatise	
   youth	
   sexual	
  behaviour.	
  For	
  example,	
  one	
  young	
  woman,	
  Aimee,	
  told	
  us:	
   	
   I	
   don’t	
   think	
   I’d	
   respond	
   very	
   well	
   to	
   that.	
   Well,	
   the	
   vulgarity	
   almost	
   …[pause]	
  reinforces	
  shame	
  […]	
  If	
  I	
  got	
  that	
  information,	
  I	
  think	
  I	
  would	
  feel	
   more	
  awkward.	
   	
    	
    	
    26	
  	
    2.3.5	
  Potential	
  benefits	
  	
   A	
   few	
   youth	
   in	
   the	
   study,	
   especially	
   youth	
   who	
   described	
   themselves	
   as	
   relatively	
   well	
   informed	
   and	
   comfortable	
   with	
   sexual	
   health	
   topics,	
   acknowledged	
   the	
   potential	
  role	
  and	
  benefit	
  of	
  reverse	
  discourse	
  in	
  online	
  sexual	
  health	
  resources.	
  	
  For	
   these	
   youth,	
   reverse	
   discourse	
   offered	
   safe	
   spaces	
   within	
   which	
   to	
   explore	
   sexual	
   health	
   topics,	
   with	
   a	
   sex-­‐positive	
   agenda	
   and	
   a	
   non-­‐judgmental	
   approach.	
   As	
   one	
   young	
  woman,	
  Lira,	
  explained:	
   	
   To	
  me,	
  it	
  sounds	
  like	
  someone	
  is	
  actually	
  interested	
  in	
  and	
  passionate	
  about	
   the	
  topic	
  of	
  sexual	
  health	
  and	
  wants	
  to	
  convey	
  that	
  to	
  people	
  reading	
  it.	
  	
   	
   While	
   these	
   youth	
   were	
   amenable	
   to	
   the	
   use	
   of	
   reverse	
   discourse	
   in	
   sexual	
   health	
   promotion,	
   they	
   often	
   recognized	
   that	
   this	
   might	
   not	
   work	
   well	
   for	
   all	
   youth.	
   For	
   example,	
   when	
   asked	
   about	
   seeing	
   more	
   explicit	
   content	
   on	
   a	
   website,	
   Daniel	
   told	
   us:	
   	
   “Personally	
   I	
   don’t	
   mind,	
   but	
   I	
   know	
   some	
   people	
   that	
   would.”	
   During	
   a	
   focus	
   group,	
   one	
   youth	
   pointed	
   out	
   that	
   as	
   a	
   relatively	
   empowered	
   and	
   privileged	
   university	
   student	
   he	
   felt	
   receptive	
   to	
   enactments	
   of	
   reverse	
   discourse,	
   but	
   that	
   other	
   youth	
   may	
   be	
   differentially	
   positioned	
   in	
   terms	
   of	
   their	
   willingness	
   and	
   capacity	
  to	
  uptake	
  information	
  presented	
  in	
  this	
  way.	
  For	
  example,	
  one	
  young	
  man,	
   Trevor,	
   explained	
   that	
   while	
   the	
   use	
   of	
   reverse	
   discourse	
   may	
   be	
   effective	
   for	
   youth	
   who	
  occupy	
  social	
  positions	
  that	
  allow	
  them	
  to	
  be	
  receptive	
  to	
  this	
  strategy,	
  it	
  may	
   inadvertently	
  create	
  barriers	
  to	
  access	
  for	
  other	
  youth.	
  He	
  acknowledged	
  that,	
  as	
  a	
   university	
   student,	
   he	
   was	
   likely	
   to	
   have	
   been	
   exposed	
   to	
   a	
   wide	
   variety	
   of	
   sexual	
    	
    	
    27	
  	
    health	
   information,	
   and	
   thus	
   was	
   more	
   likely	
   to	
   be	
   receptive	
   to	
   reverse	
   discourse	
   approaches.	
  However,	
  he	
  questioned:	
  	
  “What	
  about	
  for	
  a	
  group	
  that	
  don't	
  know	
  any	
   information.	
  	
  	
  Like	
  we	
  probably	
  know	
  a	
  larger	
  chunk	
  than	
  a	
  lot	
  of	
  kids	
  who	
  don't	
  go	
  to	
   university,	
  and	
  haven't	
  graduated	
  high	
  school.”	
  	
  As	
   Trevor	
   suggested,	
   for	
   these	
   youth,	
   enactments	
  of	
  reverse	
  discourse	
  would	
  likely	
  be	
  less	
  accessible.	
   	
   2.4	
  Discussion	
   	
   These	
  findings	
  reveal	
  how,	
  despite	
  the	
  best	
  intentions,	
  the	
  use	
  of	
  reverse	
  discourse	
   can	
  have	
  undesired	
  and	
  unpredicted	
  effects	
  on	
  youth’s	
  perceptions	
  of	
  online	
  sexual	
   health	
   promotion	
   efforts.	
   While,	
   for	
   some	
   youth,	
   enactments	
   of	
   reverse	
   discourse	
   can	
   have	
   neutral	
   or	
   even	
   positive	
   effects	
   on	
   their	
   experiences	
   with	
   web-­‐based	
   sexual	
   health	
   resources	
   (e.g.,	
   by	
   conveying	
   an	
   engaged	
   tone	
   to	
   the	
   reader),	
   these	
   approaches	
   did	
   not	
   resonate	
   with	
   many	
   of	
   the	
   participants.	
   In	
   fact,	
   often	
   the	
   opposite	
  effect	
  was	
  achieved	
  –	
  many	
  youth	
  perceived	
  these	
  approaches	
  as	
  artificial	
   and/or	
  exaggerated	
  representations	
  of	
  youth’s	
  own	
  discourses	
  pertaining	
  to	
  sexual	
   health.	
  Reverse	
  discourse	
  also	
  was	
  perceived	
  to	
  have	
  negative	
  effects	
  on	
  the	
  saliency	
   and	
   credibility	
   of	
   online	
   sexual	
   health	
   information.	
   Young	
   people	
   in	
   this	
   study	
   suggested	
   that	
   negative	
   social	
   mores	
   were	
   associated	
   with	
   explicit	
   portrayals	
   of	
   young	
   people’s	
   sexual	
   lives	
   on	
   the	
   websites,	
   revealing	
   how	
   reverse	
   discourse	
   potentially	
   re-­‐stigmatizes	
   youth	
   by	
   re-­‐emphasizing	
   youth	
   sexual	
   activity	
   as	
   inherently	
   risky	
   or	
   immoral.	
   This	
   research	
   illuminates	
   the	
   importance	
   of	
    	
    	
    28	
  	
    considering	
  these	
  and	
  other	
  socio-­‐technical	
  aspects	
  of	
  Internet-­‐based	
  sexual	
  health	
   interventions.	
   	
   Health	
   promotion	
   efforts	
   should	
   be	
   informed	
   by	
   both	
   evidence	
   and	
   theory	
   (Barak,	
   2003;	
   Barak	
   &	
   Fisher,	
   2001;	
   Crosby	
   &	
   Noar,	
   2010;	
   Green,	
   2000).	
   However,	
   the	
   theoretical	
  and	
  empirical	
  foundations	
  underpinning	
  the	
  use	
  of	
  reverse	
  discourse	
  in	
   online	
  sexual	
  health	
  promotion	
  are	
  unclear.	
  Some	
  ways	
  in	
  which	
  reverse	
  discourse	
   has	
   been	
   employed	
   within	
   sexual	
   health	
   promotion	
   interventions	
   include	
   peer-­‐ delivered	
  information	
  that	
  aims	
  to	
  be	
  relatable	
  to	
  youth,	
  use	
  their	
  own	
  language	
  and	
   break	
   down	
   communication	
   barriers	
   about	
   a	
   stigmatized	
   topic.	
   While	
   these	
   approaches	
   have	
   been	
   enthusiastically	
   promoted	
   (World	
   Health	
   Organization,	
   1991)	
  and	
  are	
  informed	
  by	
  behavioural	
  theories	
  (e.g.,	
  Social	
  Learning	
  Theory),	
  the	
   evidence	
   for	
   their	
   effectiveness	
   remains	
   inconclusive	
   (Harden	
   et	
   al.,	
   2001;	
   Turner,	
   1999).	
  	
   	
   It	
   is	
   also	
   worth	
   examining	
   the	
   use	
   of	
   reverse	
   discourse	
   in	
   this	
   area	
   from	
   a	
   Foucaultian	
   perspective.	
   While	
   the	
   adoption	
   of	
   such	
   an	
   approach	
   is	
   an	
   attempt	
   to	
   operationalize	
   a	
   reverse	
   discourse,	
   ultimately,	
   these	
   are	
   the	
   strategies	
   used	
   by	
   intervention	
  planners	
  to	
  achieve	
  public	
  health	
  goals	
  (e.g.,	
  decreasing	
  the	
  spread	
  of	
   sexually	
   transmitted	
   infections;	
   lowering	
   teen	
   pregnancy	
   rates).	
   Reverse	
   discourses	
   are	
  intended	
  to	
  contest	
  dominant	
  notions	
  of	
  what/who	
  is	
  compliant	
  and	
  what/who	
   is	
  rebellious,	
  wherein	
  existing	
  power	
  structures	
  are	
  contested.	
  However,	
  rather	
  than	
   being	
   subversive	
   in	
   nature,	
   these	
   strategies	
   may	
   not	
   reflect	
   youth	
   sexual	
    	
    	
    29	
  	
    empowerment	
   beginning	
   to	
   ‘speak	
   for	
   itself’,	
   nor	
   a	
   youth	
   sexuality	
   demanding	
   the	
   legitimation	
   of	
   its	
   own	
   ‘naturality’,	
   as	
   described	
   by	
   Foucault	
   (1978).	
   Shoveller	
   and	
   Johnson	
   (2006)	
   describe	
   the	
   shift	
   from	
   adult-­‐	
   to	
   peer-­‐led	
   models	
   of	
   sexual	
   health	
   education	
  over	
  the	
  past	
  two	
  decades,	
  and	
  argue	
  that	
  the	
  adoption	
  of	
  young	
  people	
  as	
   the	
  ‘voices’	
  advocating	
  for	
  ‘safe	
  choices’	
  constitutes	
  a	
  perpetuation	
  of	
  the	
  sex-­‐as-­‐risk	
   discourse	
  of	
  adult	
  ‘experts’,	
  rather	
  than	
  an	
  empowering	
  experience.	
   	
   Furthermore,	
  by	
  consistently	
  juxtaposing	
  enactments	
  (or	
  rather,	
  interpretations)	
  of	
   youth	
  culture	
  with	
  traditional	
  risk	
  discourse,	
  it	
  serves	
  to	
  re-­‐stigmatize	
  youth	
  sexual	
   behaviour	
   as	
   inherently	
   ‘risky’	
   (Fortenberry,	
   2003).	
   Stigma	
   is	
   a	
   socially	
   constructed	
   concept,	
   and	
   according	
   to	
   Goffman’s	
   foundational	
   work	
   on	
   the	
   subject,	
   can	
   be	
   associated	
   with	
   physical	
   attributes	
   (e.g.,	
   a	
   sexually	
   transmitted	
   infection),	
   moral	
   attributes	
  (e.g.,	
  engaging	
  in	
  risky	
  behaviour),	
  or	
  ‘tribal’	
  affiliation	
  (Goffman,	
  1986).	
   Nack	
   extends	
   this	
   concept	
   of	
   ‘tribe’	
   beyond	
   familial/ethnic	
   associations	
   in	
   the	
   context	
   of	
   sexual	
   behaviour	
   norms	
   attributed	
   to	
   a	
   particular	
   group	
   (Nack,	
   2002).	
  	
   Youth	
   represent	
   a	
   socially	
   distinct	
   group,	
   and	
   youth’s	
   understanding	
   of	
   their	
   identities	
  as	
  sexual	
  beings	
  is	
  informed	
  by	
  many	
  of	
  the	
  morals	
  that	
  are	
  entrenched	
  in	
   negative	
   social	
   constructs	
   of	
   youth	
   sexuality	
   (e.g.,	
   stigmatization	
   of	
   certain	
   sexual	
   behaviours	
  as	
  ‘risky’	
  or	
  immoral).	
  Normative	
  conceptions	
  of	
  young	
  people’s	
  sexual	
   behaviour	
  shape	
  youth’s	
  views	
  of	
  the	
  ‘tribe’	
  of	
  sexually	
  active	
  youth	
  to	
  which	
  they	
   belong	
   (or	
   will	
   belong),	
   and	
   some	
   approaches	
   may	
   risk	
   exacerbating	
   stigma	
   associated	
  with	
  youth	
  (especially	
  those	
  who	
  are	
  sexually	
  active).	
  	
  	
   	
    	
    	
    30	
  	
    Greaves	
  et	
  al	
  (2010)	
  describes	
  the	
  “internalized	
  stigma”	
  resulting	
  from	
  “developed	
   processes	
   of	
   self-­‐stigmatisation	
   and	
   secondary	
   deviant	
   identities”	
   (p.	
   527).	
   Often,	
   the	
  context	
  that	
  would	
  inspire	
  a	
  young	
  man	
  or	
  woman	
  to	
  seek	
  online	
  sexual	
  health	
   services	
   might	
   already	
   render	
   likely	
   the	
   harbouring	
   of	
   some	
   internalized	
   stigma	
   (e.g.,	
   about	
   behaviour	
   they	
   suspect	
   may	
   be	
   ‘risky’).	
   Youth	
   experiencing	
   anxiety	
   related	
   to	
   prior	
   sexual	
   behaviour	
   who	
   encounter	
   reverse	
   discourse	
   in	
   web-­‐based	
   sexual	
   health	
   resources	
   may	
   interpret	
   it	
   as	
   a	
   reification	
   of	
   their	
   suspicions.	
   In	
   this	
   regard,	
   enactments	
   of	
   reverse	
   discourse	
   potentially	
   serve	
   to	
   augment	
   internalized	
   stigma	
   (that	
   a	
   youth	
   may	
   already	
   be	
   experiencing).	
   For	
   many	
   youth,	
   stigma	
   (both	
   internal	
   and	
   external)	
   represents	
   a	
   significant	
   barrier	
   to	
   accessing	
   conventional	
   sexual	
  health	
  services	
  and	
  information	
  (Fortenberry	
  et	
  al.,	
  2002;	
  Lichtenstein,	
  2003;	
   Lichtenstein	
  &	
  Bachmann,	
  2005;	
  Rusch	
  et	
  al.,	
  2008;	
  Shoveller	
  et	
  al.,	
  2009).	
  Thus,	
  it	
  is	
   imperative	
   that	
   novel,	
   online	
   approaches	
   attend	
   to	
   and	
   avoid	
   possible	
   sources	
   of	
   stigma	
  within	
  web-­‐based	
  interventions.	
   	
   Furthermore,	
  by	
  framing	
  youth	
  sexuality	
  in	
  this	
  way,	
  health	
  promotion	
  efforts	
  risk	
   oversimplifying	
   youth’s	
   sexual	
   behaviour/experiences	
   –	
   a	
   complex,	
   multifaceted	
   aspect	
   of	
   young	
   people’s	
   lives.	
   Schalet	
   (2004)	
   describes	
   the	
   ‘dramatization	
   of	
   adolescent	
  sexuality’,	
  highlighting	
  internal	
  conflicts	
  between	
  ‘impulse	
  and	
  cognition’	
   –	
  two	
  paradigms	
  that	
  ‘limit	
  us	
  in	
  our	
  ability	
  to	
  conceptualize	
  and	
  promote’	
  positive	
   adolescent	
   sexuality.	
   Conventional	
   social	
   norms	
   reinforce	
   these	
   as	
   contradictory	
   states	
  –	
  sexually,	
  young	
  people	
  are	
  either	
  informed	
  and	
  ‘in-­‐control’,	
  or	
  uninformed	
   and	
  ‘risky’	
  (Shoveller	
  &	
  Johnson,	
  2006).	
  	
  Both	
  paradigms	
  equate	
  sex	
  with	
  risk,	
  and	
    	
    	
    31	
  	
    assume	
  that	
  the	
  best	
  way	
  to	
  promote	
  healthy	
  sexuality	
  among	
  youth	
  is	
  by	
  stressing	
   its	
   inherent	
   risks	
   (Schalet,	
   2011).	
   In	
   some	
   ways,	
   the	
   use	
   of	
   reverse	
   discourse	
   in	
   online	
   sexual	
   health	
   promotion	
   may	
   unintentionally	
   re-­‐emphasize	
   this	
   dichotomy	
   (e.g.,	
  by	
  consistent	
  ‘representations’	
  of	
  youth	
  sexual	
  culture	
  in	
  the	
  context	
  of	
  risk).	
   Instead,	
   efforts	
   should	
   focus	
   on	
   sharing	
   important	
   information	
   with	
   youth	
   pertaining	
   to	
   their	
   sexual	
   health	
   without	
   buttressing	
   this	
   misleading,	
   reductionist	
   perspective.	
   	
   There	
   are	
   several	
   limitations	
   to	
   the	
   findings	
   described	
   in	
   this	
   chapter.	
   As	
   a	
   researcher,	
   my	
   interpretation	
   of	
   reverse	
   discourse	
   is	
   based	
   on	
   a	
   theoretical	
   sensitivity	
   to	
   the	
   concept,	
   one	
   with	
   which	
   the	
   youth	
   in	
   this	
   study	
   were	
   not	
   (presumably)	
   familiar.	
   Thus,	
   examples	
   of	
   reverse	
   discourse	
   (according	
   to	
   the	
   aforementioned	
   lens)	
   were	
   offered,	
   as	
   well	
   as	
   other	
   text	
   and	
   images,	
   allowing	
   participants	
  to	
  draw	
  on	
  their	
  own	
  understandings	
  and	
  reactions,	
  without	
  imposing	
   the	
   interviewer’s	
   own	
   perceptions	
   on	
   the	
   discussions.	
   In	
   addition,	
   the	
   sample	
   was	
   composed	
   of	
   youth	
   who	
   volunteered	
   to	
   participate	
   in	
   a	
   research	
   study	
   about	
   sexual	
   health,	
   and	
   thus	
   were	
   likely	
   to	
   have	
   a	
   moderate-­‐to-­‐high	
   comfort	
   level	
   with	
   such	
   topics	
   (which	
   provides	
   an	
   interesting	
   juxtaposition	
   to	
   the	
   largely	
   negative	
   reactions	
   to	
   the	
   use	
   of	
   reverse	
   discourse).	
   In	
   fact,	
   in	
   many	
   ways,	
   youth’s	
   (often	
   strong)	
   reactions	
  to	
  online	
  representations	
  of	
  reverse	
  discourse	
  were	
  surprising,	
  given	
  the	
   strong	
  theoretical	
  basis	
  for	
  informal,	
  peer-­‐‘voiced’	
  approaches.	
  Rather	
  than	
  lending	
   credence,	
   and/or	
   contesting	
   contemporary	
   conceptualizations	
   regarding	
   youth	
   sexuality,	
   web-­‐based	
   enactments	
   of	
   reverse	
   discourse	
   within	
   sexual	
   health	
    	
    	
    32	
  	
    resources	
   had	
   several	
   unintended,	
   negative	
   effects.	
   While	
   these	
   findings	
   are	
   not	
   meant	
  to	
  be	
  generalizable	
  to	
  all	
  youth,	
  or	
  all	
  online	
  interventions,	
  they	
  represent	
  a	
   starting	
   point	
   from	
   which	
   to	
   examine,	
   question,	
   and	
   perhaps	
   reassess	
   the	
   use	
   of	
   reverse	
  discourse	
  in	
  promoting	
  sexual	
  health	
  to	
  youth	
  online.	
   	
    	
    	
    	
    33	
  	
    Chapter	
  3.0	
  Interrogating	
  gendered	
  stereotypes:	
  young	
  people’s	
   descriptions	
  of	
  online	
  sexual	
  health	
  approaches2	
   3.1	
  Introduction	
   3.1.1	
  Background	
  	
   In	
  Canada,	
  and	
  in	
  many	
  Western,	
  high-­‐income	
  countries,	
  STIs	
  (including	
  chlamydia	
   and	
   gonorrhea)	
   disproportionately	
   affect	
   youth,	
   with	
   rates	
   that	
   are	
   high	
   and	
   climbing	
   sharply	
   (Division	
   of	
   STD	
   Prevention,	
   2011;	
   HPA,	
   2008;	
   PHAC,	
   2010a;	
   2010b).	
   Unfortunately,	
   significant	
   knowledge	
   gaps	
   remain	
   with	
   respect	
   to	
   sexual	
   health	
  for	
  many	
  youth	
  in	
  Canada	
  (White	
  et	
  al.,	
  2007),	
  and	
  youth	
  engagement	
  in	
  STI	
   testing	
   remains	
   a	
   public	
   health	
   challenge	
   (CATIE,	
   2011;	
   2011;	
   Mill	
   et	
   al.,	
   2008;	
   Moses	
   &	
   Elliott,	
   2002).	
   	
   With	
   this	
   in	
   mind,	
   novel	
   intervention	
   strategies	
   are	
   harnessing	
   the	
   capacity	
   of	
   the	
   Internet	
   to	
   reach	
   populations	
   at	
   risk	
   of	
   poor	
   sexual	
   health	
  outcomes.	
  	
   	
   Many	
   young	
   people	
   report	
   using	
   Internet	
   in	
   their	
   quest	
   for	
   sexual	
   health	
   (e.g.,	
   searching	
  online	
  for	
  STI	
  testing	
  options;	
  finding	
  information	
  on	
  safe	
  sex	
  practices)	
   (Borzekowski	
  &	
  Rickert,	
  2001;	
  Hesse	
  et	
  al.,	
  2005;	
  Jones,	
  2011;	
  Jones	
  &	
  Biddlecom,	
   2011).	
   Compared	
   to	
   conventional,	
   in-­‐person	
   approaches,	
   web-­‐based	
   sexual	
   health	
   education	
   and	
   services	
   are	
   new	
   in	
   Canada.	
   As	
   such,	
   comparatively	
   little	
   research	
   attention	
   has	
   been	
   paid	
   to	
   this	
   emerging	
   field.	
   Furthermore,	
   health	
   information-­‐ seeking	
   is	
   a	
   complex	
   process,	
   wherein	
   youth	
   rely	
   upon	
   a	
   wide	
   range	
   of	
   online	
   	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
   2	
  A version of this chapter is under review for publication. Davis,	
  W.,	
  Shoveller,	
  J.A.,	
   Oliffe,	
  J.L.,	
  &	
  Gilbert,	
  M.	
  Interrogating	
  gendered	
  stereotypes:	
  Young	
  people’s	
   descriptions	
  of	
  online	
  sexual	
  health	
  approaches.	
  Submitted	
  February	
  2012.	
   	
    	
    34	
  	
    sources	
   and	
   operationalize	
   a	
   unique	
   set	
   of	
   practices	
   for	
   identifying	
   salient,	
   credible,	
   and	
   high	
   quality	
   information	
   and	
   services	
   (Adams	
   et	
   al.,	
   2006;	
   Borzekowski	
   &	
   Rickert,	
  2001;	
  Eysenbach	
  &	
  Köhler,	
  2002;	
  Gray	
  et	
  al.,	
  2005;	
  Hu,	
  2010;	
  Jones,	
  2011;	
   Jones	
   &	
   Biddlecom,	
   2011).	
   Some	
   research	
   has	
   begun	
   to	
   explore	
   more	
   nuanced	
   aspects	
  of	
  web-­‐based	
  sexual	
  health	
  service	
  utilization	
  (Gray,	
  Klein,	
  Cantrill,	
  &	
  Noyce,	
   2002;	
  Jones	
  &	
  Biddlecom,	
  2011).	
  	
  	
   	
   3.1.2	
  Gender	
  and	
  online	
  health	
  activities	
   In	
   terms	
   of	
   frequency	
   of	
   Internet	
   use,	
   young	
   men	
   and	
   women	
   are	
   now	
   generally	
   thought	
   to	
   ‘log-­‐on’	
   with	
   similar	
   regularity	
   (Brodie,	
   Flournoy,	
   Altman,	
   &	
   Blendon,	
   2000;	
   Fallows,	
   2005;	
   Helsper,	
   2010).	
   However,	
   women	
   and	
   men	
   visit	
   different	
   websites	
  when	
  they	
  are	
  online	
  and	
  communicate	
  in	
  different	
  ways	
  while	
  on	
  the	
  web	
   (Seale	
   et	
   al.,	
   2006;	
   Wasserman	
   &	
   Richmond-­‐Abbott,	
   2005).	
   For	
   example,	
   there	
   is	
   some	
   evidence	
   that	
   when	
   using	
   the	
   Internet,	
   women	
   are	
   somewhat	
   more	
   motivated	
   by	
   interpersonal	
   communication,	
   while	
   men	
   tend	
   to	
   be	
   more	
   information-­‐driven	
   (Jackson,	
  Ervin,	
  &	
  Gardner,	
  2001).	
  Some	
  research	
  has	
  shown	
  that	
  women	
  are	
  more	
   frequent	
   users	
   of	
   the	
   Internet	
   for	
   health	
   information	
   than	
   men	
   (Baker,	
   Wagner,	
   Singer,	
  &	
  Bundorf,	
  2003;	
  Brodie	
  et	
  al.,	
  2000;	
  Escoffery	
  et	
  al.,	
  2005),	
  although	
  there	
  is	
   conflicting	
   evidence	
   on	
   this	
   (Hanauer,	
   Dibble,	
   &	
   Fortin,	
   2004).	
   In	
   fact,	
   a	
   large,	
   nationally	
   representative	
   longitudinal	
   study	
   of	
   Americans	
   12+	
   years	
   of	
   age	
   found	
   that	
  men	
  and	
  women	
  used	
  the	
  Internet	
  to	
  address	
  a	
  health	
  problem	
  for	
  oneself	
  (or,	
   for	
  a	
  loved	
  one)	
  with	
  similar	
  regularity	
  (Ybarra	
  &	
  Suman,	
  2008).	
  	
  	
   	
   	
    	
    35	
  	
    When	
  they	
  are	
  online,	
  women	
  are	
  more	
  likely	
  than	
  men	
  to	
  focus	
  on	
  a	
  specific	
  illness	
   or	
   its	
   symptoms,	
   while	
   men	
   tend	
   to	
   focus	
   on	
   disease	
   prognosis	
   and	
   treatment	
   (Johnson,	
   Oliffe,	
   Kelly,	
   Galdas,	
   &	
   Ogrodniczuk,	
   2011;	
   Knight	
   et	
   al.,	
   in	
   press;	
   Rainie,	
   2002).	
   Compared	
   to	
   women,	
   men	
   appear	
   to	
   be	
   less	
   concerned	
   with	
   the	
   perceived	
   credibility	
   of	
   online	
   health	
   information	
   (Robertson,	
   2007).	
   Women	
   report	
   more	
   effort	
   required	
   to	
   find	
   the	
   health	
   information	
   they	
   are	
   seeking,	
   while	
   men	
   report	
   more	
   positive	
   online	
   health	
   seeking	
   experiences	
   (e.g.,	
   higher	
   satisfaction	
   with	
   the	
   information	
  they	
  locate;	
  greater	
  ease	
  in	
  locating	
  it)	
   (Addis	
  &	
  Mahalik,	
  2003;	
  Barker,	
   Ricardo,	
  Nascimento,	
  Olukoya,	
  &	
  Santos,	
  2010;	
  Lee	
  &	
  Owens,	
  2002;	
  O'Brien	
  &	
  Hunt,	
   2005;	
   Oliffe	
   et	
   al.,	
   in	
   press;	
   Robertson,	
   2007;	
   Shephard,	
   1996;	
   Shoveller	
   et	
   al.,	
   2010;	
   Ybarra	
   &	
   Suman,	
   2008).	
   The	
   potentially	
   moderating	
   influence	
   of	
   gender	
   on	
   online	
   health	
   information-­‐seeking	
   behaviour	
   (e.g.,	
   differing	
   attitudes	
   towards	
   using	
   the	
   web	
   for	
   this	
   purpose)	
   are	
   only	
   beginning	
   to	
   be	
   explored	
   (Ilie,	
   Van	
   Slyke,	
   &	
   Green,	
   2005;	
  Mo,	
  Malik,	
  &	
  Coulson,	
  2009).	
  	
  	
   	
   3.1.3	
  Gendered	
  stereotypes	
  and	
  sexual	
  health	
  practices	
   Socio-­‐cultural	
   factors	
   (e.g.,	
   perceptions	
   of	
   masculinities	
   and	
   femininities)	
   exert	
   considerable	
   influence	
   on	
   young	
   people’s	
   health	
   behaviours	
   (e.g.,	
   accessing	
   health	
   care)(Barker,	
   Ricardo,	
   Nascimento,	
   Olukoya,	
   &	
   Santos,	
   2010;	
   Johnson	
   et	
   al.,	
   2011;	
   Lee	
  &	
  Owens,	
  2002;	
  Oliffe,	
  Kelly,	
  Bottorff,	
  Johnson,	
  &	
  Wong,	
  2011;	
  Tolman,	
  Striepe,	
   &	
  Harmon,	
  2003).	
  A	
  emerging	
  body	
  of	
  work	
  seeks	
  to	
  understand	
  the	
  relationships	
   between	
  young	
  people’s	
  gender,	
  identity,	
  and	
  social	
  context	
  (Popay,	
  2000),	
  and	
  how	
   these	
   factors	
   intersect	
   with	
   gendered	
   stereotypes	
   to	
   shape	
   experiences	
   with	
   	
    	
    36	
  	
    conventional	
   sexual	
   health	
   services	
   (Goldenberg,	
   Shoveller,	
   Ostry,	
   &	
   Koehoorn,	
   2008a;	
   Shoveller	
   et	
   al.,	
   2009;	
   Shoveller	
   et	
   al.,	
   2010).	
   Within	
   staff-­‐client	
   interactions,	
   gender	
   stereotyping	
   is	
   a	
   salient	
   issue	
   for	
   many	
   youth	
   in	
   sexual	
   health	
   contexts	
   (Lichtenstein	
  &	
  Bachmann,	
  2005;	
  Shoveller	
  et	
  al.,	
  2009).	
  	
   	
   For	
  example,	
  pervasive	
  social	
  norms	
  that	
  place	
  high	
  value	
  on	
  young	
  women’s	
  sexual	
   ‘morality’	
   (e.g.,	
   limiting	
   their	
   number	
   of	
   sexual	
   partners;	
   staying	
   ‘clean’)	
   may	
   lead	
   women	
  to	
  fear	
  being	
  labeled	
  negatively	
  for	
  testing	
  positive	
  for	
  an	
  STI	
  (East,	
  Jackson,	
   O’Brien,	
   &	
   Peters,	
   2011;	
   Goldenberg,	
   Shoveller,	
   Koehoorn,	
   &	
   Ostry,	
   2008b;	
   Nwokolo	
   et	
  al.,	
  2002;	
  Shafer	
  et	
  al.,	
  2002).	
  In	
  fact,	
  some	
  women	
  cite	
  fear	
  of	
  stigma	
  from	
  peers	
   or	
   health	
   care	
   provider	
   (e.g.,	
   being	
   labeled	
   as	
   promiscuous	
   or	
   ‘unladylike’)	
   as	
   a	
   reason	
   to	
   avoid	
   testing	
   (Goldenberg,	
   Shoveller,	
   Ostry,	
   &	
   Koehoorn,	
   2008a;	
   Lichtenstein,	
   2003;	
   Shoveller	
   et	
   al.,	
   2009;	
   Shoveller	
   et	
   al.,	
   2010),	
   while	
   other	
   cite	
   fear	
   or	
   blame	
   from	
   their	
   partner(s)	
   or	
   family	
   	
   (Lichtenstein	
   &	
   Bachmann,	
   2005;	
   Sheahan	
  et	
  al.,	
  1994;	
  Shoveller	
  et	
  al.,	
  2009).	
  Dominant	
  ideals	
  of	
  masculinity	
  (i.e.,	
  self-­‐ reliance;	
   physical	
   toughness)	
   conflict	
   with	
   many	
   requirements	
   of	
   health	
   care-­‐ seeking	
   (e.g.,	
   admitting	
   the	
   need	
   for	
   help),	
   effectively	
   discouraging	
   men’s	
   use	
   of	
   health	
   care	
   services	
   (Addis	
   &	
   Mahalik,	
   2003;	
   Courtenay,	
   2004;	
   East	
   et	
   al.,	
   2011;	
   Goldenberg,	
  Shoveller,	
  Koehoorn,	
  &	
  Ostry,	
  2008b;	
  Lee	
  &	
  Owens,	
  2002;	
  Nwokolo	
  et	
   al.,	
  2002;	
  Robertson,	
  2007;	
  Shafer	
  et	
  al.,	
  2002).	
  For	
  example,	
  despite	
  targeted	
  sexual	
   health	
   promotion	
   efforts,	
   many	
   young	
   men	
   do	
   not	
   feel	
   they	
   have	
   permission	
   to	
   engage	
   in	
   discussions	
   about	
   sexual	
   health	
   concerns	
   with	
   male	
   peers	
   or	
   service	
   providers	
   (Lichtenstein,	
   2003;	
   Shoveller	
   et	
   al.,	
   2010),	
   a	
   phenomenon	
   especially	
    	
    	
    37	
  	
    evident	
  among	
  men	
  who	
  align	
  with	
  ‘traditional’	
  beliefs	
  about	
  gender	
  roles	
  (Emmers-­‐ Sommer,	
   Nebel,	
   &	
   Allison,	
   2009;	
   Sheahan	
   et	
   al.,	
   1994).	
   Within	
   heterosexual	
   relationships,	
  women	
  are	
  often	
  the	
  primary	
  caretakers	
  of	
  sexual	
  health	
  (Darroch	
  et	
   al.,	
   2003;	
   Oliffe	
   et	
   al.,	
   in	
   press;	
   Shoveller	
   et	
   al.,	
   2010),	
   effectively	
   shaping	
   expectations	
   that	
   the	
   responsibility	
   for	
   safe-­‐sex	
   and	
   sexual	
   health	
   resides	
   with	
   women	
   partners	
   (e.g.,	
   advocating	
   for	
   condom	
   use;	
   procuring	
   oral	
   contraceptives;	
   accessing	
  STI	
  testing).	
  	
   	
   Overall,	
  this	
  creates	
  an	
  environment	
  that	
  exposes	
  young	
  people’s	
  experiences	
  with	
   sexual	
  health	
  services	
  to	
  the	
  stigmatizing	
  effects	
  of	
  gendered	
  stereotyping,	
  a	
  reality	
   that	
   potentially	
   is	
   extended	
   to	
   web-­‐based	
   services	
   (Emmers-­‐Sommer	
   et	
   al.,	
   2009;	
   Magee,	
  Bigelow,	
  DeHaan,	
  &	
  Mustanski,	
  2011;	
  Mo	
  et	
  al.,	
  2009;	
  Robinson	
  &	
  Robertson,	
   2010;	
  Thelwall,	
  Wilkinson,	
  &	
  Uppal,	
  2010).	
  This	
  chapter	
  uses	
  data	
  from	
  a	
  qualitative	
   study	
  with	
  32	
  young	
  men	
  and	
  women	
  (ages	
  15	
  to	
  24	
  years)	
  to	
  examine	
  a	
  group	
  of	
   young	
   people’s	
   descriptions	
   gendered	
   stereotypes	
   as	
   they	
   pertain	
   to	
   online	
   sexual	
   health	
  approaches.	
   	
   3.2	
  Methods	
   3.2.1	
  Recruitment	
   Young	
  people	
  (ages	
  15	
  to	
  24	
  years)	
  were	
  recruited	
  through	
  the	
  use	
  of	
  posters	
  (e.g.,	
   at	
  local	
  sexual	
  health	
  clinics;	
  at	
  community	
  colleges),	
  and	
  online	
  using	
  targeted	
  ads	
   (e.g.,	
   Craigslist;	
   Facebook).	
   	
   	
   A	
   purposive	
   sampling	
   strategy	
   was	
   utilized	
   to	
   recruit	
   participants	
  from	
  a	
  variety	
  of	
  ages	
  and	
  backgrounds	
  and	
  to	
  capture	
  a	
  diverse	
  set	
  of	
   	
    	
    38	
  	
    experiences.	
   Participant	
   demographics	
   were	
   reviewed	
   to	
   aid	
   recruitment	
   of	
   a	
   range	
   of	
  youth	
  from	
  diverse	
  social	
  locations.	
  For	
  example,	
  the	
  perspectives	
  of	
  youth	
  who	
   identified	
   as	
   lesbian,	
   gay,	
   bisexual,	
   and	
   transgendered	
   (LGBT)	
   were	
   solicited	
   by	
   recruiting	
   from	
   local	
   queer	
   youth	
   drop-­‐in	
   centres	
   and	
   LGBT	
   youth	
   list-­‐serves.	
   Recruitment	
   was	
   also	
   conducted	
   at	
   multicultural	
   community	
   centres,	
   youth	
   transition	
   houses,	
   and	
   drop-­‐in	
   services	
   for	
   street-­‐involved	
   or	
   at-­‐risk	
   youth.	
   Participants	
   were	
   English-­‐speaking	
   youth	
   (ages	
   15-­‐24)	
   who	
   lived	
   in	
   the	
   study	
   community	
  (Metro	
  Vancouver)	
  and	
  who	
  had	
  been	
  sexually	
  active	
  and	
  had	
  tested	
  (or	
   considered	
  being	
  tested)	
  for	
  STIs.	
  Eligibility	
  was	
  confirmed	
  by	
  phone	
  or	
  email,	
  and	
   participants	
  were	
  invited	
  to	
  participate	
  in	
  an	
  interview	
  (or	
  a	
  focus	
  group,	
  if	
  one	
  was	
   scheduled),	
  to	
  take	
  place	
  at	
  a	
  university	
  office.	
  The	
  study	
  received	
  approval	
  of	
  The	
   University	
  of	
  British	
  Columbia	
  Behavioural	
  Research	
  Ethics	
  Board.	
   	
   3.2.2	
  Data	
  collection	
   In-­‐depth,	
   individual	
   interviews	
   and	
   focus	
   groups	
   were	
   conducted	
   by	
   a	
   trained,	
   experienced	
   researcher,	
   and	
   took	
   1.5-­‐2	
   hours	
   to	
   complete;	
   youth	
   received	
   a	
   $25	
   honorarium	
  for	
  their	
  participation.	
  	
  Three	
  focus	
  groups	
  were	
  conducted:	
  one	
  men-­‐ only,	
  one	
  women-­‐only,	
  and	
  one	
  focus	
  group	
  with	
  both	
  men	
  and	
  women.	
  During	
  the	
   interviews	
   and	
   focus	
   groups,	
   participants	
   were	
   encouraged	
   to	
   draw	
   on	
   their	
   experiences,	
  where	
  possible	
  providing	
  details	
  about	
  specific	
  social	
  contexts	
  to	
  share	
   their	
  perspectives	
  (e.g.,	
  relationships	
  with	
  sexual	
  partners;	
  gendered	
  expectations	
  of	
   sexual	
   behaviour)	
   about	
   sexual	
   health-­‐seeking	
   behaviours,	
   including	
   the	
   use	
   of	
   online	
  resources.	
  Internet-­‐based	
  STI	
  testing,	
  and	
  web-­‐based	
  sexual	
  health	
  education	
   	
    	
    39	
  	
    and	
   counseling	
   were	
   discussed	
   with	
   participants,	
   who	
   were	
   asked	
   to	
   consider	
   a	
   range	
   of	
   services	
   when	
   sharing	
   their	
   perspectives.	
   Midway	
   through	
   the	
   interview,	
   youth	
  browsed	
  and	
  reviewed	
  four	
  sexual	
  health	
  websites,	
  including	
  local,	
  national,	
   and	
  international	
  resources.	
  The	
  four	
  websites	
  stdresource.com;	
  sexualityandu.ca3;	
   optionsforsexualhealth.org;	
  and	
  scarleteen.com	
  were	
  selected	
  to	
  solicit	
  participants	
   opinions	
   about	
   a	
   range	
   of	
   styles	
   and	
   approaches,	
   while	
   not	
   overwhelming	
   youth	
   with	
  too	
  many	
  sites	
  within	
  the	
  time	
  frame	
  of	
  the	
  interview.	
  Participants	
  were	
  also	
   encouraged	
  to	
  share	
  their	
  perspectives	
  about	
  any	
  additional	
  online	
  resources	
  they	
   may	
  have	
  used	
  previously.	
  	
   	
   3.2.3	
  Analysis	
  	
   Interviews	
  and	
  focus	
  groups	
  were	
  transcribed,	
  and	
  all	
  identifying	
  information	
  was	
   removed	
   (e.g.,	
   participants	
   were	
   assigned	
   pseudonyms).	
   Transcripts	
   of	
   interviews	
   and	
   focus	
   groups	
   were	
   organized	
   using	
   qualitative	
   data	
   analysis	
   software	
   (QSR	
   NVivo	
  8TM).	
  Constant	
  comparative	
  techniques	
  informed	
  the	
  analysis	
  (Corbin,	
  1998;	
   Darroch	
  et	
  al.,	
  2003;	
  Oliffe	
  et	
  al.,	
  in	
  press).	
  An	
  initial	
  set	
  of	
  codes	
  was	
  developed	
  to	
   organize	
  the	
  data	
  and	
  compartmentalize	
  the	
  analyses;	
  transcripts	
  were	
  coded	
  line-­‐ by-­‐line	
  to	
  identify	
  concepts	
  embedded	
  within	
  youth’s	
  narratives.	
  	
  As	
  data	
  collection	
   progressed	
   and	
   participants	
   shared	
   novel	
   viewpoints,	
   new	
   concepts	
   were	
   identified	
   and	
   incorporated	
   into	
   the	
   interview	
   question	
   guide	
   and	
   the	
   coding.	
   As	
   data	
   were	
   gathered	
  throughout	
  the	
  study,	
  the	
  codes	
  were	
  more	
  fully	
  defined	
  and	
  labeled;	
  the	
   	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
   3	
  The	
  website	
  for	
  sexualityandu.ca	
  was	
  updated	
  with	
  significant	
  design	
  changes	
   midway	
  through	
  the	
  study.	
   	
    	
    40	
  	
    coding	
   also	
   advanced	
   to	
   more	
   theoretical	
   levels	
   to	
   include	
   analyses	
   that	
   examined	
   the	
   ways	
   in	
   which	
   the	
   data	
   included	
   references	
   to	
   social	
   constructions	
   of	
   masculinity	
   and	
   femininity.	
   	
   Thirteen	
   youth	
   met	
   for	
   a	
   five-­‐hour	
   event	
   (a	
   Youth	
   Roundtable),	
   wherein	
   initial	
   findings	
   were	
   reviewed,	
   and	
   discussed	
   and	
   expanded	
   upon,	
   for	
   which	
   they	
   were	
   compensated	
   with	
   an	
   $80	
   honorarium.	
   These	
   sessions	
   were	
   audio-­‐recorded	
   and	
   transcribed,	
   and	
   the	
   resulting	
   data	
   were	
   used	
   to	
   verify,	
   correct,	
  and	
  conceptually	
  advance	
  the	
  results.	
   	
   3.3	
  Findings	
   3.3.1	
  Study	
  participants	
  	
   In	
  total,	
  interviews	
  and	
  focus	
  groups	
  were	
  conducted	
  with	
  12	
  male,	
  19	
  female,	
  and	
  1	
   transgendered	
   youth.	
   Participants’	
   mean	
   age	
   was	
   20.0	
   years.	
   	
   See	
   Table	
   1	
   for	
   participants’	
  self-­‐identified	
  socio-­‐demographic	
  characteristics,	
  and	
  Table	
  2	
  for	
  their	
   previous	
  STI/HIV	
  testing	
  history.	
   	
   3.3.2	
  Gendered	
  virtual	
  spaces	
   Targeting	
  cues:	
  Participants	
  exhibited	
  a	
  high	
  degree	
  of	
  sensitivity	
  to	
  the	
  perceived	
   gender	
   of	
   a	
   website	
   –	
   that	
   is,	
   to	
   whom	
   they	
   perceived	
   the	
   website	
   was	
   targeted.	
   During	
   their	
   review	
   of	
   the	
   four	
   websites,	
   youth	
   identified	
   several	
   visual	
   website	
   cues	
   through	
   which	
   they	
   judged	
   the	
   gender-­‐sensitivity.	
   Participants	
   frequently	
   highlighted	
   specific	
   colours,	
   fonts,	
   and	
   URL	
   names	
   as	
   indicators	
   of	
   the	
   website’s	
   intended	
  gender	
  audience.	
  Colour	
  palettes	
  containing	
  pinks,	
  or	
  softer	
  pastels	
  were	
    	
    	
    41	
  	
    more	
   frequently	
   described	
   as	
   female-­‐friendly	
   (although	
   these	
   sites	
   contain	
   sexual	
   health	
   information	
   that	
   could	
   be	
   useful	
   to	
   both	
   young	
   men	
   and	
   women).	
   For	
   example,	
  the	
  primary	
  colours	
  of	
  sexualityandu.ca	
  are	
  purple,	
  turquoise,	
  and	
  pink,	
  on	
   a	
  white	
  background	
  –	
  a	
  colour	
  combination	
  that	
  many	
  youth	
  recognized	
  as	
  feminine,	
   and	
   therefore	
   targeted	
   to	
   women.	
   However,	
   this	
   website	
   contains	
   a	
   great	
   deal	
   of	
   information	
   relevant	
   to	
   both	
   men	
   and	
   women	
   (e.g.,	
   breast	
   self-­‐examination;	
   testicular	
  self-­‐examination).	
  	
   	
   For	
  many	
  youth,	
  another	
  powerful	
  indicator	
  of	
  the	
  targeted	
  gender	
  was	
  the	
  content	
   that	
  caught	
  their	
  attention.	
  That	
  is,	
  content	
  understood	
  by	
  participants	
  as	
  primarily	
   relevant	
  to	
  females	
  also	
  prompted	
  users	
  to	
  infer	
  that	
  the	
  website	
  was	
  likely	
  women-­‐ centred.	
   	
   Topics	
   included	
   pregnancy,	
   contraception,	
   and	
   sexual	
   assault,	
   and	
   the	
   inclusion	
   of	
   one	
   or	
   more	
   of	
   these	
   explicit	
   headings,	
   though	
   nestled	
   within	
   other	
   subject	
   matter,	
   prompted	
   most	
   youth	
   to	
   deem	
   the	
   entire	
   site	
   as	
   targeted	
   towards	
   women	
  (rather	
  than	
  men).	
  One	
  young	
  man,	
  Daniel,	
  commented:	
  “So	
  I	
  think	
  this	
  one	
  is	
   more	
  directed	
  to	
  a	
  woman,	
  it	
  has	
  more	
  things	
  about…pregnancy	
  and…things	
  about	
  the	
   pill…it’s	
   important	
   [for	
   girls]	
   to	
   know.”	
   Daniel’s	
   account	
   frames	
   pregnancy	
   and	
   knowledge	
  of	
  the	
  contraceptive	
  pill	
  as	
  important	
  topics	
  with	
  which	
  young	
  women	
  in	
   particular	
  should	
  be	
  familiar	
  (a	
  common	
  narrative	
  throughout	
  this	
  study).	
  	
   	
   Some	
   youth	
   initially	
   acknowledged	
   the	
   websites	
   under	
   review	
   could	
   be	
   “for	
  both”,	
   but	
  frequently	
  elaborated	
  that	
  it	
  might	
  be	
  “more	
  for	
  women.”	
  One	
  young	
  man,	
  Sunny,	
   described	
  the	
  website	
  as	
  being	
  high	
  quality	
  and	
  potentially	
  useful	
  for	
  both	
  genders,	
    	
    	
    42	
  	
    before	
   acknowledging	
   that,	
   based	
   on	
   the	
   content,	
   it	
   was	
   aimed	
   primarily	
  at	
   young	
   women:	
   	
   I	
  think	
   it’s	
   both,	
   but	
   I	
   can	
   see	
   it	
   more	
   kinda	
   female-­‐friendly,	
   I	
   guess?	
   Just	
   ‘cause	
   there’s	
  like,	
  “am	
  I	
  pregnant?”	
  and	
  date	
  rape	
  and	
  contraceptives,	
  so	
  it	
  seems	
  like	
   it’s	
  more	
  for	
  girls.	
   	
   The	
  site’s	
  main	
  page,	
  in	
  fact,	
  features	
  information	
  on	
  many	
  topics,	
  including	
  sexual	
   health	
   and	
   STIs;	
   but,	
   because	
   the	
   site’s	
   topic	
   headings	
   pertaining	
   to	
   pregnancy,	
   sexual	
  assault,	
  and	
  contraception	
  were	
  featured	
  prominently,	
  Sunny	
  concluded	
  that	
   he	
  resided	
  outside	
  the	
  principal	
  target	
  audience	
  because	
  it	
  was	
  not	
  relevant	
  to	
  men.	
  	
  	
   	
   By	
   reading	
   colours	
   and	
   content,	
   some	
   websites	
   were	
   understood	
   as	
   	
   ‘female-­‐ orientated’	
  even	
  though	
  the	
  topics	
  were	
  in	
  fact	
  relevant	
  to	
  all	
  youth.	
  	
  This	
  tendency	
   to	
   read	
   some	
   content	
   as	
   feminine	
   reveals	
   the	
   transferability	
   to	
   virtual	
   spaces	
   of	
   gendered	
   stereotypes	
   that	
   portray	
   young	
   women	
   as	
   the	
   sole	
   caretakers	
   of	
   many	
   aspects	
   of	
   sexual	
   health	
   (e.g.,	
   negotiating	
   contraception	
   use;	
   preventing	
   sexual	
   assault;	
  coping	
  with	
  pregnancy	
  concerns).	
  	
   	
   By	
   acknowledging	
   that	
   some	
   topics	
   are	
   strategically	
   directed	
   at	
   women,	
   but	
   rejecting	
   the	
   notion	
   that	
   this	
   content	
   is	
   only	
   relevant	
   to	
   females,	
   a	
   few	
   youth	
   resisted	
   traditional	
   gender	
   roles.	
   One	
   woman,	
   Melissa,	
   examined	
   the	
   content	
   of	
   sexualityandu.ca	
  	
  and	
  told	
  us:	
    	
    	
    43	
  	
    	
   I	
  mean	
  it	
  has	
  like	
  the	
  birth	
  control,	
  pregnancy…like	
  that	
  obviously	
  is	
  targeted	
   towards	
  women…	
  but	
  that’s	
  going	
  to	
  be	
  on	
  any	
  website.	
  They	
  all	
  have	
  to	
  have	
  a	
   pregnancy	
   thing.	
   I	
   mean	
   really	
   that	
   can	
   be	
   applicable	
   to	
   men	
   and	
   women.	
   If	
   you’re	
  pregnant	
  there’s	
  two	
  people	
  involved,	
  it’s	
  not	
  just	
  a	
  one-­‐person	
  thing.	
  	
   	
   Of	
  the	
  four	
  websites	
  that	
  were	
  reviewed	
  by	
  youth,	
  none	
  were	
  read	
  as	
  being	
  targeted	
   to	
   men.	
   Yet	
   embedded	
   in	
   these	
   sites	
   were	
   content	
   pertaining	
   specifically	
   to	
   young	
   men’s	
  sexual	
  health,	
  and	
  included	
  were	
  images	
  of	
  young	
  men	
  (as	
  well	
  as	
  images	
  of	
   young	
   women,	
   and	
   young	
   men	
   and	
   women	
   together).	
   That	
   is,	
   many	
   look	
   and	
   feel	
   aspects	
   of	
   the	
   site	
   led	
   youth	
   to	
   experience	
   sexual	
   health	
   websites	
   as	
   reinforcing	
   gender	
  norms	
  –	
  finding	
  them	
  to	
  be	
  predominately	
  feminine;	
  these	
  inferences	
  tend	
  to	
   be	
   based	
   on	
   socially	
   accepted	
   norms	
   of	
   femininity,	
   such	
   as	
   ‘girly’	
   colours	
   or	
   fonts.	
   Furthermore,	
   youth	
   recognize	
   many	
   aspects	
   of	
   sexual	
   health	
   as	
   fundamentally	
   female	
   domains,	
   enhancing	
   the	
   perceived	
   feminine	
   atmosphere	
   of	
   these	
   online	
   spaces.	
   	
   Youth’s	
   preferences:	
   When	
   using	
   online	
   sexual	
   health	
   websites	
   youth	
   often	
   expressed	
  a	
  preference	
  to	
  use	
  a	
  resource	
  that	
  they	
  felt	
  aligned	
  with	
  various	
  aspects	
   their	
   own	
   identity	
   (e.g.,	
   age;	
   sexual	
   experience;	
   gender	
   identity).	
   	
   Drawing	
   on	
   previous	
   experiences	
   using	
   online	
   sexual	
   health	
   resources,	
   participants	
   described	
   websites	
  targeted	
  towards	
  either	
  women	
  or	
  men	
  as	
  gender	
  sensitive.	
  For	
  example,	
   for	
   many	
   young	
   women,	
   a	
   ‘more	
   feminine’	
   website	
   was	
   understood	
   as	
   a	
   better	
    	
    	
    44	
  	
    source	
  of	
  information	
  on	
  oral	
  contraceptives.	
  Other	
  young	
  women	
  spoke	
  of	
  having	
  a	
   higher	
   comfort-­‐level	
   with	
   sexual	
   health	
   websites	
   that	
   were	
   more	
   feminine.	
   For	
   example,	
   during	
   a	
   focus	
   group,	
   several	
   young	
   women	
   described	
   their	
   preference	
   for	
   seemingly	
  ‘feminine’	
  sexual	
  health	
  websites	
  over	
  more	
  neutral	
  ones:	
   	
   Lira:	
  If	
  I	
  was	
  looking	
  for	
  specifically	
  contraceptive	
  information,	
  I	
  probably	
  tend	
   to	
  subconsciously	
  be	
  attracted	
  to	
  something	
  that	
  seems	
  feminine.	
  	
   Megan:	
  That’s	
  kind	
  of	
  what	
  I	
  was	
  thinking,	
  too.	
  	
   Researcher:	
  And	
  why	
  do	
  you	
  think	
  that?	
   Megan:	
  Guys	
  aren’t	
  taking	
  birth	
  control.	
   Researcher:	
  So,	
  you	
  would	
  look	
  for	
  a	
  feminine	
  website?	
   Megan:	
   Yeah.	
   Because	
   to	
   me,	
   it's	
   written	
   by	
   someone	
   like	
   me.	
   Someone	
   who	
   knows	
  something	
  about	
  me.	
  Because	
  we	
  both	
  like	
  something	
  similar.	
  	
   	
   Indeed,	
  many	
  youth	
  actively	
  seek	
  out	
  gender-­‐sensitive	
  sexual	
  health	
  websites.	
  	
  For	
   example,	
  in	
  the	
  same	
  focus	
  group	
  where	
  Megan	
  and	
  Lira	
  expressed	
  their	
  opinions,	
   Trevor	
   described	
   how	
   he	
   avoids	
   seemingly	
   feminine	
   websites,	
   and	
   expressed	
   an	
   active	
  preference	
  for	
  male-­‐friendly	
  online	
  spaces:	
   	
   If	
   I	
   went	
   onto	
   a	
   Web	
   site	
   that	
   looked	
   like	
   it	
   was	
   written	
   more	
   for	
   a	
   feminine	
   side,	
  I	
  would	
  probably	
  go	
  off	
  straight	
  away.	
  And	
  find	
  something	
  more	
  [suitable	
   for	
  me].	
  …If	
  it	
  was	
  between	
  a	
  neutral	
  site	
  and	
  a	
  masculine	
  site,	
  I'd	
  choose	
  the	
   site	
  that’s	
  written	
  for	
  me.	
  (Trevor)	
    	
    	
    45	
  	
    	
   Like	
   other	
   young	
   men	
   in	
   this	
   study,	
   Trevor	
   argued	
   for	
   a	
   sexual	
   health	
   websites	
   with	
   a	
  masculine	
  look	
  and	
  feel,	
  without	
  articulating	
  what	
  that	
  would	
  constitute.	
   	
   3.3.3	
  Gendered	
  stereotypes	
  about	
  online	
  sexual	
  health	
  resource-­‐seeking	
   Participants	
   shared	
   their	
   perspectives	
   on	
   the	
   ways	
   in	
   which	
   they	
   viewed	
   gender	
   affecting	
   youth’s	
   experiences	
   with	
   accessing	
   online	
   sexual	
   health	
   resources.	
   	
   Much	
   of	
   their	
   discussion	
   was	
   framed	
   in	
   ways	
   that	
   aligned	
   with	
   or	
   re-­‐affirmed	
   many	
   gendered	
   stereotypes	
   about	
   sexual	
   health	
   practices.	
   The	
   vast	
   majority	
   of	
   participants	
   suggested	
   that	
   women	
   sought	
   online	
   sexual	
   health	
   information	
   and	
   services	
  much	
  more	
  frequently	
  than	
  men,	
  citing	
  women’s	
  relatively	
  higher	
  interest,	
   need,	
  and	
  inclination	
  to	
  use	
  these	
  resources.	
   	
   Differing	
   ‘needs’:	
   One	
   of	
   the	
   primary	
   reasons	
   mentioned	
   by	
   participants	
   for	
   women’s	
   supposed	
   higher	
   use	
   of	
   the	
   Internet	
   for	
   sexual	
   health	
   purposes	
   was	
   that	
   women	
  had	
  “more	
  of	
  a	
  need”	
  to	
  access	
  sexual	
  health	
  information	
  and	
  services	
  than	
   men,	
  frequently	
  explained	
  by	
  women’s	
  heightened	
  sense	
  of	
  sexual	
  vulnerability	
  (e.g.,	
   they	
  have	
  the	
  potential	
  to	
  become	
  impregnated).	
  	
  One	
  woman,	
  Bridgette,	
  explained	
   that	
  young	
  women	
  would	
  be	
  more	
  likely	
  to	
  look	
  up	
  sexual	
  health	
  information	
  online	
   because	
  “they	
  are	
  the	
  ones	
  that	
  would	
  get	
  pregnant.	
  They	
  get	
  worried,	
  and	
  then	
  they’d	
   wanna	
  know.	
   I	
  don’t	
  know,	
  most	
  of	
  the	
  guys	
  I	
  know	
  seem	
  more	
  like	
  blasé;	
  they	
  don’t	
   care.	
  Girls	
  want	
  like	
  protection	
  and	
  stuff.	
  But	
  everyone’s	
  different,	
  some	
  guys	
  do	
  care.“	
  	
   	
   	
    	
    46	
  	
    Implicit	
   in	
   Bridgette’s	
   commentary,	
   and	
   indeed	
   the	
   commentary	
   of	
   many	
   of	
   the	
   participants,	
  are	
  notions	
  of	
  gender	
  that	
  place	
  importance	
  on	
  women’s	
  need	
  to	
  ‘take	
   care’	
  of	
  themselves,	
  while	
  excusing	
  men	
  from	
  this	
  responsibility	
  (although	
  she	
  notes	
   with	
   optimism	
   that	
   “some	
   guys	
   do	
   care”).	
   Young	
   men	
   were	
   often	
   described	
   as	
   the	
   worry-­‐free	
  partner	
  in	
  a	
  heterosexual	
  dyad,	
  with	
  the	
  capacity	
  to	
  assume	
  that	
  any	
  sex-­‐ related	
   anxieties	
   would	
   naturally	
   reside	
   with	
   the	
   woman.	
   Another	
   participant	
   commented	
  that	
  because	
  of	
  social	
  norms	
  that	
  may	
  cause	
  a	
  woman	
  to	
  be	
  labeled	
  as	
   ‘slutty’	
   or	
   ‘dirty’	
   for	
   contracting	
   an	
   STI,	
   women	
   might	
   have	
   a	
   greater	
   need	
   to	
   keep	
   themselves	
   free	
   of	
   STIs	
   by	
   staying	
   informed	
   and	
   seeking	
   relevant	
   services	
   by	
   any	
   means	
  (including	
  the	
  Internet).	
   	
   Differing	
  acceptability:	
   Several	
  participants	
  commented	
  that	
  an	
  additional	
  reason	
   for	
  the	
  perceived	
  greater	
  use	
  of	
  online	
  sexual	
  health	
  resources	
  by	
  young	
  women	
  was	
   related	
  to	
  the	
  higher	
  level	
  of	
  social	
  acceptability	
  associated	
  with	
  some	
  health	
  topics	
   considered	
   exclusively	
   feminine.	
   Youth	
   explained	
   that	
   some	
   topics,	
   including	
   contraception	
   and	
   menstruation,	
   were	
   associated	
   with	
   less	
   stigma	
   than	
   others,	
   such	
   as	
   STI	
   testing	
   or	
   STI	
   symptoms,	
   within	
   online	
   sexual	
   health	
   resources.	
   Because	
   women	
  were	
  expected	
  to	
  keep	
  themselves	
  informed	
  on	
  particularly	
  ‘female’	
  topics,	
   utilizing	
   online	
   sexual	
   health	
   resources	
   was	
   affirmed	
   as	
   due	
   diligence.	
   	
   Less	
   stigmatizing	
   and	
   potentially	
   embarrassing	
   subjects	
   were	
   seen	
   to	
   effectively	
   serve	
   as	
   ‘gateway’	
  topics	
  for	
  some	
  young	
  women,	
  allowing	
  them	
  to	
  more	
  surreptitiously	
  seek	
   out	
  information	
  that	
  could	
  potentially	
  be	
  incriminating,	
  such	
  as	
  locations	
  of	
  local	
  STI	
    	
    	
    47	
  	
    testing	
   services.	
   Megan	
   described	
   how	
   her	
   searches	
   for	
   ‘feminine’	
   sexual	
   health	
   information	
  online	
  facilitated	
  her	
  learning	
  about	
  more	
  sensitive	
  topics,	
  like	
  STIs:	
   	
   Like,	
  I	
  hate	
  to	
  say.	
  But	
  I	
  almost	
  feel	
  like	
  girls	
  are	
  more	
  interested	
  in	
  safe	
  sex.	
  Just	
   because	
   we	
   are	
   the	
   ones	
   who	
   stand	
   getting	
   pregnant.	
   Or	
   we	
   would	
   be	
   stuck	
   with	
  that	
  kind	
  of	
  thing.	
  Looking	
  that	
  up	
  [online],	
  I	
  think	
  the	
  STIs	
  come	
  into	
  it.	
   Because	
  I	
  just	
  connected	
  it.	
  I	
  would	
  look	
  up	
  both.	
  Whereas,	
  that’s	
  what	
  I	
  mean.	
  I	
   might	
  go	
  to	
  a	
  Web	
  site	
  looking	
  up	
  birth	
  control.	
  And	
  then,	
  looking	
  up	
  STIs,	
  as	
   well,	
  or	
  something.	
  Whereas	
  guys	
  are	
  like,	
  OK.	
  Got	
  my	
  condom.	
  I'm	
  good	
  to	
  go.	
   	
   Conversely	
  if	
  a	
  young	
  man	
  were	
  to	
  be	
  searching	
  for	
  topics	
  ‘relevant’	
  to	
  them	
  such	
  as	
   STIs	
  this	
  could	
  carry	
  significantly	
  high	
  levels	
  of	
  stigma.	
   	
   Differing	
   nature/disposition:	
   In	
   addition	
   to	
   being	
   expected	
   to	
   abide	
   by	
   gendered	
   social	
   expectations,	
   young	
   women	
   were	
   also	
   described	
   as	
   being	
   more	
   intrinsically	
   inclined	
   to	
   go	
   online	
   for	
   sexual	
   health	
   activities.	
   Participants	
   frequently	
   distinguished	
  between	
  what	
  they	
  saw	
  as	
  men’s	
  and	
  women’s	
  differing	
  personality-­‐ based	
   predispositions	
   to	
   use	
   web-­‐based	
   sexual	
   health	
   resources.	
   One	
   young	
   woman	
   told	
  us:	
   	
  Yeah	
  I	
  mean	
  I	
  think	
  females	
  are	
  probably	
  the	
  ones	
  that	
  are	
  more	
  likely	
  to	
  go	
   looking…	
  like…	
  to	
  go	
  check…	
  you	
  know...I	
  mean	
  I	
  have	
  no	
  idea,	
  I’m	
  not	
  a	
  guy,	
   but	
  I	
  feel	
  like	
  women	
  are	
  more	
  paranoid	
  in	
  general	
  so	
  they’re	
  like,	
  ‘Okay,	
  let’s	
   look	
  this	
  stuff	
  up.’	
  (Melissa)	
    	
    	
    48	
  	
    	
   Melissa’s	
  description	
  reflects	
  another	
  common	
  stereotype	
  about	
  young	
  women	
  and	
   their	
   perceived	
   heightened	
   attention	
   to	
   sexual	
   health	
   issues.	
   Indeed,	
   many	
   participants	
  suggested	
  that	
  young	
  women	
  are	
  more	
  fearful	
  by	
  nature,	
  or	
  more	
  likely	
   to	
  be	
  anxious,	
  and	
  thus	
  are	
  more	
  likely	
  to	
  access	
  online	
  sexual	
  health	
  resources	
  than	
   young	
   men.	
   	
   Correspondingly,	
   one	
   young	
   woman	
   spoke	
   of	
   men’s	
   reluctance	
   to	
   conduct	
  online	
  searches	
  for	
  sexual	
  health	
  as	
  being	
  related	
  to	
  their	
  more	
  ‘worry-­‐free’	
   demeanors:	
   	
   Roxanne:	
   I	
   think	
   like	
   in	
   general,	
   I	
   would	
   think	
   that	
   just	
   men	
   in	
   general,	
   like	
   males	
  would	
  be	
  less	
  likely	
  to	
  search	
  anything.	
  	
   Researcher:	
  And	
  why	
  do	
  you	
  think	
  men	
  in	
  general	
  might	
  be	
  less	
  likely?	
   Roxanne:	
  I	
  think	
  they	
  are	
  just	
  less	
  worrisome	
  usually.	
  [laughs]	
   Researcher:	
  About?	
   Roxanne:	
   About	
   anything.	
   Girls	
   are	
   very	
   like	
   everything	
   has	
   to	
   be	
   going	
   perfectly	
   and	
   they	
   need	
   to	
   know	
   exactly	
   what’s	
   gonna	
   happen	
   and	
   exactly	
   what’s	
   gonna	
   be	
   like,	
   and	
   what	
   they	
   need	
   to	
   know	
   beforehand	
   where	
   as	
   men	
   are	
  just	
  like	
  “ah,	
  we’ll	
  see	
  what	
  happens.”	
  I	
  think	
  they’d	
  like	
  pay	
  attention	
  less	
   when	
  they	
  are	
  hearing	
  about	
  STIs	
  and	
  things	
  like	
  that,	
  whereas	
  girls	
  are	
  more	
   concerned.	
  That	
  was	
  a	
  really	
  big	
  generalization	
  but…	
   	
   Other	
   participants	
   suggested	
   that	
   men	
   would	
   have	
   differed	
   in	
   the	
   ways	
   in	
   which	
   they	
   used	
   online	
   sexual	
   health	
   resources,	
   suggesting	
   that,	
   once	
   online,	
   men	
   would	
    	
    	
    49	
  	
    be	
   more	
   information-­‐driven,	
   and	
   less	
   likely	
   to	
   spend	
   time	
   browsing	
   websites	
   extensively,	
  or	
  at	
  a	
  leisurely	
  pace.	
  For	
  example,	
  one	
  young	
  woman,	
  Coral,	
  explained	
   that	
   young	
   men	
   would	
   not	
   want	
   to	
   access	
   a	
   sexual	
   health	
   website	
   “that	
   has	
   like	
   games	
   about	
   sexual	
   health	
   and	
   stuff.	
   I	
   mean,	
   they	
   probably	
   just	
   wanna	
   go	
   on,	
   read	
   what	
   they	
   wanna	
   know,	
   and	
   get	
   off”.	
   Coral	
   compared	
   young	
   women’s	
   online	
   practices	
   to	
   young	
   men’s,	
   saying	
   that,	
   in	
   contrast,	
   young	
   women	
   would	
   be	
   more	
   likely	
  to	
  spend	
  time	
  perusing	
  a	
  site	
  for	
  additional,	
  superfluous	
  resources	
  and	
  sites	
  to	
   which	
  they	
  could	
  return	
  (e.g.,	
  for	
  future	
  reference).	
   	
   There	
   was	
   also	
   a	
   general	
   perception	
   among	
   the	
   study	
   participants	
   that	
   men	
   were	
   less	
  likely	
  than	
  women	
  to	
  be	
  able	
  to	
  talk	
  about	
  sexual	
  health	
  issues	
  face-­‐to-­‐face	
  (e.g.,	
   with	
  friends;	
  sexual	
  health	
  educators).	
  Both	
  men	
  and	
  women	
  in	
  the	
  study	
  frequently	
   characterized	
   men	
   as	
   being	
   reluctant	
   to	
   discuss	
   these	
   issues	
   in	
   person,	
   due	
   to	
   social	
   norms	
   that	
   discouraged	
   such	
   behaviour	
   (see	
   Knight	
   et	
   al,	
   2012).	
   	
   Often,	
   youth	
   imparted	
  that	
  for	
  a	
  young	
  man	
  to	
  seek	
  information	
  pertaining	
  to	
  sexual	
  health	
  was	
   to	
   admit	
   vulnerability	
   –	
   something	
   that	
   contradicts	
   pervasive	
   masculine	
   ideals	
   of	
   independence	
  and	
  virility	
  that	
  comes	
  from	
  men’s	
  ‘natural	
  instincts’	
  about	
  sex:	
   	
   I	
  feel	
  like	
  guys	
  compared	
  to	
  girls	
  anyway,	
  may	
  be	
  more	
  proud.	
  They	
  think	
  that	
   they're	
  all	
  ready	
  and	
  don't	
  need	
  that	
  help.	
  They’ve	
  gotten	
  enough	
  information	
   already.	
  And	
  I've	
  heard	
  people	
  talk	
  like	
  that	
  before.	
  And	
  you	
  would	
  be	
  surprised	
   about	
   how	
   much	
   information	
   they	
   actually	
   don't	
   know.	
   I	
   think	
   that’s	
   one	
   of	
   the	
    	
    	
    50	
  	
    biggest	
  problems	
  these	
  days.	
  It's	
  people	
  thinking	
  they	
  know	
  more	
  information	
   than	
  they	
  actually	
  do.	
  (Trevor)	
   	
   By	
  limiting	
  the	
  acceptability	
  of	
  openly	
  pursuing	
  sexual	
  health	
  information	
  (both	
  in-­‐ person	
   and	
   online),	
   gendered	
   stereotypes	
   were	
   seen	
   to	
   affect	
   men’s	
   online	
   sexual	
   health	
   seeking	
   behaviours.	
   One	
   young	
   woman,	
   Jane,	
   expressed	
   that	
   men	
   would	
   be	
   more	
   likely	
   than	
   women	
   to	
   “put	
   up	
   a	
   wall”,	
   and	
   refuse	
   to	
   access	
   sexual	
   health	
   resources	
  online.	
  She	
  explained:	
   	
   You	
  know	
  how	
  guys	
  are,	
  all,	
  ‘Oh	
  I	
  don’t	
  want	
  to	
  look	
  for	
  directions	
  because	
  I’m	
  a	
   man,	
  I	
  can	
  find	
  everything’.	
  So	
  it’s	
  kind	
  of	
  like	
  the	
  same	
  thing	
  that	
  they	
  can	
  deal	
   with	
   it	
   themselves.	
   While	
   the	
   young	
   women	
   would	
   probably	
   just,	
   like	
   if	
   they	
   need	
  help	
  they	
  would	
  go	
  and	
  get	
  it.	
  Think	
  a	
  little	
  more	
  logically,	
  I	
  think,	
  if	
  that	
   makes	
  sense?	
  (Jane)	
   	
   Like	
   many	
   participants,	
   Jane’s	
   narrative	
   is	
   complicit	
   with	
   gender	
   norms	
   that	
   reinforce	
   stereotypes	
   about	
   masculinity,	
   while	
   excusing	
   men	
   from	
   responsibilities	
   associated	
  with	
  sexual	
  health	
  practices.	
   	
   In	
  the	
  same	
  vein,	
  however,	
  these	
  gendered	
  stereotypes	
  were	
  perceived	
  by	
  youth	
  as	
   making	
  young	
  men	
  somewhat	
  more	
  prone	
  to	
  go	
  online	
  than	
  to	
  seek	
  in-­‐person	
  help,	
   (while	
   remaining	
   much	
   less	
   likely	
   than	
   young	
   women	
   to	
   do	
   either).	
   In	
   fact,	
   citing	
   heightened	
   privacy	
   and	
   anonymity,	
   the	
   Internet	
   was	
   frequently	
   described	
   by	
    	
    	
    51	
  	
    participants	
  as	
  a	
  medium	
  with	
  a	
  very	
  high	
  potential	
  to	
  fill	
  the	
  existing	
  gap	
  in	
  sexual	
   health	
  information,	
  counseling,	
  support	
  for	
  young	
  men:	
   	
   I	
  definitely	
  think	
  they’d	
  be	
  more	
  likely	
  to	
  access	
  a	
  website	
  than	
  like	
  ask	
  a	
  peer	
   or	
  ask	
  a	
  nurse.	
  Just	
  ‘cause	
  it’s	
  something	
  you	
  can	
  do	
  kind	
  of	
  privately	
  and	
  not	
   tell	
  anyone,	
  and	
  it’s	
  like	
  that.	
  	
   	
   While	
  the	
  capacity	
  for	
  the	
  Internet	
  to	
  allow	
  men	
  to	
  bypass	
  external	
  judgments	
  and	
   masculine	
   expectations	
   (e.g.,	
   by	
   offering	
   anonymous	
   and	
   private	
   access	
   to	
   services),	
   participants	
   re-­‐emphasized	
   that	
   young	
   men’s	
   internalized	
   notions	
   of	
   what	
   constituted	
   masculine	
   behaviour	
   (e.g.,	
   being	
   self-­‐reliant;	
   avoiding	
   health	
   care)	
   would	
   still	
   constitute	
   a	
   significant	
   barrier	
   to	
   access,	
   regardless	
   of	
   the	
   help-­‐seeking	
   forum.	
   	
   3.4	
  Discussion	
   	
   These	
   findings	
   highlight	
   the	
   gendered	
   nature	
   of	
   the	
   online	
   sexual	
   health	
   care-­‐ seeking	
   experience.	
   Youth’s	
   descriptions	
   of	
   gender	
   norms	
   within	
   online	
   sexual	
   health	
  resource	
  utilization	
  align	
  with	
  other	
  research	
  findings	
  that	
  illustrate	
  the	
  role	
   of	
   gender	
   norms	
   in	
   informing	
   sexual	
   health	
   practices	
   (Addis	
   &	
   Mahalik,	
   2003;	
   Barker,	
  Ricardo,	
  Nascimento,	
  Olukoya,	
  &	
  Santos,	
  2010;	
  Lee	
  &	
  Owens,	
  2002;	
  Magee	
  et	
   al.,	
   2011;	
   Mo	
   et	
   al.,	
   2009;	
   O'Brien	
   &	
   Hunt,	
   2005;	
   Oliffe	
   et	
   al.,	
   in	
   press;	
   Robertson,	
   2007;	
  Robinson	
  &	
  Robertson,	
  2010;	
  Shephard,	
  1996;	
  Shoveller	
  et	
  al.,	
  2010;	
  Thelwall	
    	
    	
    52	
  	
    et	
   al.,	
   2010).	
   While	
   life-­‐course	
   issues	
   (including	
   biology	
   based	
   variations)	
   are	
   implicated	
   in	
   gender	
   differences	
   in	
   sexual	
   health	
   care	
   practices	
   (e.g.,	
   using	
   online	
   resources	
  for	
  sexual	
  health),	
  these	
  discrepancies	
  are	
  likely	
  due	
  also,	
  in	
  part,	
  to	
  the	
   influence	
   of	
   gender	
   norms,	
   including	
   those	
   previously	
   described	
   (Corbin,	
   1998;	
   Goldenberg,	
  Shoveller,	
  Koehoorn,	
  &	
  Ostry,	
  2008b;	
  Greene,	
  2000;	
  Lichtenstein,	
  2003;	
   2004;	
   Shoveller,	
   Johnson,	
   &	
   Langille,	
   2004;	
   Shoveller	
   et	
   al.,	
   2010).	
   In	
   their	
   descriptions	
  of	
  young	
  men	
  and	
  women’s	
  use	
  of	
  online	
  sexual	
  health	
  resources,	
  many	
   of	
   these	
   gender	
   norms	
   were	
   (re)produced	
   by	
   youth	
   participants.	
   For	
   example,	
   most	
   youth	
   suggested	
   that	
   young	
   women	
   seek	
   online	
   sexual	
   health	
   information	
   and	
   services	
  much	
  more	
  frequently	
  than	
  young	
  men.	
  	
  This	
  greater	
  propensity	
  for	
  use	
  of	
   online	
   sexual	
   health	
   resources	
   was	
   explained	
   in	
   a	
   variety	
   of	
   ways	
   (e.g.,	
   women’s	
   higher	
  interest	
  in	
  seeking	
  sexual	
  health	
  care	
  and	
  information;	
  perceived	
  higher	
  need	
   for	
   women	
   to	
   protect	
   their	
   sexual	
   health;	
   women’s	
   greater	
   natural	
   inclination	
   to	
   seek	
   help	
   in	
   general).	
   Often,	
   youth	
   drew	
   heavily	
   on	
   the	
   stereotype	
   of	
   the	
   adventurous	
   and	
   free-­‐willed	
   man,	
   in	
   contrast	
   to	
   the	
   constraints	
   and	
   gender	
   disability	
  associated	
  with	
  being	
  a	
  woman,	
  especially	
  in	
  the	
  context	
  of	
  heterosexual	
   partnerships.	
   While	
   biology	
   and	
   female	
   reproductive	
   anatomy	
   does	
   render	
   the	
   heterosexual	
   encounter	
   as	
   more	
   likely	
   to	
   impact	
   the	
   woman’s	
   biology	
   –	
   both	
   in	
   terms	
   of	
   reproductive	
   and	
   STI	
   issues	
   (Gray-­‐Swain	
   &	
   Peipert,	
   2006)	
   –	
   participants’	
   discussions	
   tended	
   to	
   rely	
   on	
   the	
   social	
   construction	
   of	
   sex	
   (e.g.,	
   women	
   bearing	
   primary	
   responsibility	
   for	
   unplanned	
   pregnancies;	
   women	
   experiencing	
   more	
   stigma	
  if	
  an	
  STI	
  is	
  contracted).	
   	
    	
    	
    53	
  	
    Many	
   topics	
   contained	
   within	
   sexual	
   health	
   websites	
   are	
   important	
   for	
   healthy	
   sexuality	
   of	
   women	
   and	
   men	
   (e.g.,	
   taking	
   steps	
   to	
   prevent	
   sexual	
   assault	
   is	
   important	
   for	
   young	
   men;	
   pregnancy	
   affects	
   both	
   sexual	
   partners);	
   yet,	
   participants	
   typically	
  described	
  online	
  sexual	
  health	
  content	
  as	
  relevant	
  only	
  to	
  women.	
  	
  In	
  this	
   way,	
   most	
   participants	
   reinforced	
   stereotypes	
   about	
   masculinity,	
   wherein	
   women	
   subordinately	
   take	
   responsibility	
   for	
   maintaining	
   sexual	
   health	
   and	
   safety,	
   while	
   men	
  are	
  de	
  facto	
  concerned	
  primarily	
  with	
  performance	
  and	
  pleasure	
  (Goldenberg,	
   Shoveller,	
   Koehoorn,	
   &	
   Ostry,	
   2008b;	
   Greene,	
   2000;	
   Lichtenstein,	
   2003;	
   2004;	
   Oliffe	
   et	
  al.,	
  in	
  press;	
  Shoveller	
  et	
  al.,	
  2004;	
  Shoveller	
  et	
  al.,	
  2010).	
  Despite	
  some	
  efforts	
  to	
   target	
   men,	
   the	
   visual	
   culture	
   of	
   many	
   sexual	
   health	
   websites	
   overwhelmingly	
   positions	
  femininity	
  as	
  the	
  primary	
  reference	
  for	
  sexual	
  health	
  care	
  behaviours.	
  This	
   conflation	
   of	
   women	
   and	
   sexual	
   health	
   within	
   virtual	
   settings	
   buttresses	
   existing	
   gendered	
   stereotypes	
   about	
   responsibilities	
   within	
   sexual	
   relationships	
   (Medley-­‐ Rath	
   &	
   Simonds,	
   2010;	
   Oliffe	
   et	
   al.,	
   in	
   press).	
   Furthermore,	
   as	
   youth	
   try	
   to	
   find	
   salient,	
   high-­‐quality	
   information	
   and	
   services	
   about	
   on	
   the	
   Internet	
   (Gray	
   et	
   al.,	
   2005;	
   Medley-­‐Rath	
   &	
   Simonds,	
   2010),	
   the	
   feminization	
   of	
   many	
   online	
   spaces	
   could	
   potentially	
   act	
   as	
   a	
   deterrent	
   for	
   young	
   men	
   trying	
   to	
   access	
   ‘relevant’	
   sexual	
   health	
   information.	
  This	
  effect	
  could	
  be	
  especially	
  magnified	
  for	
  those	
  young	
  men	
  who	
  are	
   unfamiliar	
   with	
   online	
   sexual	
   health	
   resources.	
   Previous	
   research	
   has	
   called	
   attention	
   to	
   the	
   feminization	
   of	
   ‘real-­‐world’	
   STI	
   clinic	
   spaces	
   and	
   has	
   noted	
   the	
   barriers	
  this	
  can	
  present	
  to	
  young	
  men	
  wishing	
  to	
  access	
  such	
  services	
  (Shoveller	
  et	
   al.,	
  2009).	
  	
   	
    	
    	
    54	
  	
    Moreover,	
   for	
   the	
   young	
   men	
   in	
   this	
   study,	
   using	
   online	
   sexual	
   health	
   resources	
   implied	
  two	
  things	
  with	
  respect	
  to	
  their	
  perceptions	
  about	
  their	
  own	
  masculinities.	
   First,	
  it	
  was	
  perceived	
  as	
  signifying	
  a	
  need	
  for	
  assistance	
  or	
  an	
  interest	
  in	
  health	
  care	
   –	
   behaviour	
   that	
   would	
   be	
   resisted	
   by	
   stereotypical	
   masculine	
   ideals	
   that	
   endorse	
   male	
   independence	
   and	
   sexual	
   prowess	
   (Addis	
   &	
   Mahalik,	
   2003;	
   Barker,	
   Ricardo,	
   Nascimento,	
   Olukoya,	
   &	
   Santos,	
   2010).	
   Second,	
   in	
   contrast	
   to	
   young	
   women,	
   who	
   could	
  be	
  accessing	
  such	
  sites	
  for	
  an	
  array	
  of	
  reasons	
  (e.g.,	
  birth	
  control	
  information),	
   young	
  men’s	
  use	
  of	
  these	
  resources	
  could	
  be	
  interpreted	
  as	
  evidence	
  of	
  them	
  having	
   an	
   STI.	
   Both	
   of	
   these	
   realities	
   function	
   as	
   potential	
   barriers	
   for	
   young	
   men	
   and	
   closely	
   mirror	
   known	
   access	
   impediments	
   for	
   in-­‐person	
   sexual	
   health	
   services	
   for	
   young	
   men	
   (Knight,	
   2011;	
   Lichtenstein,	
   2003;	
   Lichtenstein	
   &	
   Bachmann,	
   2005;	
   Shoveller	
  et	
  al.,	
  2009;	
  Shoveller	
  et	
  al.,	
  2010).	
  	
   	
   These	
  discussions	
  with	
  youth	
  offer	
  a	
  glimpse	
  of	
  the	
  ways	
  in	
  which	
  social	
  norms	
  that	
   govern	
   young	
   men	
   and	
   women’s	
   gender	
   performances	
   shape	
   the	
   ways	
   in	
   which	
   online	
  sexual	
  health	
  resources	
  might	
  be	
  used	
  by	
  youth.	
  Furthermore,	
  these	
  findings	
   reveal	
  how	
  some	
  gender-­‐related	
  barriers	
  associated	
  with	
  conventional	
  sexual	
  health	
   services	
  may	
  be	
  reproduced	
  online.	
  For	
  example,	
  while	
  many	
  sexual	
  health	
  websites	
   include	
   information	
   targeted	
   towards	
   young	
   men	
   as	
   well	
   as	
   young	
   women	
   (presumably	
  to	
  reach	
  both	
  genders),	
  participants	
  consistently	
  perceived	
  these	
  sites	
   as	
  either	
  neutral	
  or	
  feminized,	
  leaving	
  young	
  men	
  with	
  a	
  paucity	
  of	
  ‘male-­‐friendly’	
   online	
  sexual	
  health	
  resources.	
  In	
  many	
  ways,	
  online	
  spaces	
  are	
  inherently	
  gendered	
   (Mo,	
  et	
  al.,	
  2009);	
  attempts	
  by	
  online	
  program	
  designers	
  to	
  offer	
  neutral	
  spaces	
  may	
    	
    	
    55	
  	
    fail	
   to	
   acknowledge	
   the	
   influences	
   of	
   a	
   wider	
   set	
   of	
   social	
   relations	
   (e.g.,	
   gender	
   norms)	
   within	
   which	
   youth	
   operate	
   (and	
   to	
   which	
   they	
   contribute)	
   (East	
   et	
   al.,	
   2011;	
   Knight,	
   2011;	
   Magee	
   et	
   al.,	
   2011;	
   Shoveller	
   et	
   al.,	
   2004;	
   2011).	
   Therefore,	
   ‘gender	
   neutral’	
   online	
   approaches	
   potentially	
   translate	
   into	
   yet	
   another	
   sphere	
   within	
  which	
  gendered	
  social	
  norms	
  (e.g.,	
  concerning	
  men’s	
  and	
  women’s	
  roles	
  and	
   responsibilities	
  relating	
  to	
  sexual	
  health)	
  remain	
  and	
  are	
  reaffirmed.	
  	
  Previous	
  work	
   in	
   youth	
   sexual	
   health	
   and	
   STI	
   testing	
   (Oliffe	
   et	
   al.,	
   in	
   press)	
   highlighted	
   similar	
   issues,	
   whereby	
   men	
   are	
   assumed	
   to	
   be	
   less	
   interested	
   in	
   or	
   committed	
   to	
   investigating	
   aspects	
   of	
   sexual	
   health	
   including	
   contraception	
   and	
   pregnancy.	
   Though	
   much	
   of	
   the	
   current	
   work	
   is	
   based	
   on	
   data	
   drawn	
   from	
   people	
   who	
   primarily	
   have	
   experience	
   with	
   services	
   offered	
   via	
   traditional	
   clinics,	
   it	
   was	
   clear	
   that	
   the	
   ‘virtual’	
   examples	
   that	
   were	
   reviewed	
   by	
   participants	
   did	
   little	
   to	
   disrupt	
   those	
  gender	
  norms.	
  	
   	
   Overall,	
   the	
   tendency	
   was	
   to	
   juxtapose	
   men’s	
   and	
   women’s	
   pursuit	
   of	
   online	
   services;	
   however,	
   there	
   were	
   nuances	
   within	
   the	
   youth’s	
   responses	
   –	
   youth	
   often	
   acknowledged	
  that	
  despite	
  it	
  being	
  more	
  in	
  young	
  women’s	
  ‘nature’	
  to	
  access	
  online	
   (and	
   offline)	
   sexual	
   health	
   resources,	
   perhaps	
   web-­‐based	
   provision	
   freed	
   men	
   to	
   operate	
  outside	
  masculine	
  ideals	
  that	
  traditionally	
  inhibit	
  their	
  use	
  of	
  these	
  services.	
   Citing	
  heightened	
  privacy	
  and	
  anonymity,	
  the	
  Internet	
  was	
  frequently	
  described	
  by	
   participants	
  as	
  a	
  medium	
  with	
  high	
  potential	
  to	
  fill	
  the	
  existing	
  gap	
  in	
  sexual	
  health	
   information,	
   counseling,	
   support	
   for	
   young	
   men.	
   However,	
   juxtaposed	
   with	
   a	
   perceived	
   lack	
   of	
   male-­‐friendly	
   online	
   sexual	
   health	
   resources,	
   this	
   represents	
   a	
    	
    	
    56	
  	
    missed	
   opportunity	
   to	
   reach	
   young	
   men,	
   many	
   of	
   whom	
   experience	
   unmet	
   sexual	
   health	
  needs.	
   	
   Broader	
   applications	
   of	
   the	
   findings	
   described	
   in	
   this	
   chapter	
   are	
   limited	
   in	
   some	
   ways.	
   While	
   the	
   young	
   men	
   and	
   women	
   in	
   this	
   study	
   commented	
   on	
   content	
   and	
   styles	
   they	
   considered	
   to	
   be	
   feminine	
   within	
   the	
   websites	
   reviewed,	
   they	
   were	
   offered	
   little	
   opportunity	
   to	
   identify	
   content	
   and	
   styles	
   particularly	
   suited	
   for	
   young	
   men.	
   It	
   has	
   been	
   argued	
   that,	
   often,	
   masculinities	
   are	
   more	
   fully	
   understood	
   from	
   this	
   angle	
   –	
   what	
   is	
   not	
   of	
   masculine	
   appeal	
   or	
   engaging	
   for	
   men	
   with	
   respect	
   to	
   their	
  sexual	
  health.	
  Ultimately,	
  knowing	
  what	
  is	
  ‘un-­‐male’	
  does	
  little	
  to	
  inform	
  what	
   is	
  ‘male-­‐friendly’,	
  and	
  researchers	
  are	
  left	
  with	
  little	
  insight	
  to	
  what	
  might	
  constitute	
   a	
   masculine	
   ‘look-­‐and-­‐feel’	
   toward	
   offering	
   men-­‐centred	
   online	
   sexual	
   health	
   resources.	
  	
  	
  	
   	
   In	
   addition,	
   youth	
   who	
   participated	
   in	
   this	
   study	
   self-­‐selected	
   and	
   were	
   willing	
   to	
   discuss	
   issues	
   pertaining	
   to	
   sexual	
   health	
   and	
   sexuality,	
   and,	
   while	
   efforts	
   were	
   made	
  to	
  engage	
  with	
  youth	
  from	
  a	
  variety	
  of	
  backgrounds	
  and	
  life	
  experiences,	
  it	
  is	
   likely	
   that	
   this	
   sample	
   was	
   more	
   comfortable	
   with	
   issues	
   pertaining	
   to	
   young	
   people’s	
   sexuality	
   than	
   youth	
   at	
   large.	
   Furthermore,	
   both	
   the	
   virtual	
   and	
   the	
   ‘real’	
   worlds	
   within	
   which	
   youth	
   access	
   sexual	
   health	
   information	
   and	
   services	
   are	
   rapidly	
   changing;	
   thus,	
   these	
   findings	
   afford	
   a	
   snapshot	
   of	
   contemporary	
   youth	
   culture	
   at	
   the	
   time	
   this	
   study	
   was	
   conducted	
   (whether	
   these	
   findings	
   remain	
   constant	
   over	
   significant	
   periods	
   of	
   time	
   remains	
   unknown).	
   Also,	
   within	
   the	
   time	
    	
    	
    57	
  	
    limitations	
   of	
   the	
   interviews	
   and	
   focus	
   groups,	
   only	
   a	
   small	
   number	
   of	
   websites	
   were	
   able	
   to	
   be	
   reviewed	
   in-­‐depth;	
   thus,	
   this	
   analysis	
   is	
   not	
   claimed	
   as	
   being	
   drawn	
   from	
  a	
  systematic	
  evaluation	
  and	
  gender	
  comparison	
  of	
  existing	
  web-­‐based	
  sexual	
   health	
   resources.	
   	
   Instead,	
   these	
   findings	
   inform	
   a	
   starting	
   point	
   for	
   an	
   empirical	
   review	
  of	
  the	
  gendered	
  qualities	
  of	
  online	
  sexual	
  health	
  websites	
  available	
  to	
  youth	
   –	
  building	
  on	
  important	
  work	
  in	
  this	
  area	
  (Buhi	
  et	
  al.,	
  2010;	
  Horvath,	
  Iantaffi,	
  Grey,	
   &	
   Bockting,	
   2011;	
   Keller,	
   LaBelle,	
   Karimi,	
   &	
   Gupta,	
   2004;	
   Knight	
   et	
   al.,	
   in	
   press)	
   –	
   an	
   important	
  next	
  step	
  in	
  understanding	
  the	
  ways	
  in	
  which	
  gendered	
  stereotypes	
  and	
   intervention	
   design	
   approaches	
   function	
   to	
   affect	
   youth’s	
   use	
   of	
   web-­‐based	
   sexual	
   health	
  resources.	
   	
   Much	
   of	
   the	
   broader	
   literature	
   concerning	
   men	
   and	
   health	
   care	
   seeking	
   suggests	
   that	
  men	
  tend	
  to	
  seek	
  help	
  only	
  when	
  faced	
  with	
  a	
  problem	
  –	
  most	
  often	
  pain	
  	
  –	
  as	
   opposed	
   to	
   proactive	
   or	
   pre-­‐emptive	
   approaches	
   (Addis	
   &	
   Mahalik,	
   2003;	
   Johnson	
   et	
   al.,	
   2011;	
   Knight	
   et	
   al.,	
   in	
   press;	
   O'Brien	
   &	
   Hunt,	
   2005).	
   In	
   this	
   regard,	
   STI	
   information	
   is	
   the	
   key	
   concern,	
   and	
   a	
   symptom	
   thereof	
   is	
   typically	
   what	
   brings	
   men	
   online	
   for	
   related	
   information	
   (and/or	
   toward	
   service	
   providers).	
   In	
   light	
   of	
   these	
   findings,	
   the	
   idealistic	
   notion	
   that	
   the	
   provision	
   of	
   health	
   services	
   online	
   might	
   be	
   the	
  catalyst	
  to	
  change	
  men’s	
  self-­‐health	
  and/or	
  help-­‐seeking	
  is	
  presumptuous,	
  if	
  not	
   naïve.	
  	
    	
    	
    	
    58	
  	
    Chapter	
  4.0	
  Discussion	
  	
   The	
   current	
   thesis	
   demonstrates	
   how	
   youth’s	
   experiences	
   with	
   online	
   sexual	
   health	
   resources	
   are	
   heavily	
   influenced	
   by	
   ‘real	
   world’	
   youth	
   culture	
   (e.g.,	
   values;	
   beliefs;	
   practices).	
   These	
   analyses	
   provided	
   an	
   in-­‐depth	
   examination	
   of	
   the	
   ways	
   in	
   which	
   reverse	
   discourse	
   within	
   online	
   sexual	
   health	
   resource	
   contexts	
   can	
   negatively	
   affect	
   perceptions	
   of	
   these	
   resources,	
   as	
   well	
   as	
   illustrated	
   the	
   ways	
   in	
   which	
   gendered	
   stereotypes	
   regarding	
   sexual	
   health	
   help-­‐seeking	
   practices	
   extend	
   to	
   online	
   practices.	
   These	
   findings	
   advance	
   the	
   empirical	
   and	
   theoretical	
   knowledge	
   about	
  youth’s	
  experiences	
  accessing	
  online	
  sexual	
  health	
  services.	
   	
   4.1	
  Summary	
  of	
  findings	
   	
   Chapter	
   2,	
   ‘Sounds	
   like	
   the	
   person	
   you’re	
   drinking	
   with’:	
   Examining	
   youth’s	
   perspectives	
  on	
  the	
  use	
  of	
  reverse	
  discourse	
  in	
  web-­‐based	
  sexual	
  health	
  interventions	
   examined	
   the	
   use	
   of	
   reverse	
   discourse	
   in	
   internet-­‐based	
   sexual	
   health	
   promotion	
   and	
   analyzes	
   youth’s	
   perspectives	
   on	
   this	
   approach.	
   Youth	
   were	
   asked	
   to	
   provide	
   their	
  perspectives	
  on	
  samples	
  of	
  written	
  (e.g.,	
  clinical	
  language;	
  colloquial	
  language)	
   and	
  visual	
  (e.g.,	
  generic,	
  stock	
  images;	
  sexualized	
  images)	
  depictions	
  of	
  sexual	
  health	
   topics	
   on	
   English-­‐language	
   sexual	
   health	
   websites.	
   More	
   explicit	
   styles	
   elicited	
   negative	
   responses	
   from	
   youth	
   in	
   terms	
   of	
   perceived	
   appeal,	
   trust,	
   and	
   quality	
   of	
   these	
   websites.	
   For	
   example,	
   negative	
   social	
   mores	
   were	
   associated	
   with	
   some	
   of	
   the	
  more	
  explicit	
  portrayals	
  of	
  young	
  people’s	
  sexual	
  lives	
  on	
  the	
  websites,	
  revealing	
   how	
  reverse	
  discourse	
  re-­‐stigmatizes	
  youth	
  by	
  re-­‐emphasizing	
  youth	
  sexual	
  activity	
    	
    	
    59	
  	
    as	
   inherently	
   risky	
   or	
   immoral.	
   Reverse	
   discourse	
   was	
   perceived	
   to	
   have	
   negative	
   effects	
  on	
  the	
  saliency	
  and	
  credibility	
  of	
  online	
  sexual	
  health	
  information.	
  	
   	
   Chapter	
   3,	
   Interrogating	
  gendered	
  stereotypes:	
  Young	
  people’s	
  descriptions	
  of	
  online	
   sexual	
  health	
  approaches,	
  provided	
  insights	
  into	
  the	
  ways	
  in	
  which	
  gendered	
  norms	
   feature	
   in	
   youth’s	
   receptivity	
   to	
   and	
   recommendations	
   for	
   online	
   sexual	
   health	
   resources	
   (e.g.,	
   Internet-­‐based	
   Sexually	
   Transmitted	
   Infection	
   (STI)	
   testing;	
   online	
   sexual	
   health	
   education).	
   Gendered	
   stereotypes	
   can	
   influence	
   youth’s	
   experiences	
   accessing	
   conventional,	
   face-­‐to-­‐face	
   sexual	
   health	
   services;	
   however	
   the	
   interconnections	
   between	
   gender	
   and	
   youth’s	
   uptake	
   of	
   online	
   sexual	
   health	
   resources	
   is	
   poorly	
   understood.	
   Study	
   participants	
   discussed	
   and	
   critiqued	
   an	
   array	
   of	
   existing	
   websites,	
   suggesting	
   the	
   graphics	
   and	
   content	
   anchored	
   them	
   as	
   feminized	
   spaces.	
   Many	
   gender	
   stereotypes	
   that	
   influence	
   non-­‐virtual	
   health-­‐ seeking	
   behaviours	
   prevailed	
   in	
   youth’s	
   descriptions	
   about	
   the	
   likely	
   end-­‐users	
   of	
   online	
   sexual	
   health	
   resources.	
   For	
   example,	
   young	
   women	
   were	
   represented	
   as	
   being	
   more	
   frequent	
   users	
   of	
   online	
   resources	
   than	
   young	
   men,	
   due	
   to	
   young	
   women’s	
   ‘nature’	
   (e.g.,	
   diligence	
   around	
   self-­‐sexual	
   health),	
   desire	
   to	
   maintain	
   a	
   good	
   reputation	
   	
   (e.g.,	
   to	
   remain	
   free	
   of	
   STIs	
   for	
   fear	
   of	
   being	
   labeled	
   negatively),	
   and	
  the	
  social	
  milieu	
  (e.g.,	
  norms	
  that	
  frame	
  young	
  women	
  as	
  caretakers	
  of	
  sexual	
   relationships).	
  Some	
  online	
  services	
  were	
  described	
  as	
  ‘male-­‐friendly’	
  because	
  they	
   were	
   perceived	
   to	
   provide	
   young	
   men	
   the	
   opportunity	
   to	
   access	
   sexual	
   health	
   services	
   anonymously	
   amid	
   avoiding	
   potentially	
   emasculating	
   face-­‐to-­‐face	
   discussions	
  with	
  peers,	
  partners	
  or	
  providers.	
  	
  	
    	
    	
    60	
  	
    4.2	
  Implications	
  for	
  web-­‐based	
  sexual	
  health	
  interventions	
   	
   The	
   current	
   thesis	
   provides	
   new	
   evidence	
   to	
   inform	
   online	
   sexual	
   health	
   interventions	
   for	
   young	
   men	
   and	
   women.	
   While	
   a	
   growing	
   body	
   of	
   research	
   supports	
   online	
   approaches	
   to	
   sexual	
   health	
   services	
   (as	
   compared	
   to	
   face-­‐to-­‐face	
   clinical	
  encounters)(Bilardi	
  et	
  al.,	
  2009;	
  Peeling,	
  2006;	
  Ross,	
  Ison,	
  &	
  Radcliffe,	
  2006),	
   we	
  have	
  yet	
  to	
  fully	
  explore	
  the	
  nexus	
  of	
  the	
  social	
  and	
  technical	
  aspects	
  of	
  online	
   sexual	
  health	
  websites.	
  	
  The	
  current	
  thesis	
  offers	
  new	
  insights	
  regarding	
  the	
  role	
  of	
   social	
   factors	
   (e.g.,	
   ethnicity,	
   sexual	
   identity)	
   and	
   how	
   they	
   are	
   thought	
   to	
   affect	
   experiences	
  with	
  online	
  sexual	
  health	
  resources	
  (Daneback	
  et	
  al.,	
  2011;	
  Magee	
  et	
  al.,	
   2011;	
  Romocki,	
  2004;	
  Ross	
  et	
  al.,	
  2006).	
  	
   	
   Some	
   other	
   research	
   challenges	
   the	
   idea	
   that	
   online	
   approaches	
   effectively	
   ‘neutralize’	
   the	
   effects	
   of	
   negative	
   social	
   relations	
   (e.g.,	
   stigma;	
   stereotyping)	
   (Christofides	
   &	
   Islam,	
   2009;	
   Holmes	
   &	
   O'Byrne,	
   2006).	
   Acknowledging	
   the	
   socio-­‐ technical	
   nature	
   of	
   the	
   human-­‐computer	
   interface	
   (Mackenzie	
   et	
   al.,	
   2007),	
   new	
   intervention	
   approaches	
   must	
   attend	
   to	
   the	
   complexities	
   inherent	
   in	
   online	
   sexual	
   health	
   services	
   (e.g.,	
   Internet-­‐based	
   STI/HIV	
   testing;	
   web-­‐based	
   sexual	
   health	
   counselling;	
   email-­‐based	
   partner	
   notification)	
   (Simkins,	
   2007).	
   For	
   example,	
   it	
   is	
   known	
   that	
   women	
   and	
   men	
   communicate	
   differently	
   online	
   (as	
   they	
   do	
   offline)	
   (Guiller,	
   2007)	
   and	
   online	
   communication	
   is	
   prone	
   to	
   the	
   incorporation	
   of	
   ‘real	
   world’	
   stereotypes	
   (e.g.,	
   conformation	
   to	
   gendered	
   expectations	
   about	
   behaviour;	
   differential	
   responses	
   to	
   masculinized/feminized	
   text)	
   (Christofides	
   &	
   Islam,	
   2009).	
   While	
  the	
  face-­‐to-­‐face	
  interactions	
  benefit	
  from	
  the	
  nuances	
  of	
  contextualized	
  body	
    	
    	
    61	
  	
    language,	
   conversation	
   flow,	
   and	
   setting	
   (be	
   they	
   positive	
   or	
   negative),	
   online	
   interactions	
   lack	
   this	
   advantage,	
   and	
   may	
   be	
   constructed	
   and/or	
   understood	
   differently	
  (Garcia,	
  Standlee,	
  &	
  Bechkoff,	
  2009;	
  Ho,	
  2008).	
  	
   	
   For	
  example,	
  while	
  the	
  use	
  of	
  reverse	
  discourse	
  (e.g.,	
  to	
  contest	
  negative	
  judgments	
   relating	
  to	
  youth	
  sexual	
  behaviour)	
  may	
  be	
  effective	
  in	
  some	
  face-­‐to-­‐face	
  contexts,	
   the	
  current	
  thesis	
  suggests	
  that	
  this	
  might	
  not	
  always	
  be	
  the	
  case	
  in	
  virtual	
  contexts.	
   Instead,	
   intervention	
   designers	
   should	
  consider	
  focusing	
  on	
  engaging	
  youth	
  online	
   through	
  a	
  professional,	
  information-­‐driven	
  approach.	
  While	
  online	
  approaches	
  that	
   convey	
   an	
   engaged,	
   non-­‐judgmental	
   attitude	
   are	
   important,	
   consideration	
   must	
   be	
   taken	
   to	
   avoid	
   more	
   explicit	
   portrayals	
   of	
   young	
   people’s	
   sexual	
   lives	
   on	
   the	
   websites	
   with	
   which	
   negative	
   social	
   mores	
   may	
   be	
   associated.	
   In	
   this	
   way,	
   online	
   sexual	
  health	
  interventions	
  may	
  avoid	
  re-­‐stigmatizing	
  youth	
  sexual	
  activity	
  (e.g.,	
  as	
   inherently	
   risky	
   or	
   immoral).	
   Furthermore,	
   as	
   previous	
   research	
   has	
   shown	
   that	
   youth	
   are	
   reluctant	
   to	
   fully	
   trust	
   web-­‐based	
   sexual	
   health	
   resources	
   (Jones,	
   2011;	
   Jones	
   et	
   al.,	
   2011),	
   it	
   is	
   imperative	
   that	
   interventions	
   of	
   this	
   nature	
   cultivate	
   an	
   approach	
   that	
   fosters	
   a	
   sense	
   of	
   trust,	
   respect	
   and	
   credibility	
   –	
   something	
   potentially	
   undermined	
   by	
   the	
   employment	
   of	
   reverse	
   discourse.	
   While	
   reverse	
   discourse	
   may	
   be	
   employed	
   to	
   reach	
   youth	
   by	
   using	
   ‘their	
   language’,	
   slang	
   or	
   colloquialisms	
  should	
  be	
  used	
  with	
  caution.	
  Acknowledging	
  that	
  there	
  are	
  tradeoffs	
   between	
   conveying	
   accurate	
   information	
   and	
   avoiding	
   overly	
   clinical	
   language,	
   online	
   sexual	
   health	
   resources	
   should	
   strike	
   a	
   balance	
   and	
   convey	
   informative	
   content	
   that	
   resonates	
   with	
   the	
   audiences	
   (and	
   is	
   within	
   an	
   accessible	
   reading	
    	
    	
    62	
  	
    level).	
   	
   As	
   discussed	
   in	
   the	
   current	
   thesis,	
   in	
   many	
   ways,	
   online	
   spaces	
   are	
   inherently	
   gendered	
  (Mo	
  et	
  al.,	
  2009).	
  Attempts	
  by	
  online	
  program	
  designers	
  to	
  offer	
  ‘neutral’	
   spaces	
   may	
   fail	
   to	
   acknowledge	
   the	
   influences	
   of	
   a	
   wider	
   set	
   of	
   social	
   relations	
   (e.g.,	
   gender	
  norms)	
  within	
  which	
  youth	
  operate	
  (and	
  to	
  which	
  they	
  contribute)	
  (East	
  et	
   al.,	
   2011;	
   Knight,	
   2011;	
   Magee	
   et	
   al.,	
   2011;	
  Shoveller	
   et	
   al.,	
   2004;	
   2011).	
   To	
   begin	
   to	
   address	
  this,	
  intervention	
  planners	
  can	
  take	
  several	
  possible	
  approaches.	
   Somewhat	
   analogous	
   to	
   conventional	
   health	
   practices,	
   young	
   men’s	
   online	
   sexual	
   health-­‐ related	
  practices	
  (e.g.,	
  searching	
  for	
  local	
  STI/HIV	
  testing	
  services)	
  are	
  likely	
  to	
  be	
   shaped	
  by	
  masculine	
  ideals	
  (Knight	
  et	
  al.,	
  in	
  press).	
  Thus,	
  efforts	
  should	
  be	
  made	
  to	
   design	
  online	
  sexual	
  health	
  resources	
  that	
  are	
  especially	
  ‘male-­‐friendly’,	
  keeping	
  in	
   mind	
   what	
   has	
   been	
   learned	
   about	
   engaging	
   men	
   online	
   in	
   disciplines	
   other	
   than	
   health	
   (Jackson	
   et	
   al.,	
   2001;	
   Moss	
   &	
   Gunn,	
   2006).	
   	
   Inherent	
   in	
   this	
   is	
   the	
   idea	
   that	
   interventions	
   must,	
   in	
   some	
   ways,	
   meet	
   men	
   ‘where	
   they’re	
   at’;	
   however,	
   care	
   must	
   be	
  taken	
  to	
  avoid	
  inadvertently	
  reproducing	
  limiting	
  portrayals	
  of	
  gender	
  roles	
  (e.g.,	
   stereotypes	
   about	
   men	
   as	
   being	
   sexually	
   irresponsible)	
   and/or	
   endorsing	
   male	
   patriarchal	
   hegemony	
   (Knight,	
   2011;	
   Larkin,	
   Andrews	
   &	
   Mitchell,	
   2006).	
   Instead,	
   interventions	
  must	
  take	
  a	
  careful,	
  nuanced	
  approach,	
  and	
  be	
  considerate	
  of	
  intended	
   as	
   well	
   as	
   unintended	
   consequences	
   related	
   to	
   gendered	
   aspects	
   of	
   youth’s	
   sexual	
   health.	
   	
    	
    	
    63	
  	
    Alternatively,	
   efforts	
   could	
   be	
   taken	
   to	
   engage	
   men	
   within	
   sexual	
   health	
   websites	
   targeted	
   towards	
   ‘both’	
   genders.	
   However,	
   many	
   ‘gender	
   neutral’	
   approaches	
   to	
   online	
   approaches	
   potentially	
   translate	
   into	
   yet	
   another	
   sphere	
   within	
   which	
   gendered	
  social	
  norms	
  (e.g.,	
  concerning	
  men	
  and	
  women’s	
  roles	
  and	
  responsibilities	
   relating	
   to	
   sexual	
   health)	
   remain	
   and	
   are	
   often	
   re-­‐produced.	
   In	
   designing	
   new	
   interventions,	
   there	
   is	
   an	
   opportunity	
   to	
   purposefully	
   re-­‐write	
   gender	
   within	
   online	
   sites	
  (Barker,	
  Ricardo,	
  Nascimento,	
  Olukoya,	
  &	
  Santos,	
  2010;	
  Robinson	
  &	
  Robertson,	
   2010).	
   For	
   example,	
   date	
   rape	
   could	
   (re)chronicled	
   as	
   a	
   men’s	
   issue	
   –	
   with	
   men	
   positioned	
   much	
   more	
   positively	
   as	
   being	
   part	
   of	
   the	
   solution,	
   including	
   lobbying	
   and	
  more	
  aggressively	
  legislating	
  against	
  it).	
  Similarly,	
  youth	
  pregnancy	
  could	
  also	
   be	
   reshaped	
   as	
   a	
   shared	
   issue	
   (e.g.,	
   information	
   framing	
   responsibility	
   for	
   pregnancy	
  prevention	
  as	
  a	
  shared	
  responsibility	
  within	
  heterosexual	
  partnerships).	
   	
   4.3	
  Implications	
  for	
  future	
  research	
  	
   	
   While	
   the	
   current	
   thesis	
   offers	
   an	
   analysis	
   of	
   youth’s	
   descriptions	
   of	
   gendered	
   stereotypes	
  relating	
  to	
  online	
  sexual	
  health	
  website	
  use,	
  a	
  possible	
  next	
  step	
  would	
   be	
   to	
   collect	
   primary	
   data	
   regarding	
   gendered	
   access	
   to	
   sexual	
   health	
   sites.	
   For	
   example,	
   a	
   quantitative	
   analysis	
   examining	
   how	
   young	
   men	
   and	
   women	
   use	
   web-­‐ based	
   sexual	
   health	
   resources	
   (e.g.,	
   in	
   what	
   circumstances;	
   how	
   often	
   particular	
   sexual	
  health	
  websites	
  are	
  used	
  by	
  men	
  versus	
  women)	
  would	
  contribute	
  valuable	
   insights	
  to	
  gendered	
  aspects	
  of	
  web-­‐based	
  sexual	
  health	
  resource	
  use.	
  This	
  type	
  of	
    	
    	
    64	
  	
    research	
  could	
  further	
  illuminate	
  the	
  validity	
  and	
  usefulness	
  youth’s	
  predictions	
  of	
   what	
  they	
  ‘would’	
  do,	
  using	
  evaluative	
  data	
  indicating	
  what	
  they	
  actually	
  ‘do’	
  do.	
  	
  	
  	
  	
  	
   	
   It	
   has	
   been	
   argued	
   that,	
   often,	
   masculinities	
   are	
   more	
   fully	
   understood	
   by	
   considering	
  what	
  is	
  not	
  masculine.	
  Knowing	
  what	
  is	
  ‘un-­‐male’	
  does	
  little	
  to	
  inform	
   an	
   understanding	
   of	
   what	
   is	
   particularly	
   ‘male-­‐friendly’	
   within	
   web-­‐based	
   sexual	
   health	
   resources.	
   In	
   order	
   to	
   gain	
   insight	
   into	
   what	
   might	
   constitute	
   a	
   masculine	
   ‘look-­‐and-­‐feel’,	
  an	
  important	
  next	
  step	
  –	
  which	
  could	
  ultimately	
  inform	
  the	
  design	
  of	
   many	
  prospective	
  interventions	
  –	
  would	
  be	
  to	
  understand	
  what	
  type(s)	
  of	
  content	
   and	
   design	
   would	
   optimize	
   the	
   engagement	
   of	
   young	
   men,	
   contributing	
   to	
   the	
   development	
   and	
   expansion	
   of	
   men-­‐centred	
   online	
   sexual	
   health	
   resources.	
   For	
   example,	
   young	
   men	
   could	
   be	
   engaged	
   to	
   share	
   their	
   opinions	
   on	
   what	
   might	
   constitute	
  male-­‐friendly	
  content	
  and/or	
  design,	
  in	
  order	
  to	
  improve	
  saliency	
  of	
  and	
   access	
  to	
  web-­‐based	
  sexual	
  health	
  resources	
  for	
  young	
  men.	
  	
   	
   	
   4.3	
  Strengths	
  and	
  limitations	
  	
   	
   The	
  current	
  thesis	
  constitutes	
  an	
  exploration	
  of	
  youth’s	
  perspectives	
  on	
  web-­‐based	
   sexual	
   health	
   resources,	
   which	
   will	
   ultimately	
   contribute	
   to	
   the	
   development	
   of	
   more	
   youth-­‐‘friendly’	
   sexual	
   health	
   services	
   for	
   young	
   men	
   and	
   women.	
   While	
   interviews	
   and	
   focus	
   groups	
   were	
   designed	
   in	
   an	
   open-­‐ended	
   way	
   to	
   facilitate	
   participant	
  introspection	
  and	
  insightful	
  discussions,	
  ultimately,	
  youth	
  may	
  describe	
   online	
  experiences	
  and	
  behaviour	
  dissimilar	
  to	
  behaviour	
  actually	
  exhibited	
  (Suler,	
    	
    	
    65	
  	
    2004).	
   Furthermore,	
   compared	
   to	
   a	
   larger	
   sample	
   typically	
   used	
   in	
   quantitative	
   studies,	
  the	
  current	
  thesis	
  draws	
  data	
  from	
  a	
  relatively	
  small	
  number	
  of	
  interviews	
   and	
   focus	
   groups.	
   However,	
   these	
   in-­‐depth	
   data	
   collection	
   activities	
   allowed	
   for	
   a	
   more	
  in-­‐depth	
  exploration	
  of	
  issues	
  that	
  may	
  have	
  been	
  challenging	
  to	
  explore	
  using	
   quantitative	
   methodology,	
   and	
   the	
   purposive	
   sampling	
   strategy	
   allowed	
   for	
   the	
   exploration	
  of	
  a	
  diversity	
  of	
  perspectives.	
   	
   While	
  the	
  feasibility	
  and	
  acceptability	
  of	
  internet-­‐based	
  sexual	
  health	
  interventions	
   for	
   youth	
   has	
   been	
   established,	
   rigorous	
   evaluations	
   are	
   regrettably	
   infrequent	
   (Bennett	
  &	
  Glasgow,	
  2009;	
  McFarlane,	
  Kachur,	
  Klausner,	
  Roland,	
  &	
  Cohen,	
  2005;	
  C.	
   Rietmeijer,	
  2007).	
  The	
  utilization	
  of	
  web-­‐based	
  approaches	
  to	
  promote	
  youth	
  sexual	
   health	
  is	
  often	
  described	
  as	
  something	
  of	
  a	
  ‘new’	
  frontier	
  (Bennett	
  &	
  Glasgow,	
  2009;	
   Rietmeijer	
  &	
  McFarlane,	
  2009);	
  and,	
  Internet-­‐based	
  initiatives	
  are	
  being	
  developed	
   with	
   great	
   urgency	
   and	
   proliferation.	
   Unfortunately,	
   at	
   the	
   leading	
   edge	
   of	
   these	
   avant-­‐garde	
   initiatives	
   lies	
   a	
   “Catch-­‐22”	
   situation:	
   if	
   technology-­‐based	
   approaches	
   are	
  to	
  remain	
  up-­‐to-­‐date	
  with	
  the	
  dynamic	
  web-­‐environment,	
  interventions	
  must	
  be	
   simultaneously	
   developed	
   and	
   studied	
   (as	
   opposed	
   to	
   the	
   more	
   traditional	
   pilot-­‐ evaluate-­‐deploy	
  strategy).	
  In	
  Canada	
  in	
  particular,	
  online	
  sexual	
  health	
  services	
  are	
   relatively	
   new	
   and	
   have	
   received	
   little	
   research	
   attention.	
   	
   In	
   order	
   to	
   best	
   design	
   online	
   sexual	
   health	
   services	
   to	
   meet	
   the	
   needs	
   of	
   youth,	
   and	
   to	
   not	
   exacerbate	
   barriers	
   associated	
   with	
   existing,	
   conventional	
   (i.e.,	
   face-­‐to-­‐face)	
   services	
   (Harvey,	
   Churchill,	
  Crawford,	
  &	
  Brown,	
  2008;	
  Shoveller	
  et	
  al.,	
  2009),	
  such	
  an	
  examination	
  of	
   youth’s	
   perspectives	
   is	
   necessary	
   to	
   incorporate	
   into	
   the	
   development	
   and	
    	
    	
    66	
  	
    implementation	
   of	
   new	
   online	
   approaches.	
   To	
   ensure	
   timely	
   and	
   effective	
   translation	
   of	
   knowledge,	
   ongoing	
   research	
   findings	
   were	
   shared	
   with	
   BCCDC	
   program	
  planners	
  throughout	
  the	
  data	
  collection	
  and	
  analysis	
  process	
  through	
  my	
   integration	
   with	
   the	
   OSHSP	
   planning	
   team	
   (e.g.,	
   through	
   participation	
   in	
   regular	
   working	
   group	
   meetings).	
   Ultimately,	
   by	
   engaging	
   in	
   research	
   that	
   explores	
   some	
   of	
   the	
   socially	
   embedded	
   aspects	
   of	
   youth’s	
   participation	
   in	
   Internet-­‐based	
   sexual	
   health	
  activities,	
  we	
  can	
  pave	
  more	
  equitable	
  access	
  to	
  sexual	
  health	
  resources	
  for	
   youth,	
  both	
  online	
  and	
  offline.	
  	
    	
    	
    	
    67	
  	
    	
   References	
   	
   	
   Adams,	
  S.,	
  de	
  Bont,	
  A.,	
  &	
  Berg,	
  M.	
  (2006).	
  Looking	
  for	
  answers,	
  constructing	
   reliability:	
  an	
  exploration	
  into	
  how	
  Dutch	
  patients	
  check	
  web-­‐based	
  medical	
   information.	
  International	
  journal	
  of	
  Medical	
  Informatics,	
  75(1),	
  66–72.	
  	
   Addis,	
  M.	
  E.,	
  &	
  Mahalik,	
  J.	
  R.	
  (2003).	
  Men,	
  masculinity,	
  and	
  the	
  contexts	
  of	
  help	
   seeking.	
  American	
  Psychologist,	
  58(1),	
  5–14.	
  	
   Audrey,	
  S.,	
  Holliday,	
  J.,	
  &	
  Campbell,	
  R.	
  (2006).	
  It's	
  good	
  to	
  talk:	
  Adolescent	
   perspectives	
  of	
  an	
  informal,	
  peer-­‐led	
  intervention	
  to	
  reduce	
  smoking.	
  Social	
   Science	
  &	
  Medicine,	
  63(2),	
  320–334.	
   Bailey	
  J.V.,	
  Murray,	
  E.,	
  Rait,	
  G.,	
  Mercer,	
  C.H.,	
  Morris,	
  R.W.,	
  Peacock,	
  R.,	
  Cassell,	
  J.,	
  &	
   Nazareth,	
  I.	
  (2010).	
  Interactive	
  computer-­‐based	
  interventions	
  for	
  sexual	
  health	
   promotion,	
  1–56.	
  Cochrane	
  Database	
  of	
  Systematic	
  Reviews,	
  2010(9),	
  Article	
   CD006483.	
  Retrieved	
  January	
  24,	
  2012.	
   Baker,	
  L.,	
  Wagner,	
  T.	
  H.,	
  Singer,	
  S.,	
  &	
  Bundorf,	
  M.	
  K.	
  (2003).	
  Use	
  of	
  the	
  Internet	
  and	
  e-­‐ mail	
  for	
  health	
  care	
  information:	
  results	
  from	
  a	
  national	
  survey.	
  Journal	
  of	
  the	
   American	
  Medical	
  Association,	
  289(18),	
  2400–2406.	
  	
   Barak,	
  A.	
  (2003).	
  Experience	
  with	
  an	
  Internet-­‐based,	
  theoretically	
  grounded	
   educational	
  resource	
  for	
  the	
  promotion	
  of	
  sexual	
  and	
  reproductive	
  health.	
   Sexual	
  and	
  Relationship	
  Therapy,	
  38(4),	
  324-­‐332.	
   Barak,	
  A.,	
  &	
  Fisher,	
  W.	
  A.	
  (2001).	
  Toward	
  an	
  internet-­‐driven,	
  theoretically-­‐based,	
   innovative	
  approach	
  to	
  sex	
  education.	
  Journal	
  of	
  Sex	
  Research,	
  38(4),	
  324–332.	
  	
    	
    	
    68	
  	
    Barker,	
  G.,	
  Ricardo,	
  C.,	
  Nascimento,	
  M.,	
  Olukoya,	
  A.,	
  &	
  Santos,	
  C.	
  (2010a).	
  Questioning	
   gender	
  norms	
  with	
  men	
  to	
  improve	
  health	
  outcomes:	
  Evidence	
  of	
  impact.	
  Global	
   Public	
  Health,	
  5(5),	
  539–553.	
  	
   BCCDC.	
  (2011).	
  HIV	
  and	
  Sexually	
  Transmitted	
  Infections,	
  1–85.	
  Retrieved	
  21	
   January	
  2012	
  from:	
  http://www.bccdc.ca/NR/rdonlyres/2035512C-­‐DBEC-­‐ 495B-­‐A332-­‐ C410EE9520C7/0/CPS_Report_STI_HIV_2010_annual_report_FINAL_20111122. pdf	
   Ben-­‐Zeʼev,	
  A.,	
  &	
  Ben-­‐Ze'ev,	
  A.	
  (2004).	
  Love	
  online:	
  Emotions	
  on	
  the	
  Internet.	
   Cambridge:	
  Cambridge	
  University	
  Press.	
   Bennett,	
  G.	
  G.,	
  &	
  Glasgow,	
  R.	
  E.	
  (2009).	
  The	
  delivery	
  of	
  public	
  health	
  interventions	
   via	
  the	
  Internet:	
  actualizing	
  their	
  potential.	
  Annual	
  Review	
  of	
  Public	
  Health,	
  30,	
   273–292.	
  	
   Bilardi,	
  J.	
  E.,	
  Fairley,	
  C.	
  K.,	
  Hopkins,	
  C.	
  A.,	
  Hocking,	
  J.	
  S.,	
  Sze,	
  J.	
  K.,	
  &	
  Chen,	
  M.	
  Y.	
  (2010).	
   Let	
  Them	
  Know:	
  evaluation	
  of	
  an	
  online	
  partner	
  notification	
  service	
  for	
   chlamydia	
  that	
  offers	
  E-­‐mail	
  and	
  SMS	
  messaging.	
  Sexually	
  Transmitted	
  Diseases,	
   37(9),	
  563–565.	
  	
   Bilardi,	
  J.	
  E.,	
  Sanci,	
  L.	
  A.,	
  Fairley,	
  C.	
  K.,	
  Hocking,	
  J.	
  S.,	
  Mazza,	
  D.,	
  Henning,	
  D.	
  J.,	
  Sawyer,	
   S.	
  M.,	
  et	
  al.	
  (2009).	
  The	
  experience	
  of	
  providing	
  young	
  people	
  attending	
  general	
   practice	
  with	
  an	
  online	
  risk	
  assessment	
  tool	
  to	
  assess	
  their	
  own	
  sexual	
  health	
   risk.	
  BMC	
  Infectious	
  Diseases,	
  9(29).	
  	
   Borzekowski,	
  D.	
  L.,	
  &	
  Rickert,	
  V.	
  I.	
  (2001).	
  Adolescent	
  cybersurfing	
  for	
  health	
   information:	
  a	
  new	
  resource	
  that	
  crosses	
  barriers.	
  Archives	
  of	
  Pediatrics	
  &	
    	
    	
    69	
  	
    Adolescent	
  Medicine,	
  155(7),	
  813–817.	
   Brodie,	
  M.,	
  Flournoy,	
  R.,	
  Altman,	
  D.,	
  &	
  Blendon,	
  R.	
  (2000).	
  Health	
  information,	
  the	
   Internet,	
  and	
  the	
  digital	
  divide.	
  Health	
  Affairs,	
  19(6),	
  255-­‐265.	
   Buhi,	
  E.	
  R.,	
  Daley,	
  E.	
  M.,	
  Oberne,	
  A.,	
  Smith,	
  S.	
  A.,	
  Schneider,	
  T.,	
  &	
  Fuhrmann,	
  H.	
  J.	
   (2010).	
  Quality	
  and	
  accuracy	
  of	
  sexual	
  health	
  information	
  web	
  sites	
  visited	
  by	
   young	
  people.	
  Journal	
  of	
  Adolescent	
  Health,	
  47(2),	
  206–208.	
   Bull,	
  S.,	
  Phibbs,	
  S.,	
  Watson,	
  S.,	
  &	
  McFarlane,	
  M.	
  (2007).	
  What	
  do	
  young	
  adults	
  expect	
   when	
  they	
  go	
  online?	
  Lessons	
  for	
  development	
  of	
  an	
  STD/HIV	
  and	
  pregnancy	
   prevention	
  website.	
  Journal	
  of	
  Medical	
  Systems,	
  31(2),	
  149–158.	
   CATIE.	
  (2011).	
  hIV	
  In	
  Canada,	
  1–84.	
  Retrieved	
  21	
  January	
  2012	
  from:	
   http://www.catie.ca/pdf/Canada/HIV-­‐in-­‐Canada_ES.pdf	
   Catwell,	
  L.,	
  &	
  Sheikh,	
  A.	
  (2009).	
  Evaluating	
  eHealth	
  interventions:	
  the	
  need	
  for	
   continuous	
  systemic	
  evaluation.	
  PLoS	
  medicine,	
  6(8),	
  e1000126.	
  	
   Christofides,	
  E.,	
  &	
  Islam,	
  T.	
  (2009).	
  Gender	
  stereotyping	
  over	
  instant	
  messenger:	
  The	
   effects	
  of	
  gender	
  and	
  context.	
  Computers	
  in	
  Human	
  Behavior,	
  25(4),	
  897-­‐901.	
   Cline,	
  R.	
  J.,	
  &	
  Haynes,	
  K.	
  M.	
  (2001).	
  Consumer	
  health	
  information	
  seeking	
  on	
  the	
   Internet:	
  the	
  state	
  of	
  the	
  art.	
  Health	
  Education	
  Research,	
  16(6),	
  671–692.	
   Corbin,	
  J.	
  (1998).	
  Basics	
  of	
  qualitative	
  research:	
  Techniques	
  and	
  procedures	
  for	
   developing	
  grounded	
  theory.	
  Thousand	
  Oaks:	
  SAGE	
  Publications.	
   Courtenay,	
  W.	
  H.	
  (2004).	
  Best	
  practices	
  for	
  improving	
  college	
  men's	
  health.	
  New	
   Directions	
  for	
  Student	
  Services,	
  2004(107),	
  59–74.	
  	
   Crosby,	
  R.,	
  &	
  Noar,	
  S.	
  M.	
  (2010).	
  Theory	
  development	
  in	
  health	
  promotion:	
  are	
  we	
   there	
  yet?	
  Journal	
  of	
  Behavioral	
  Medicine,	
  33(4),	
  259–263.	
  	
    	
    	
    70	
  	
    Da	
  Silva,	
  S.	
  (1998).	
  Transvaluing	
  Immaturity:	
  Reverse	
  Discourses	
  of	
  Male	
   Homosexuality	
  in	
  EM	
  Forster's	
  Posthumously	
  Published	
  Fiction.	
  Criticism,	
  40.	
   Danaher,	
  B.	
  G.,	
  &	
  Seeley,	
  J.	
  R.	
  (2009).	
  Methodological	
  issues	
  in	
  research	
  on	
  web-­‐ based	
  behavioral	
  interventions.	
  Annals	
  of	
  Behavioral	
  Medicine,	
  38(1),	
  28–39.	
  	
   Daneback,	
  K.,	
  Månsson,	
  S.-­‐A.,	
  Ross,	
  M.	
  W.,	
  &	
  Markham,	
  C.	
  M.	
  (2011).	
  The	
  Internet	
  as	
  a	
   source	
  of	
  information	
  about	
  sexuality.	
  Sex	
  Education,	
  epublished	
  ahead	
  of	
  print,	
   1-­‐16.	
   Darroch,	
  J.,	
  Myers,	
  L.,	
  &	
  Cassell,	
  J.	
  (2003).	
  Sex	
  differences	
  in	
  the	
  experience	
  of	
  testing	
   positive	
  for	
  genital	
  chlamydia	
  infection:	
  a	
  qualitative	
  study	
  with	
  implications	
  for	
   public	
  health	
  and	
  for	
  a	
  national	
  screening	
  programme.	
  Sexually	
  Transmitted	
   Infections,	
  79(5),	
  372–373.	
   de	
  Cabo,	
  R.	
  M.,	
  Gimeno,	
  R.,	
  &	
  Martínez,	
  M.	
  (2011).	
  Perpetuating	
  gender	
  stereotypes	
   via	
  the	
  internet?	
  An	
  analysis	
  of	
  the	
  women's	
  presence	
  in	
  Spanish	
  online	
   newspapers.	
  Retrieved	
  18	
  February	
  2012	
  from:	
  http://mpra.ub.uni-­‐ muenchen.de/33557/1/MPRA_paper_33557.pdf	
   Demiris,	
  G.,	
  Afrin,	
  L.	
  B.,	
  Speedie,	
  S.,	
  Courtney,	
  K.	
  L.,	
  Sondhi,	
  M.,	
  Vimarlund,	
  V.,	
  Lovis,	
   C.,	
  et	
  al.	
  (2008).	
  Patient-­‐centered	
  applications:	
  use	
  of	
  information	
  technology	
  to	
   promote	
  disease	
  management	
  and	
  wellness.	
  A	
  white	
  paper	
  by	
  the	
  AMIA	
   knowledge	
  in	
  motion	
  working	
  group.	
  Journal	
  of	
  the	
  American	
  Medical	
   Informatics	
  Association,	
  15(1),	
  8–13.	
  	
   CDC	
  Division	
  of	
  STD	
  Prevention	
  (2011).	
  Sexually	
  Transmitted	
  Disease	
  Surveillance	
   2010,	
  1–187.	
  Retrieved	
  24	
  February	
  2012,	
  from:	
   http://www.cdc.gov/std/stats10/surv2010.pdf	
    	
    	
    71	
  	
    East,	
  L.,	
  Jackson,	
  D.,	
  O’Brien,	
  L.,	
  &	
  Peters,	
  K.	
  (2011).	
  Stigma	
  and	
  stereotypes:	
  Women	
   and	
  sexually	
  transmitted	
  infections.	
  Collegian:	
  Journal	
  of	
  the	
  Royal	
  College	
  of	
   Nursing	
  Australia,	
  19(1),	
  15-­‐21	
   Emmers-­‐Sommer,	
  T.,	
  Nebel,	
  S.,	
  &	
  Allison,	
  M.	
  (2009).	
  Patient	
  –provider	
   communication	
  about	
  sexual	
  health:	
  The	
  relationship	
  with	
  gender,	
  age,	
  gender-­‐ stereotypical	
  beliefs,	
  and	
  perceptions	
  of	
  communication	
  inappropriateness.	
  Sex	
   Roles,	
  60,	
  669-­‐681	
   Escoffery,	
  C.,	
  Miner,	
  K.	
  R.,	
  Adame,	
  D.	
  D.,	
  Butler,	
  S.,	
  McCormick,	
  L.,	
  &	
  Mendell,	
  E.	
   (2005).	
  Internet	
  use	
  for	
  health	
  information	
  among	
  college	
  students.	
  Journal	
  of	
   American	
  College	
  Health,	
  53(4),	
  183–188.	
  	
   Eysenbach,	
  G.	
  (2006).	
  Infodemiology:	
  tracking	
  flu-­‐related	
  searches	
  on	
  the	
  web	
  for	
   syndromic	
  surveillance.	
  AMIA	
  Annual	
  Symposium	
  proceedings,	
  244–248.	
   Eysenbach,	
  G.,	
  &	
  Köhler,	
  C.	
  (2002).	
  How	
  do	
  consumers	
  search	
  for	
  and	
  appraise	
   health	
  information	
  on	
  the	
  world	
  wide	
  web?	
  Qualitative	
  study	
  using	
  focus	
   groups,	
  usability	
  tests,	
  and	
  in-­‐depth	
  interviews,	
  BMJ,	
  324(7337),	
  573–577.	
   Fallows,	
  D.	
  (2005).	
  How	
  men	
  and	
  women	
  use	
  the	
  Internet.	
  Pew	
  Internet	
  and	
   American	
  Life	
  Project.	
  Retrieved	
  22	
  January	
  2012	
  from:	
   http://www.pewinternet.org/~/media//Files/Reports/2005/PIP_Women_and _Men_online.pdf.pdf	
   Flew,	
  T.,	
  &	
  Smith,	
  R.	
  K.	
  (2011).	
  New	
  media:	
  An	
  introduction.	
  Oxford:	
  Oxford	
   University	
  Press.	
   Forrest,	
  S.,	
  &	
  Strange,	
  V.	
  (2002).	
  A	
  comparison	
  of	
  students'	
  evaluations	
  of	
  a	
  peer-­‐ delivered	
  sex	
  education	
  programme	
  and	
  teacher-­‐led	
  provision.	
  Sex	
  Education,	
    	
    	
    72	
  	
    2(3),	
  195-­‐214.	
   Fortenberry,	
  J.	
  (2003).	
  Adolescent	
  sex	
  and	
  the	
  rhetoric	
  of	
  risk.	
  In:	
  Reducing	
   Adolescent	
  Risk:	
  Toward	
  an	
  Integrated	
  Approach.	
  Thousand	
  Oaks,	
  Calif:	
  Sage	
   Publications,	
   Fortenberry,	
  J.	
  D.,	
  McFarlane,	
  M.,	
  Bleakley,	
  A.,	
  Bull,	
  S.,	
  Fishbein,	
  M.,	
  Grimley,	
  D.	
  M.,	
   Malotte,	
  C.	
  K.,	
  et	
  al.	
  (2002).	
  Relationships	
  of	
  stigma	
  and	
  shame	
  to	
  gonorrhea	
  and	
   HIV	
  screening.	
  American	
  Journal	
  of	
  Public	
  Health,	
  92(3),	
  378–381.	
   Foucault,	
  M.	
  (1978).	
  The	
  History	
  of	
  Sexuality,	
  vol.	
  1.	
  New	
  York:	
  Vintage	
  Books.	
   Fox,	
  S.,	
  Rainie,	
  L.,	
  Horrigan,	
  J.,	
  Lenhart,	
  A.,	
  &	
  Spooner,	
  T.	
  (2000).	
  The	
  online	
   healthcare	
  revolution:	
  How	
  the	
  web	
  helps	
  Americans	
  take	
  better	
  care	
  of	
   themselves.	
  Pew	
  Internet	
  &	
  American	
  Life	
  Project.	
  Retrieved	
  18	
  February	
  2012	
   from:	
   http://www.pewinternet.org/~/media//Files/Reports/2000/PIP_Health_Repo rt.pdf.pdf	
   Fox,	
  S.,	
  Rainie,	
  L.,	
  Horrigan,	
  J.,	
  Lenhart,	
  A.,	
  &	
  Spooner,	
  T.	
  (2002).	
  Vital	
  decisions:	
  How	
   Internet	
  users	
  decide	
  what	
  information	
  to	
  trust	
  when	
  they	
  or	
  their	
  loved	
  ones	
  are	
   sick.	
  Retrieved	
  January	
  22,	
  2012	
  from:	
   http://www.pewinternet.org/~/media//Files/Reports/2002/PIP_Vital_Decisio ns_May2002.pdf.pdf	
   Garcia,	
  A.,	
  Standlee,	
  A.,	
  &	
  Bechkoff,	
  J.	
  (2009).	
  Ethnographic	
  approaches	
  to	
  the	
   internet	
  and	
  computer-­‐mediated	
  communication.	
  	
  Journal	
  of	
  Contemporary	
   Ethnography.	
  38(1),	
  52-­‐84	
   Goffman,	
  E.	
  (1986).	
  Stigma:	
  notes	
  on	
  the	
  management	
  of	
  spoiled	
  identity.	
  New	
    	
    	
    73	
  	
    York/USA:	
  Touchstone.	
   Goldenberg,	
  S.	
  M.,	
  Shoveller,	
  J.	
  A.,	
  Ostry,	
  A.	
  C.,	
  &	
  Koehoorn,	
  M.	
  (2008a).	
  Sexually	
   transmitted	
  infection	
  (STI)	
  testing	
  among	
  young	
  oil	
  and	
  gas	
  workers:	
  the	
  need	
   for	
  innovative,	
  place-­‐based	
  approaches	
  to	
  STI	
  control.	
  Canadian	
  Journal	
  of	
  Public	
   Health,	
  99(4),	
  350–354.	
   Goldenberg,	
  S.,	
  Shoveller,	
  J.,	
  Koehoorn,	
  M.,	
  &	
  Ostry,	
  A.	
  (2008b).	
  Barriers	
  to	
  STI	
   testing	
  among	
  youth	
  in	
  a	
  Canadian	
  oil	
  and	
  gas	
  community.	
  Health	
  &	
  Place,	
  14(4),	
   718–729.	
  	
   Gray,	
  N.	
  J.,	
  Klein,	
  J.	
  D.,	
  Cantrill,	
  J.	
  A.,	
  &	
  Noyce,	
  P.	
  R.	
  (2002).	
  Adolescent	
  girls'	
  use	
  of	
  the	
   Internet	
  for	
  health	
  information:	
  issues	
  beyond	
  access.	
  Journal	
  of	
  Medical	
   Systems,	
  26(6),	
  545–553.	
   Gray,	
  N.	
  J.,	
  Klein,	
  J.	
  D.,	
  Noyce,	
  P.	
  R.,	
  Sesselberg,	
  T.	
  S.,	
  &	
  Cantrill,	
  J.	
  A.	
  (2005).	
  Health	
   information-­‐seeking	
  behaviour	
  in	
  adolescence:	
  the	
  place	
  of	
  the	
  internet.	
  Social	
   Science	
  &	
  Medicine,	
  60(7),	
  1467–1478.	
  	
   Gray-­‐Swain,	
  M.	
  R.,	
  &	
  Peipert,	
  J.	
  F.	
  (2006).	
  Pelvic	
  inflammatory	
  disease	
  in	
  adolescents.	
   Current	
  Opinion	
  in	
  Obstetrics	
  &	
  Gynecology,	
  18(5),	
  503–510.	
  	
   Greaves,	
  L.,	
  Oliffe,	
  J.	
  L.,	
  Ponic,	
  P.,	
  Kelly,	
  M.	
  T.,	
  &	
  Bottorff,	
  J.	
  L.	
  (2010).	
  Unclean	
  fathers,	
   responsible	
  men:	
  Smoking,	
  stigma	
  and	
  fatherhood.	
  Health	
  Sociology	
  Review,	
   19(4),	
  522-­‐533.	
  	
   Green,	
  J.	
  (2000).	
  The	
  role	
  of	
  theory	
  in	
  evidence-­‐based	
  health	
  promotion	
  practice.	
   Health	
  Education	
  Research,	
  15(2),	
  125–129.	
   Greene,	
  M.	
  E.	
  (2000).	
  Changing	
  Women	
  and	
  Avoiding	
  Men:	
  Gender	
  Stereotypes	
  and	
   Reproductive	
  Health	
  Programmes.	
  IDS	
  Bulletin,	
  31(2),	
  49–59.	
  	
    	
    	
    74	
  	
    Guiller,	
  J.	
  (2007).	
  Students'	
  linguistic	
  behaviour	
  in	
  online	
  discussion	
  groups:	
  Does	
   gender	
  matter?	
  Computers	
  in	
  Human	
  Behavior,	
  23(5),	
  2240-­‐2255.	
   Hanauer,	
  D.,	
  Dibble,	
  E.,	
  &	
  Fortin,	
  J.	
  (2004).	
  Internet	
  use	
  among	
  community	
  college	
   students:	
  implications	
  in	
  designing	
  healthcare	
  interventions.	
  Journal	
  of	
   American	
  College	
  Health,	
  52(5),	
  197-­‐202.	
   Harden,	
  A.,	
  Oakley,	
  A.,	
  &	
  Oliver,	
  S.	
  (2001).	
  Peer-­‐delivered	
  health	
  promotion	
  for	
   young	
  people:	
  A	
  systematic	
  review	
  of	
  different	
  study	
  designs.	
  Health	
  Education	
   Journal,	
  60(4),	
  339–353.	
  	
   Harvey,	
  K.,	
  Churchill,	
  D.,	
  Crawford,	
  P.,	
  Brown,	
  B.,	
  Mullany,	
  L.,	
  Macfarlane,	
  A.,	
  &	
   McPherson,	
  A.	
  (2008b).	
  Health	
  communication	
  and	
  adolescents:	
  what	
  do	
  their	
   emails	
  tell	
  us?	
  Family	
  Practice,	
  25(4),	
  304–311.	
  	
   Heathfield,	
  H.	
  A.,	
  &	
  Buchan,	
  I.	
  E.	
  (1996).	
  Current	
  evaluations	
  of	
  information	
   technology	
  in	
  health	
  care	
  are	
  often	
  inadequate.	
  BMJ,	
  313(7063),	
  1008.	
   Helsper,	
  E.	
  (2010).	
  Gendered	
  internet	
  use	
  across	
  generations	
  and	
  life	
  stages.	
   Communication	
  Research,	
  37(3)	
  352–374	
   Hesse,	
  B.	
  W.,	
  Nelson,	
  D.	
  E.,	
  Kreps,	
  G.	
  L.,	
  Croyle,	
  R.	
  T.,	
  Arora,	
  N.	
  K.,	
  Rimer,	
  B.	
  K.,	
  &	
   Viswanath,	
  K.	
  (2005).	
  Trust	
  and	
  Sources	
  of	
  Health	
  Information:	
  The	
  Impact	
  of	
   the	
  Internet	
  and	
  Its	
  Implications	
  for	
  Health	
  Care	
  Providers:	
  Findings	
  From	
  the	
   First	
  Health	
  Information	
  National	
  Trends	
  Survey.	
  Archives	
  of	
  Internal	
  Medicine,	
   165(22),	
  2618.	
  	
   Hilton,	
  G.	
  L.	
  S.	
  (2003).	
  Listening	
  to	
  the	
  Boys:	
  English	
  boys'	
  views	
  on	
  the	
  desirable	
   characteristics	
  of	
  teachers	
  of	
  sex	
  education.	
  	
  Sex	
  Education,	
  3(1),	
  33-­‐45.	
   Ho,	
  S.	
  (2008).	
  Social-­‐psychological	
  influences	
  on	
  opinion	
  expression	
  in	
  face-­‐to-­‐face	
    	
    	
    75	
  	
    and	
  computer-­‐mediated	
  communication.	
  Communication	
  Research,	
  35(2),	
  190-­‐ 207.	
   Hogben,	
  M.,	
  &	
  Hood,	
  J.	
  (2011).	
  Acquired	
  skills	
  in	
  sexually	
  transmitted	
  disease	
   prevention:	
  partner	
  services	
  and	
  tailoring	
  interventions	
  to	
  populations.	
  Sexually	
   Transmitted	
  Diseases,	
  38(5),	
  365–366.	
   Holmes,	
  D.,	
  &	
  O'Byrne,	
  P.	
  (2006).	
  The	
  art	
  of	
  public	
  health	
  nursing:	
  using	
  confession	
   technè	
  in	
  the	
  sexual	
  health	
  domain.	
  Journal	
  of	
  advanced	
  nursing,	
  56(4),	
  430–437.	
  	
   Horvath,	
  K.	
  J.,	
  Iantaffi,	
  A.,	
  Grey,	
  J.	
  A.,	
  &	
  Bockting,	
  W.	
  (2011).	
  A	
  Review	
  of	
  the	
  Content	
   and	
  Format	
  of	
  Transgender-­‐Related	
  Webpages.	
  Health	
  Communication,	
  e-­‐ published	
  ahead	
  of	
  print.	
   HPA.	
  (2008).	
  Sexually	
  transmitted	
  infections	
  and	
  young	
  people	
  in	
  the	
  United	
  Kingdom:	
   2008	
  report	
  (pp.	
  1–8).	
  Retrieved	
  25	
  February	
  2012	
  from:	
   http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1216022461534	
   Hu,	
  Y.	
  (2010).	
  Effects	
  of	
  online	
  health	
  sources	
  on	
  credibility	
  and	
  behavioral	
   intentions.	
  Communication	
  Research, 37(1)	
  105–132.	
   Ilie,	
  V.,	
  Van	
  Slyke,	
  C.,	
  &	
  Green,	
  G.	
  (2005).	
  Gender	
  differences	
  in	
  perceptions	
  and	
  use	
   of	
  communication	
  technologies:	
  a	
  diffusion	
  of	
  innovation	
  approach.	
  Information	
   Resources	
  Management	
  Journal,	
  18(3),	
  13-­‐31	
   Ingham,	
  R.	
  (2005).	
  'We	
  didn‘t	
  cover	
  that	
  at	
  school’:	
  Education	
  against	
  pleasure	
  or	
   education	
  for	
  pleasure?	
  Sex	
  Education,	
  5(4),	
  375-­‐38	
   Jackson,	
  L.,	
  Ervin,	
  K.,	
  &	
  Gardner,	
  P.	
  (2001).	
  Gender	
  and	
  the	
  Internet:	
  Women	
   communicating	
  and	
  men	
  searching.	
  Sex	
  Roles,	
  44(5-­‐6),	
  363-­‐379.	
   Jancin,	
  B.	
  (2009,	
  Nov	
  1).	
  Web-­‐Based	
  STD	
  Tool	
  Makes	
  Screening	
  Accessible.	
  Internal	
    	
    	
    76	
  	
    Medicine	
  News,	
  Retrieved	
  from:	
  http://www.internalmedicinenews.com	
   Johnson,	
  J.	
  L.,	
  Oliffe,	
  J.	
  L.,	
  Kelly,	
  M.	
  T.,	
  Galdas,	
  P.,	
  &	
  Ogrodniczuk,	
  J.	
  S.	
  (2011).	
  Men's	
   discourses	
  of	
  help-­‐seeking	
  in	
  the	
  context	
  of	
  depression.	
  Sociology	
  of	
  Health	
  &	
   Illness.	
  34(3),	
  345-­‐361	
   Jones,	
  R.	
  (2011).	
  The	
  more	
  things	
  change…:	
  The	
  relative	
  importance	
  of	
  the	
  internet	
   as	
  a	
  source	
  of	
  contraceptive	
  information	
  for	
  teens.	
  Sexuality	
  Research	
  and	
  Social	
   Policy,	
  8(1),	
  27-­‐37.	
   Jones,	
  R.	
  K.,	
  &	
  Biddlecom,	
  A.	
  E.	
  (2011).	
  Is	
  the	
  internet	
  filling	
  the	
  sexual	
  health	
   information	
  gap	
  for	
  teens?	
  An	
  exploratory	
  study.	
  Journal	
  of	
  Health	
   Communication,	
  16(2),	
  112–123.	
  	
   Jones,	
  R.,	
  Biddlecom,	
  A.,	
  &	
  Hebert,	
  L.	
  (2011).	
  Teens	
  Reflect	
  on	
  Their	
  Sources	
  of	
   Contraceptive	
  Information.	
  Journal	
  of	
  Adolescent	
  Research, 26(4)	
  423-­‐446.	
   Kanuga,	
  M.,	
  &	
  Rosenfeld,	
  W.	
  (2004).	
  Adolescent	
  sexuality	
  and	
  the	
  internet:	
  the	
  good,	
   the	
  bad,	
  and	
  the	
  URL.	
  Journal	
  of	
  Pediatric	
  and	
  Adolescent	
  Gynecology,	
  17(2),	
  117– 124.	
   Kehily,	
  M.	
  (2002).	
  Sexing	
  the	
  subject:	
  teachers,	
  pedagogies	
  and	
  sex	
  education.	
  Sex	
   Education,	
  2(3),	
  215-­‐231	
   Keller,	
  S.	
  N.,	
  LaBelle,	
  H.,	
  Karimi,	
  N.,	
  &	
  Gupta,	
  S.	
  (2004).	
  Talking	
  about	
  STD/HIV	
   prevention:	
  a	
  look	
  at	
  communication	
  online.	
  AIDS	
  Care,	
  16(8),	
  977–992.	
  	
   Kiene,	
  S.	
  M.,	
  &	
  Barta,	
  W.	
  D.	
  (2006).	
  A	
  brief	
  individualized	
  computer-­‐delivered	
  sexual	
   risk	
  reduction	
  intervention	
  increases	
  HIV/AIDS	
  preventive	
  behavior.	
  Journal	
  of	
   Adolescent	
  Health,	
  39(3),	
  404–410.	
  	
   Kingfisher,	
  C.	
  (1996).	
  Women	
  on	
  welfare:	
  Conversational	
  sites	
  of	
  acquiescence	
  and	
    	
    	
    77	
  	
    dissent.	
  Discourse	
  &	
  Society,	
  7(4),	
  531-­‐557.	
   Kirby,	
  D.,	
  Short,	
  L.,	
  Colins,	
  J.,	
  Rugg,	
  D.,	
  Kolber,	
  L.,	
  Howard,	
  M.,	
  Miller,	
  B.,	
  Sonenstein,	
  F.,	
   &	
  Zabin,	
  L.S.	
  (1994).	
  School-­‐based	
  programs	
  to	
  reduce	
  sexual	
  risk	
  behaviors:	
  a	
   review	
  of	
  effectiveness.	
  Public	
  Health	
  Reports,	
  109(3),	
  339-­‐360.	
  	
   Knight,	
  R.	
  (2011).	
  Masculinity,	
  heteronormativity	
  and	
  young	
  men's	
  sexual	
  health	
  in	
   British	
  Columbia,	
  Canada.	
  Unpublished	
  thesis,	
  University	
  of	
  British	
  Columbia.	
   Knight,	
  R.	
  E.,	
  Shoveller,	
  J.,	
  Oliffe,	
  J.,	
  Gilbert,	
  M.,	
  Frank,	
  B.,	
  &	
  Ogilvie,	
  G.	
  (in	
  press).	
  ‘Guy	
   Talk’	
  and	
  ‘Manning	
  Up’:	
  A	
  discourse	
  analysis	
  of	
  how	
  young	
  men	
  talk	
  about	
   sexual	
  health.	
  Sociology	
  of	
  Health	
  &	
  Illness,	
  in	
  press.	
   Laurent,	
  M.	
  R.,	
  &	
  Vickers,	
  T.	
  J.	
  (2009).	
  Seeking	
  health	
  information	
  online:	
  does	
   Wikipedia	
  matter?	
  Journal	
  of	
  the	
  American	
  Medical	
  Informatics	
  Association,	
   16(4),	
  471–479.	
   Lee,	
  C.,	
  &	
  Owens,	
  R.	
  G.	
  (2002).	
  Issues	
  for	
  a	
  Psychology	
  of	
  Men's	
  Health.	
  Journal	
  of	
   Health	
  Psychology,	
  7(3),	
  209–217.	
   Levine,	
  D.	
  (2011).	
  Using	
  Technology,	
  New	
  Media,	
  and	
  Mobile	
  for	
  Sexual	
  and	
   Reproductive	
  Health.	
  Sexuality	
  Research	
  and	
  Social	
  Policy,	
  8(1),	
  18–26.	
  	
   Levine,	
  D.,	
  Scott,	
  K.,	
  Ahrens,	
  K.,	
  &	
  Kent,	
  C.	
  (2006).	
  inSPOT.	
  org:	
  A	
  unique	
  online	
   partner	
  notification	
  system.	
  Proceedings	
  from	
  the	
  2006	
  National	
  STD	
  Prevention	
   Conference.	
  May	
  9,	
  2006,	
  Iacksonville,	
  Florida.	
  	
   Lichtenstein,	
  B.	
  (2003).	
  Stigma	
  as	
  a	
  barrier	
  to	
  treatment	
  of	
  sexually	
  transmitted	
   infection	
  in	
  the	
  American	
  deep	
  south:	
  issues	
  of	
  race,	
  gender	
  and	
  poverty.	
  Social	
   Science	
  &	
  Medicine,	
  57(12),	
  2435–2445.	
  	
   Lichtenstein,	
  B.	
  (2004).	
  Caught	
  at	
  the	
  Clinic.	
  Gender	
  &	
  Society, 18	
  (3)	
  369-­‐388	
  	
    	
    	
    78	
  	
    Lichtenstein,	
  B.,	
  &	
  Bachmann,	
  L.	
  H.	
  (2005).	
  Staff	
  affirmations	
  and	
  client	
  criticisms:	
   staff	
  and	
  client	
  perceptions	
  of	
  quality	
  of	
  care	
  at	
  sexually	
  transmitted	
  disease	
   clinics.	
  Sexually	
  Transmitted	
  Diseases,	
  32(5),	
  281–285.	
   Lightfoot,	
  M.,	
  Comulada,	
  W.	
  S.,	
  &	
  Stover,	
  G.	
  (2007).	
  Computerized	
  HIV	
  preventive	
   intervention	
  for	
  adolescents:	
  indications	
  of	
  efficacy.	
  American	
  Journal	
  of	
  Public	
   Health,	
  97(6),	
  1027–1030.	
  	
   Lim,	
  M.	
  S.	
  C.,	
  Hocking,	
  J.	
  S.,	
  Aitken,	
  C.	
  K.,	
  Fairley,	
  C.	
  K.,	
  Jordan,	
  L.,	
  Lewis,	
  J.	
  A.,	
  &	
   Hellard,	
  M.	
  E.	
  (2012).	
  Impact	
  of	
  text	
  and	
  email	
  messaging	
  on	
  the	
  sexual	
  health	
  of	
   young	
  people:	
  a	
  randomized	
  controlled	
  trial.	
  Journal	
  of	
  Epidemiology	
  and	
   Community	
  Health,	
  66(1),	
  69–74.	
  	
   Macfarlane,	
  A.,	
  &	
  McPherson,	
  A.	
  (2007).	
  “Am	
  I	
  normal?”Teenagers,	
  sexual	
  health	
  and	
   the	
  internet.	
  Social	
  Science	
  &	
  Medicine,	
  65,	
  771–781.	
   Mackenzie,	
  S.	
  L.	
  C.,	
  Kurth,	
  A.	
  E.,	
  Spielberg,	
  F.,	
  Severynen,	
  A.,	
  Malotte,	
  C.	
  K.,	
  St	
   Lawrence,	
  J.,	
  &	
  Fortenberry,	
  J.	
  D.	
  (2007).	
  Patient	
  and	
  staff	
  perspectives	
  on	
  the	
   use	
  of	
  a	
  computer	
  counseling	
  tool	
  for	
  HIV	
  and	
  sexually	
  transmitted	
  infection	
  risk	
   reduction.	
  Journal	
  of	
  Adolescent	
  Health,	
  40(6),	
  572.e9–16.	
  	
   Magee,	
  J.	
  C.,	
  Bigelow,	
  L.,	
  DeHaan,	
  S.,	
  &	
  Mustanski,	
  B.	
  S.	
  (2011).	
  Sexual	
  Health	
   Information	
  Seeking	
  Online:	
  A	
  Mixed-­‐Methods	
  Study	
  Among	
  Lesbian,	
  Gay,	
   Bisexual,	
  and	
  Transgender	
  Young	
  People.	
  Health	
  Education	
  &	
  Behavior,	
   epublished	
  ahead	
  of	
  print.	
   Marcy,	
  H.	
  (2003).	
  No	
  place	
  to	
  grow:	
  The	
  unsafe	
  and	
  unstable	
  housing	
  conditions	
  of	
   Illinois	
  pregnant	
  and	
  parenting	
  youth	
  and	
  their	
  children.	
  Retrieved	
  19	
  February	
   2012	
  from:	
  http://www.impactresearch.org/documents/noplacetogrow.pdf	
    	
    	
    79	
  	
    Mazzarella,	
  S.	
  (2005).	
  Girl	
  wide	
  web:	
  Girls,	
  the	
  Internet,	
  and	
  the	
  negotiation	
  of	
   identity.	
  New	
  York:	
  Peter	
  Lang	
  Publishing.	
   McFarlane,	
  M.,	
  Kachur,	
  R.,	
  Klausner,	
  J.	
  D.,	
  Roland,	
  E.,	
  &	
  Cohen,	
  M.	
  (2005).	
  Internet-­‐ based	
  health	
  promotion	
  and	
  disease	
  control	
  in	
  the	
  8	
  cities:	
  successes,	
  barriers,	
   and	
  future	
  plans.	
  Sexually	
  Transmitted	
  Diseases,	
  32(10	
  Suppl),	
  S60–4.	
   McMahan,	
  C.,	
  &	
  Hovland,	
  R.	
  (2009).	
  Online	
  Marketing	
  Communications:	
  Exploring	
   Online	
  Consumer	
  Behavior	
  by	
  Examining	
  Gender	
  Differences	
  and	
  Interactivity	
   within	
  Internet	
  Advertising.	
  Journal	
  of	
  Interactive	
  Advertising,	
  10(1),	
  61-­‐76.	
   Measor,	
  L.	
  (2004).	
  Young	
  people's	
  views	
  of	
  sex	
  education:	
  gender,	
  information	
  and	
   knowledge.	
  Sex	
  Education,	
  4(2),	
  153–166.	
  	
   Medley-­‐Rath,	
  S.	
  R.,	
  &	
  Simonds,	
  W.	
  (2010).	
  Consuming	
  contraceptive	
  control:	
   gendered	
  distinctions	
  in	
  web-­‐based	
  contraceptive	
  advertising.	
  Culture,	
  Health	
  &	
   Sexuality,	
  12(7),	
  783–795.	
  	
   Mellanby,	
  A.	
  R.	
  (2001).	
  A	
  comparative	
  study	
  of	
  peer-­‐led	
  and	
  adult-­‐led	
  school	
  sex	
   education.	
  Health	
  Education	
  Research,	
  16(4),	
  481–492.	
  	
   Mill,	
  J.	
  E.,	
  Jackson,	
  R.	
  C.,	
  Worthington,	
  C.	
  A.,	
  Archibald,	
  C.	
  P.,	
  Wong,	
  T.,	
  Myers,	
  T.,	
   Prentice,	
  T.,	
  et	
  al.	
  (2008).	
  HIV	
  testing	
  and	
  care	
  in	
  Canadian	
  Aboriginal	
  youth:	
  a	
   community	
  based	
  mixed	
  methods	
  study.	
  BMC	
  Infectious	
  Diseases,	
  8,	
  132.	
  	
   Mo,	
  P.	
  K.	
  H.,	
  Malik,	
  S.	
  H.,	
  &	
  Coulson,	
  N.	
  S.	
  (2009).	
  Gender	
  differences	
  in	
  computer-­‐ mediated	
  communication:	
  a	
  systematic	
  literature	
  review	
  of	
  online	
  health-­‐ related	
  support	
  groups.	
  Patient	
  Education	
  and	
  Counseling,	
  75(1),	
  16–24.	
  	
   Moses,	
  S.,	
  &	
  Elliott,	
  L.	
  (2002).	
  Sexually	
  transmitted	
  diseases	
  in	
  Manitoba:	
  evaluation	
   of	
  physician	
  treatment	
  practices,	
  STD	
  drug	
  utilization,	
  and	
  compliance	
  with	
    	
    	
    80	
  	
    screening	
  and	
  treatment	
  guidelines.	
  Sexually	
  Transmitted	
  Diseases,	
  29(12),	
  840– 846.	
   Moss,	
  G.,	
  &	
  Gunn,	
  R.	
  (2006).	
  Some	
  men	
  like	
  it	
  black,	
  some	
  women	
  like	
  it	
  pink:	
   consumer	
  implications	
  of	
  differences	
  in	
  male	
  and	
  female	
  website	
  design.	
  Journal	
   of	
  Consumer	
  Behaviour,	
  5(4),	
  328–34.	
   Myrick,	
  R.	
  (1996).	
  AIDS,	
  communication,	
  and	
  empowerment:	
  Gay	
  male	
  identity	
  and	
   the	
  politics	
  of	
  public	
  health	
  messages.	
  Binghamton,	
  NY:	
  Hawthorne	
  Press.	
   Nack,	
  A.	
  (2002).	
  Bad	
  Girls	
  and	
  Fallen	
  Women:	
  Chronic	
  STD	
  Diagnoses	
  as	
  Gateways	
   to	
  Tribal	
  Stigma.	
  Symbolic	
  Interaction,	
  25(4),	
  463–485.	
  	
   Novak,	
  D.	
  P.,	
  &	
  Karlsson,	
  R.	
  B.	
  (2006).	
  Simplifying	
  chlamydia	
  testing:	
  an	
  innovative	
   Chlamydia	
  trachomatis	
  testing	
  approach	
  using	
  the	
  internet	
  and	
  a	
  home	
   sampling	
  strategy:	
  population	
  based	
  study.	
  Sexually	
  Transmitted	
  Infections,	
   82(2),	
  142–7.	
  	
   Nwokolo,	
  N.,	
  McOwan,	
  A.,	
  &	
  Hennebry,	
  G.	
  (2002).	
  Young	
  people's	
  views	
  on	
  provision	
   of	
  sexual	
  health	
  services.	
  Sexually	
  Transmitted	
  Infections,	
  78(5),	
  342-­‐345.	
   O'Brien,	
  R.,	
  &	
  Hunt,	
  K.	
  (2005).	
  []	
  It's	
  caveman	
  stuff,	
  but	
  that	
  is	
  to	
  a	
  certain	
  extent	
  how	
   guys	
  still	
  operate‘:	
  men’s	
  accounts	
  of	
  masculinity	
  and	
  help	
  seeking.	
  Social	
   Science	
  &	
  Medicine,	
  61(3),	
  503-­‐16	
   Oliffe,	
  J.	
  L.,	
  Chabot,	
  C.,	
  Knight,	
  R.,	
  Davis,	
  W.	
  M.,	
  Bungay,	
  V.,	
  &	
  Shoveller,	
  J.	
  A.	
  (in	
  press).	
   Women	
  on	
  men’s	
  sexual	
  health	
  and	
  sexually	
  transmitted	
  infection	
  testing:	
  A	
   gender	
  relations	
  analysis.	
  Sociology	
  of	
  Health	
  and	
  Illness,	
  in	
  press.	
   Oliffe,	
  J.	
  L.,	
  Kelly,	
  M.	
  T.,	
  Bottorff,	
  J.	
  L.,	
  Johnson,	
  J.	
  L.,	
  &	
  Wong,	
  S.	
  T.	
  (2011).	
  "He's	
  more	
   typically	
  female	
  because	
  he's	
  not	
  afraid	
  to	
  cry":	
  connecting	
  heterosexual	
  gender	
    	
    	
    81	
  	
    relations	
  and	
  men”s	
  depression.	
  Social	
  Science	
  &	
  Medicine	
  (1982),	
  73(5),	
  775– 782.	
   Owens,	
  S.	
  L.,	
  Arora,	
  N.,	
  (null),	
  Peeling,	
  R.	
  W.,	
  Holmes,	
  K.	
  K.,	
  &	
  Gaydos,	
  C.	
  A.	
  (2010).	
   Utilising	
  the	
  internet	
  to	
  test	
  for	
  sexually	
  transmitted	
  infections:	
  results	
  of	
  a	
   survey	
  and	
  accuracy	
  testing.	
  Sexually	
  Transmitted	
  Infections,	
  86(2),	
  112–116.	
  	
   Peeling,	
  R.	
  W.	
  (2006).	
  Testing	
  for	
  sexually	
  transmitted	
  infections:	
  a	
  brave	
  new	
   world?	
  Sexually	
  Transmitted	
  Infections,	
  82(6),	
  425–430.	
  	
   PHAC.	
  (2010a).	
  Reported	
  cases	
  and	
  rates	
  of	
  gonorrhea	
  by	
  age	
  group	
  and	
  sex,	
  1980	
  to	
   2009.	
  Retrieved	
  22	
  January	
  2012	
  from	
  http://www.phac-­‐aspc.gc.ca/sti-­‐its-­‐surv-­‐ epi/surveillance-­‐eng.php	
   PHAC.	
  (2010b).	
  Reported	
  cases	
  and	
  rates1	
  of	
  chlamydia	
  by	
  age	
  group	
  and	
  sex,	
  1991	
  to	
   2009.	
  Retrieved	
  22	
  January	
  2012	
  from	
  http://www.phac-­‐aspc.gc.ca/sti-­‐its-­‐surv-­‐ epi/surveillance-­‐eng.php	
   Popay,	
  J.	
  (2000).	
  Narrative:	
  Research	
  on	
  gender	
  inequalities	
  in	
  health.	
  Ballmoor	
   Buckingham:	
  Open	
  University	
  Press.	
   National	
  Campaign	
  to	
  Prevent	
  Teen	
  Pregnancy.	
  (2002).	
  Not	
  Just	
  Another	
  Single	
  Issue:	
   Teen	
  Pregnancy	
  Prevention's	
  Link	
  to	
  Other	
  Critical	
  Social	
  Issues.	
  Retrieved	
  19	
   February,	
  2012	
  from:	
  http://www.eric.ed.gov/PDFS/ED462522.pdf	
   Rainie,	
  L.,	
  Horrigan,	
  J.,	
  Lenhart,	
  A.,	
  &	
  Spooner,	
  T.	
  (2002).	
  Vital	
  decisions:	
  How	
  Internet	
   users	
  decide	
  what	
  information	
  to	
  trust	
  when	
  they	
  or	
  their	
  loved	
  ones	
  are	
  sick.	
   Retrieved	
  January	
  22,	
  2012	
  from:	
   http://www.pewinternet.org/~/media//Files/Reports/2002/PIP_Vital_Decisio ns_May2002.pdf.pdf	
    	
    	
    82	
  	
    Rice,	
  R.	
  E.	
  (2006).	
  Influences,	
  usage,	
  and	
  outcomes	
  of	
  Internet	
  health	
  information	
   searching:	
  multivariate	
  results	
  from	
  the	
  Pew	
  surveys.	
  International	
  Journal	
  of	
   Medical	
  Informatics,	
  75(1),	
  8–28.	
  	
   Richard,	
  M.,	
  Chebat,	
  J.,	
  &	
  Yang,	
  Z.	
  (2010).	
  A	
  proposed	
  model	
  of	
  online	
  consumer	
   behavior:	
  Assessing	
  the	
  role	
  of	
  gender.	
  Journal	
  of	
  Business	
  Research,	
  63(9-­‐10),	
   926-­‐934.	
   Rietmeijer,	
  C.	
  (2007).	
  HIV	
  and	
  sexually	
  transmitted	
  infection	
  prevention	
  online:	
   Current	
  state	
  and	
  future	
  prospects.	
  Sexuality	
  Research	
  and	
  Social	
  Policy,	
  4(2),	
  65-­‐ 73.	
   Rietmeijer,	
  C.	
  A.,	
  &	
  McFarlane,	
  M.	
  (2009).	
  Web	
  2.0	
  and	
  beyond:	
  risks	
  for	
  sexually	
   transmitted	
  infections	
  and	
  opportunities	
  for	
  prevention.	
  Current	
  Opinion	
  in	
   Infectious	
  Diseases,	
  22(1),	
  67–71.	
  	
   Roberto,	
  A.	
  J.,	
  Zimmerman,	
  R.	
  S.,	
  Carlyle,	
  K.	
  E.,	
  Abner,	
  E.	
  L.,	
  Cupp,	
  P.	
  K.,	
  &	
  Hansen,	
  G.	
  L.	
   (2007).	
  The	
  effects	
  of	
  a	
  computer-­‐based	
  pregnancy,	
  STD,	
  and	
  HIV	
  prevention	
   intervention:	
  a	
  nine-­‐school	
  trial.	
  Health	
  Communication,	
  21(2),	
  115–124.	
  	
   Robertson,	
  S.	
  (2007).	
  Understanding	
  men	
  and	
  health.	
  masculinities,	
  identity,	
  and	
   well-­‐being	
  (p.	
  178).	
  Berkshire,	
  England:	
  Open	
  University	
  Press.	
   Robin	
  Hood	
  Foundation.	
  (1996).	
  Kids	
  having	
  kids:	
  A	
  Robin	
  Hood	
  Foundation	
  special	
   report	
  on	
  the	
  costs	
  of	
  adolescent	
  childbearing.	
  Retrieved	
  18	
  February	
  2012	
  from:	
   http://www.eric.ed.gov/PDFS/ED409389.pdf	
   Robinson,	
  M.,	
  &	
  Robertson,	
  S.	
  (2010).	
  Young	
  men's	
  health	
  promotion	
  and	
  new	
   information	
  communication	
  technologies:	
  illuminating	
  the	
  issues	
  and	
  research	
   agendas.	
  Health	
  Promotion	
  International,	
  25(3),	
  363–370.	
  	
    	
    	
    83	
  	
    Romocki,	
  L.	
  (2004).	
  Little	
  sisters	
  in	
  cyberspace:	
  Adolescent	
  Black	
  girls'	
  interactions	
   with	
  sexual	
  health	
  content	
  on	
  Internet	
  websites.	
  Proceedings	
  from	
  the	
  132nd	
   Annual	
  Meeting	
  of	
  APHA.	
  November	
  6-­‐10,	
  	
  Washington,	
  DC.	
   Rosenberger,	
  J.	
  G.,	
  Reece,	
  M.,	
  Novak,	
  D.	
  S.,	
  &	
  Mayer,	
  K.	
  H.	
  (2011).	
  The	
  Internet	
  as	
  a	
   valuable	
  tool	
  for	
  promoting	
  a	
  new	
  framework	
  for	
  sexual	
  health	
  among	
  gay	
  men	
   and	
  other	
  men	
  who	
  have	
  sex	
  with	
  men.	
  AIDS	
  and	
  Behavior,	
  15(Suppl	
  1),	
  S88–90.	
  	
   Ross,	
  J.	
  D.	
  C.,	
  Ison,	
  C.,	
  &	
  Radcliffe,	
  K.	
  W.	
  (2006).	
  A	
  paradigm	
  shift	
  in	
  testing	
  for	
   sexually	
  transmitted	
  infections.	
  Sexually	
  Transmitted	
  Infections,	
  82(6),	
  424–425.	
  	
   Rusch,	
  M.,	
  Shoveller,	
  J.,	
  Burgess,	
  S.,	
  Stancer,	
  K.,	
  Patrick,	
  D.,	
  &	
  Tyndall,	
  M.	
  (2008).	
   Association	
  of	
  sexually	
  transmitted	
  disease-­‐related	
  stigma	
  with	
  sexual	
  health	
   care	
  among	
  women	
  attending	
  a	
  community	
  clinic	
  program.	
  Sexually	
  Transmitted	
   Diseases,	
  35(6),	
  553–557.	
  	
   Schalet,	
  A.	
  (2004).	
  Must	
  we	
  fear	
  adolescent	
  sexuality?	
  Medscape	
  General	
  Medicine,	
   6(4),	
  1-­‐23.	
   Schalet,	
  A.	
  T.	
  (2011).	
  Beyond	
  abstinence	
  and	
  risk:	
  a	
  new	
  paradigm	
  for	
  adolescent	
   sexual	
  health.	
  Women's	
  Health	
  Issues,	
  21(3	
  Suppl),	
  S5–7.	
  	
   Seale,	
  C.,	
  Ziebland,	
  S.,	
  &	
  Charteris-­‐Black,	
  J.	
  (2006).	
  Gender,	
  cancer	
  experience	
  and	
   internet	
  use:	
  a	
  comparative	
  keyword	
  analysis	
  of	
  interviews	
  and	
  online	
  cancer	
   support	
  groups.	
  Social	
  Science	
  &	
  Medicine,	
  62(10),	
  2577–2590.	
  	
   Selkie,	
  E.,	
  &	
  Benson,	
  M.	
  (2011).	
  Adolescents'	
  Views	
  Regarding	
  Uses	
  of	
  Social	
   Networking	
  Websites	
  and	
  Text	
  Messaging	
  for	
  Adolescent	
  Sexual	
  Health	
   Education.	
  American	
  Journal	
  of	
  Health	
  Education,	
  42(4),	
  205-­‐212	
   Serafim,	
  I.	
  (2006).	
  Artistic	
  autonomy	
  in	
  soviet	
  cinematography.	
  Reverse	
  discourse,	
    	
    	
    84	
  	
    subversion	
  or	
  dissent?	
  Iasi	
  County:	
  Lumen	
   Shadish,	
  W.,	
  &	
  Cook,	
  T.	
  (2002).	
  Experimental	
  and	
  quasi-­‐experimental	
  designs	
  for	
   generalized	
  causal	
  inference.	
  	
  New	
  York:	
  Houghton	
  Mifflin.	
   Shafer,	
  M.-­‐A.	
  B.,	
  Tebb,	
  K.	
  P.,	
  Pantell,	
  R.	
  H.,	
  Wibbelsman,	
  C.	
  J.,	
  Neuhaus,	
  J.	
  M.,	
  Tipton,	
  A.	
   C.,	
  Kunin,	
  S.	
  B.,	
  et	
  al.	
  (2002).	
  Effect	
  of	
  a	
  clinical	
  practice	
  improvement	
   intervention	
  on	
  Chlamydial	
  screening	
  among	
  adolescent	
  girls.	
  JAMA	
  :	
  the	
  journal	
   of	
  the	
  American	
  Medical	
  Association,	
  288(22),	
  2846–2852.	
   Sheahan,	
  S.	
  L.,	
  Coons,	
  S.	
  J.,	
  Seabolt,	
  J.	
  P.,	
  Churchill,	
  L.,	
  &	
  Dale,	
  T.	
  (1994).	
  Sexual	
   behavior,	
  communication,	
  and	
  chlamydial	
  infections	
  among	
  college	
  women.	
   Health	
  Care	
  for	
  Women	
  International,	
  15(4),	
  275–286.	
  	
   Shephard,	
  B.	
  (1996).	
  Masculinity	
  and	
  the	
  male	
  role	
  in	
  sexual	
  health.	
  Planned	
   parenthood	
  challenges	
  /	
  International	
  Planned	
  Parenthood	
  Federation,	
  (2),	
  11– 14.	
  	
   Shoveller,	
  Jean	
  A,	
  &	
  Johnson,	
  J.	
  L.	
  (2006).	
  Risky	
  groups,	
  risky	
  behaviour,	
  and	
  risky	
   persons:	
  Dominating	
  discourses	
  on	
  youth	
  sexual	
  health.	
  Critical	
  Public	
  Health,	
   16(1),	
  47–60.	
   Shoveller,	
  Jean	
  A,	
  Knight,	
  R.,	
  Johnson,	
  J.,	
  Oliffe,	
  J.	
  L.,	
  &	
  Goldenberg,	
  S.	
  (2010).	
  'Not	
  the	
   swab!‘	
  Young	
  men’s	
  experiences	
  with	
  STI	
  testing.	
  Sociology	
  of	
  Health	
  &	
  Illness,	
   32(1),	
  57–73.	
  	
   Shoveller,	
  J,	
  Johnson,	
  J.,	
  &	
  Langille,	
  D.	
  (2004).	
  Socio-­‐cultural	
  influences	
  on	
  young	
   people's	
  sexual	
  development.	
  Social	
  Science	
  &	
  Medicine, 59,	
  473-­‐487. Shoveller,	
  J,	
  Johnson,	
  J.,	
  Rosenberg,	
  M.,	
  Greaves,	
  L.,	
  Patrick,	
  D.	
  M.,	
  Oliffe,	
  J.	
  L.,	
  &	
   Knight,	
  R.	
  (2009).	
  Youth's	
  experiences	
  with	
  STI	
  testing	
  in	
  four	
  communities	
  in	
    	
    	
    85	
  	
    British	
  Columbia,	
  Canada.	
  Sexually	
  Transmitted	
  Infections,	
  85(5),	
  397–401.	
  	
   Shoveller,	
  J,	
  Knight,	
  R.,	
  Davis,	
  W.,	
  Gilbert,	
  M.,	
  &	
  Ogilvie,	
  G.	
  (2011).	
  Online	
  Sexual	
   Health	
  Services:	
  Examining	
  Youth's	
  Perspectives.	
  Canadian	
  Journal	
  of	
  Public	
   Health,	
  103(1),	
  14-­‐18	
   Simkins,	
  S.	
  N.	
  (2007).	
  “There's	
  no	
  easy	
  way	
  to	
  say	
  this...":	
  STD	
  partner-­‐notification	
  in	
   the	
  digital	
  age.	
  Unpublished	
  thesis,	
  Southern	
  Utah	
  University.	
   Singh,	
  S.,	
  &	
  Darroch,	
  J.	
  E.	
  (2000).	
  Adolescent	
  pregnancy	
  and	
  childbearing:	
  levels	
  and	
   trends	
  in	
  developed	
  countries.	
  Family	
  Planning	
  Perspectives,	
  32(1),	
  14–23.	
   Suler,	
  J.	
  (2004).	
  The	
  online	
  disinhibition	
  effect.	
  Cyberpsychology	
  &	
  Behavior,	
  7(3),	
   321–326.	
   Suzuki,	
  L.,	
  &	
  Calzo,	
  J.	
  P.	
  (2004).	
  The	
  search	
  for	
  peer	
  advice	
  in	
  cyberspace:	
  An	
   examination	
  of	
  online	
  teen	
  bulletin	
  boards	
  about	
  health	
  and	
  sexuality.	
  Journal	
  of	
   Applied	
  Developmental	
  Psychology,	
  25(6),	
  685-­‐698	
   Thelwall,	
  M.,	
  Wilkinson,	
  D.,	
  &	
  Uppal,	
  S.	
  (2010).	
  Data	
  mining	
  emotion	
  in	
  social	
   network	
  communication:	
  Gender	
  differences	
  in	
  MySpace.	
  Journal	
  of	
  the	
   American	
  Society	
  for	
  Information	
  Science	
  and	
  Technology,	
  61(1),	
  190–199.	
  	
   Tolman,	
  D.	
  L.,	
  Striepe,	
  M.	
  I.,	
  &	
  Harmon,	
  T.	
  (2003).	
  Gender	
  matters:	
  constructing	
  a	
   model	
  of	
  adolescent	
  sexual	
  health.	
  Journal	
  of	
  Sex	
  Research,	
  40(1),	
  4–12.	
  	
   Turner,	
  G.	
  (1999).	
  A	
  method	
  in	
  search	
  of	
  a	
  theory:	
  peer	
  education	
  and	
  health	
   promotion.	
  Health	
  Education	
  Research,	
  14(2),	
  235-­‐247.	
   Wasserman,	
  I.	
  M.,	
  &	
  Richmond-­‐Abbott,	
  M.	
  (2005).	
  Gender	
  and	
  the	
  Internet:	
  Causes	
   of	
  Variation	
  in	
  Access,	
  Level,	
  and	
  Scope	
  of	
  Use.	
  Social	
  Science	
  Quarterly,	
  86(1),	
   252–270.	
  	
    	
    	
    86	
  	
    Weaver,	
  S.	
  (2010).	
  The	
  reverse	
  discourse	
  and	
  resistance	
  of	
  Asian	
  comedians	
  in	
  the	
   West.	
  Comedy	
  Studies,	
  1(2),	
  149-­‐158.	
   White,	
  K.,	
  Kelly,	
  K.,	
  Oliver,	
  J.,	
  &	
  Brotman,	
  M.	
  (2007).	
  Mis	
  Informed	
  Canadian	
  Youth	
  -­‐	
   Sexual	
  Health	
  Survey	
  Report.	
  United	
  Nations	
  Association	
  in	
  Canada,	
  1–39.	
   Retrieved	
  9	
  January	
  2012	
  from:	
   http://www.unac.org/en/library/unacresearch/2007CdnYouthSexualHealthSu rveyResults.pdf	
   Williams,	
  M.	
  T.,	
  &	
  Bonner,	
  L.	
  (2006).	
  Sex	
  education	
  attitudes	
  and	
  outcomes	
  among	
   North	
  American	
  women.	
  Adolescence,	
  41(161),	
  1–14.	
   Wilton,	
  T.,	
  &	
  Keeble,	
  S.,	
  Doyal,	
  L.	
  and	
  Walsh,	
  A.	
  (1995).	
  The	
  effectiveness	
  of	
  peer	
   education	
  in	
  health	
  promotion:	
  Theory	
  and	
  Practice.	
  Unpublished,	
  Faculty	
  of	
   Health	
  and	
  Community	
  Studies,	
  University	
  of	
  the	
  West	
  of	
  England.	
   World	
  Health	
  Organization.	
  (1991).	
  Global	
  Programme	
  on	
  AIDS.	
  AIDS'credible	
   messengers.	
  World	
  AIDS	
  Day	
  Features.	
  Retrieved	
  5	
  February	
  2012	
  from:	
   www.ncbi.nlm.nih.gov/pubmed/12317217	
   Ybarra,	
  M.,	
  &	
  Suman,	
  M.	
  (2008).	
  Reasons,	
  assessments	
  and	
  actions	
  taken:	
  sex	
  and	
   age	
  differences	
  in	
  uses	
  of	
  Internet	
  health	
  information.	
  Health	
  Education	
   Research,	
  23(3),	
  512–521.	
  	
   Yee,	
  N.,	
  Bailenson,	
  J.,	
  Urbanek,	
  M.,	
  Chang,	
  F.,	
  &	
  Merget,	
  D.	
  (2007).	
  The	
  unbearable	
   likeness	
  of	
  being	
  digital:	
  The	
  persistence	
  of	
  nonverbal	
  social	
  norms	
  in	
  online	
   virtual	
  environments.	
  Cyberpsychology	
  &	
  Behavior,	
  10(1),	
  115–121.	
   	
   	
   	
    	
   	
    87	
  	
    Appendices	
   Appendix	
  1:	
  Interview	
  guide	
  for	
  youth	
   	
   Online	
  STI	
  Testing	
  &	
  Youth	
   Interview	
  Guide	
   	
   	
   Description	
  of	
  Online	
  Sexual	
  Health	
  Services	
  Program:	
  We’d	
  like	
  to	
  tell	
  you	
  a	
  bit	
   about	
  a	
  new	
  program	
  that	
  is	
  being	
  developed	
  to	
  try	
  and	
  address	
  some	
  of	
  the	
   difficulties	
  young	
  people	
  might	
  have	
  in	
  getting	
  tested	
  for	
  STIs	
  and	
  in	
  getting	
  answers	
   to	
  their	
  sexual	
  health	
  questions.	
  First	
  of	
  all,	
  we	
  are	
  developing	
  a	
  website	
  where	
   young	
  people	
  can	
  access	
  sexual	
  health	
  information,	
  as	
  well	
  as	
  chat	
  online	
   anonymously	
  with	
  a	
  nurse,	
  one-­‐on-­‐one.	
  	
   	
   Review	
  the	
  informed	
  consent	
  and	
  interview	
  structure:	
  This	
  session	
  will	
  be	
  audio	
   taped	
  and	
  will	
  last	
  about	
  1	
  to	
  1.5	
  hours.	
  We’ll	
  begin	
  our	
  interview	
  by	
  completing	
  a	
   brief	
  questionnaire	
  (3-­‐5	
  minutes).	
  Then	
  I	
  will	
  ask	
  you	
  some	
  questions	
  about	
  your	
   experiences	
  with	
  STI	
  testing.	
  While	
  we’re	
  talking,	
  I’ll	
  ask	
  you	
  about	
  your	
  experiences	
   with	
  STI	
  testing	
  services,	
  as	
  well	
  as	
  what	
  you	
  think	
  about	
  using	
  online	
  sexual	
  health	
   services.	
  During	
  the	
  interview,	
  I’ll	
  be	
  taking	
  a	
  few	
  notes	
  about	
  the	
  events	
  and	
   experiences	
  you	
  describe	
  to	
  me.	
   	
   1.	
  	
  Where	
  did	
  you	
  hear	
  about	
  our	
  study?	
   	
   2.	
  	
  Can	
  you	
  tell	
  my	
  why	
  you	
  decided	
  to	
  volunteer	
  for	
  our	
  study	
  today?	
   	
   	
   The	
  next	
  set	
  of	
  questions	
  are	
  about	
  the	
  sexual	
  health	
  website	
  service	
  that	
  will	
  be	
   offered:	
   	
   Saliency	
  and	
  Credibility	
  of	
  website	
   	
   3. Where	
  would	
  you	
  prefer	
  to	
  get	
  your	
  sexual	
  health	
  information	
  from	
  -­‐-­‐	
  your	
   peers,	
  or	
  nurses/doctors?	
   • Who	
  are	
  you	
  most	
  comfortable	
  asking	
  questions	
  to?	
   • Who	
  do	
  you	
  trust	
  more?	
   	
   4. Have	
  you	
  ever	
  looked	
  for	
  health	
  information	
  online?	
  	
  Tell	
  me	
  about	
  this.	
   	
   5. Where	
  do	
  you	
  get	
  your	
  sexual	
  health	
  information	
  from?	
  Have	
  you	
  ever	
   looked	
  for	
  sexual	
  health	
  information	
  online?	
  	
  Tell	
  me	
  about	
  the	
  process	
  you	
   go	
  through	
  when	
  you	
  do	
  this.	
   • What	
  information	
  do	
  you	
  look	
  for?	
  	
  Are	
  you	
  able	
  to	
  find	
  it?	
    	
    	
    88	
  	
    • 	
    	
    	
    	
    What	
  sexual	
  health	
  information	
  is	
  difficult	
  to	
  find	
  online?	
  Is	
  there	
   anything	
  you’d	
  like	
  to	
  see	
  more	
  of	
  online?	
   	
    6. How	
  do	
  you	
  go	
  about	
  finding	
  information	
  on	
  sexual	
  health	
  on	
  the	
  internet	
   (i.e.,	
  what	
  search	
  strategies	
  would	
  you	
  use)?	
  	
  	
  	
   • For	
  example,	
  what	
  would	
  you	
  type	
  into	
  Google?	
   • What	
  would	
  you	
  type	
  into	
  Google	
  if	
  you	
  were	
  looking	
  to	
  get	
  tested	
  for	
   STIs	
  in	
  your	
  community?	
   • Have	
  you	
  ever	
  tried	
  to	
  find	
  a	
  way	
  to	
  get	
  an	
  STI	
  test	
  online	
  (e.g.,	
   referral	
  to	
  local	
  clinic,	
  mail	
  order	
  ‘kit’)?	
  	
  What	
  did	
  you	
  find?	
   	
   7. What	
  do	
  you	
  think	
  might	
  motivate	
  someone	
  to	
  access	
  online	
  sexual	
  health	
   information?	
   8. What	
  would	
  make	
  you	
  return	
  to	
  a	
  sexual	
  health	
  website,	
  once	
  you’ve	
  visited	
   it?	
   	
   9. Okay,	
  thinking	
  about	
  a	
  few	
  of	
  the	
  things	
  we	
  talked	
  about,	
  I’d	
  like	
  to	
  show	
  you	
   some	
  existing	
  sexual	
  health	
  websites	
  and	
  ask	
  for	
  your	
  thoughts	
  on	
  them.	
  	
  For	
   each	
  of	
  them,	
  I’d	
  like	
  to	
  know:	
   • What	
  do	
  you	
  like	
  about	
  it?	
   • What	
  don’t	
  you	
  like	
  about	
  it?	
   • How	
  well	
  would	
  you	
  trust	
  information	
  on	
  this	
  website?	
  	
  Why?	
   • Who	
  do	
  you	
  think	
  this	
  website	
  is	
  targeted	
  towards?	
  	
   Males/females/both?	
  	
  Teenagers/adults/both?	
   	
   List	
  of	
  5	
  websites:	
   http://www.stdresource.com/	
   http://www.sexualityandu.ca	
   http://www.optionsforsexualhealth.org/	
  	
   http://www.scarleteen.com	
  	
   • Which	
  website	
  is	
  your	
  favourite?	
  	
  Why?	
   • Which	
  website	
  would	
  you	
  trust	
  most?	
  	
  Why?	
   10. Would	
  you	
  find	
  any	
  of	
  these	
  features	
  helpful	
  on	
  a	
  sexual	
  health	
  website	
   (would	
  you	
  actually	
  use	
  them)?	
  	
  Why	
  or	
  why	
  not?	
   • Email	
  a	
  question	
  to	
  a	
  nurse	
  to	
  answer	
   • Post	
  a	
  question	
  to	
  a	
  message	
  board	
  or	
  forum	
  for	
  a	
  nurse	
  to	
  answer	
   • Post	
  a	
  question	
  to	
  a	
  message	
  board	
  or	
  forum	
  for	
  other	
  forum	
  users	
  to	
   answer	
   • Instant	
  messaging	
  or	
  chat	
  with	
  a	
  nurse	
   • Follow	
  a	
  blog	
  with	
  sexual	
  health	
  advice	
  and	
  information	
   • Listen	
  to	
  podcasts	
  on	
  sexual	
  health	
  topics	
   • Watch	
  videos	
  on	
  sexual	
  health	
  topics	
  	
   	
    89	
  	
    • FAQ	
  section	
  on	
  sexual	
  health	
  topics	
   	
   Socio-­‐technical	
  nature	
  of	
  the	
  human-­‐computer	
  interface	
   	
   11. [Language	
  Style]	
  Next,	
  I’d	
  like	
  to	
  show	
  you	
  some	
  samples	
  of	
  text	
  from	
  a	
  few	
   sexual	
  health	
  websites.	
  	
  I’d	
  like	
  you	
  to	
  have	
  a	
  look	
  at	
  them,	
  and	
  then	
  give	
  me	
   some	
  of	
  your	
  opinions	
  on	
  the	
  different	
  words	
  used.	
  	
  I’m	
  really	
  interested	
  in	
   you	
  responses	
  to	
  the	
  different	
  phrasing	
  used.	
  	
  How	
  would	
  you	
  feel	
  about	
   seeing	
  each	
  of	
  these	
  writing	
  styles	
  on	
  a	
  sexual	
  health	
  website?	
  	
  [Show	
  text	
   sample	
  page	
  1	
  to	
  participant]	
    Why	
  do	
  you	
  think	
  the	
  websites	
  use	
  these	
  various	
  types	
  of	
  writing	
  styles?	
    What	
  effects	
  would	
  each	
  of	
  these	
  writing	
  styles	
  have	
  on	
  your	
  opinion	
  of	
   the	
  websites	
  they	
  are	
  from?	
  	
  Which	
  would	
  you	
  trust	
  the	
  most?	
  	
  Which	
   would	
  you	
  most	
  want	
  to	
  read?	
    Can	
  you	
  think	
  of	
  any	
  ways	
  that	
  any	
  of	
  these	
  writing	
  styles	
  might	
  make	
  it	
   less	
  likely	
  for	
  some	
  youth	
  to	
  visit	
  the	
  sites	
  they	
  are	
  on?	
   	
   12. [Reverse	
  Discourse]	
  Now,	
  I’d	
  like	
  to	
  show	
  you	
  some	
  text	
  samples	
  that	
  use	
   certain	
  words	
  and	
  phrases.	
  	
  Please	
  have	
  a	
  read	
  through,	
  and	
  then	
  I’d	
  like	
  to	
   hear	
  your	
  opinions	
  on	
  the	
  use	
  of	
  these	
  words	
  and	
  phrases	
  in	
  a	
  sexual	
  health	
   website.	
  	
  Please	
  take	
  a	
  moment	
  and	
  use	
  a	
  highlighter	
  to	
  highlight	
  any	
  words	
   or	
  phrases	
  that	
  stick	
  out	
  to	
  you.	
  	
  	
   • First	
  of	
  all,	
  do	
  any	
  of	
  these	
  words	
  stick	
  out	
  to	
  you?	
  	
  Do	
  any	
  of	
  them	
   make	
  you	
  feel	
  uncomfortable,	
  or	
  do	
  any	
  of	
  the	
  words	
  seem	
  unnecessary	
   on	
  a	
  sexual	
  health	
  website?	
   • Why	
  do	
  you	
  think	
  some	
  websites	
  use	
  these	
  kinds	
  of	
  words	
  and	
  phrases?	
   • What	
  effect	
  does	
  the	
  use	
  of	
  these	
  words	
  and	
  phrases	
  have	
  on	
  you?	
  	
  How,	
   if	
  at	
  all,	
  does	
  it	
  affect	
  your	
  trust	
  of	
  the	
  websites?	
  	
  How,	
  if	
  at	
  all,	
  does	
  it	
   affect	
  your	
  desire	
  to	
  read	
  this	
  information?	
   • How	
  does	
  it	
  make	
  you	
  feel	
  about	
  youth	
  sexual	
  behavior	
  to	
  see	
  it	
   presented	
  in	
  this	
  way?	
   • Next,	
  are	
  there	
  any	
  words	
  or	
  phrases	
  in	
  this	
  text	
  that	
  you	
  think	
  are	
   particularly	
  good	
  in	
  getting	
  the	
  message	
  across?	
  	
  Are	
  there	
  any	
  words	
   or	
  phrases	
  that	
  you	
  can	
  think	
  of	
  that	
  could	
  replace	
  some	
  of	
  the	
  words	
  you	
   flagged	
  as	
  problematic?	
   	
   13. Now	
  I’d	
  like	
  to	
  show	
  you	
  some	
  examples	
  of	
  some	
  images	
  used	
  on	
  a	
  few	
   sexual	
  health	
  websites.	
  	
  I’d	
  like	
  you	
  to	
  have	
  a	
  look	
  at	
  them,	
  and	
  give	
  me	
  your	
   opinions	
  on	
  them.	
  	
  How	
  would	
  you	
  feel	
  about	
  seeing	
  each	
  of	
  these	
  images	
  on	
   a	
  sexual	
  health	
  website?	
  	
  	
    Why	
  do	
  you	
  think	
  the	
  websites	
  use	
  these	
  types	
  of	
  language?	
   	
   	
   	
   	
    	
    	
    90	
  	
    Diversity	
   	
   14. In	
  our	
  previous	
  studies,	
  we’ve	
  talked	
  with	
  a	
  diverse	
  group	
  of	
  youth	
  about	
   accessing	
  sexual	
  health	
  services	
  and	
  sexual	
  health	
  information.	
  	
  We’ve	
  heard	
   from	
  a	
  lot	
  of	
  different	
  youth	
  that	
  accessing	
  these	
  things	
  isn’t	
  always	
   straightforward	
  or	
  easy,	
  for	
  a	
  variety	
  of	
  reasons.	
  	
  We’d	
  like	
  to	
  share	
  with	
  you	
   two	
  stories	
  of	
  youth	
  who	
  both	
  have	
  a	
  need	
  to	
  access	
  sexual	
  health	
  services	
   and	
  information.	
   	
   Jim	
  is	
  a	
  20-­‐year-­‐old	
  male	
  who	
  identifies	
  as	
  heterosexual.	
  	
  Jim	
  grew	
  up	
  in	
  a	
   household	
  where	
  sexual	
  health	
  was	
  openly	
  discussed,	
  and	
  his	
  parents	
  were	
  not	
   troubled	
  by	
  the	
  fact	
  that	
  he	
  is	
  sexually	
  active	
  and	
  not	
  married.	
  	
  Jim	
  attends	
   university	
  and	
  lives	
  in	
  a	
  student	
  residence,	
  where	
  he	
  has	
  his	
  own	
  room	
  and	
  a	
   personal	
  laptop	
  computer.	
  	
  He	
  openly	
  discusses	
  sexual	
  health	
  issues	
  with	
  his	
   friends,	
  and	
  has	
  even	
  heard	
  of	
  a	
  few	
  good	
  websites	
  on	
  the	
  subject	
  from	
  them.	
  	
  	
   	
   Our	
  second	
  story	
  is	
  about	
  John.	
  	
  John	
  is	
  a	
  17-­‐year	
  old	
  young	
  man	
  who	
  attends	
   high	
  school	
  in	
  Vancouver	
  and	
  lives	
  at	
  home.	
  	
  John’s	
  parents	
  are	
  very	
   conservative,	
  and	
  sexuality	
  was	
  never	
  discussed	
  as	
  Jonathan	
  was	
  growing	
  up.	
  	
   They	
  don’t	
  believe	
  in	
  sex	
  before	
  marriage,	
  and	
  are	
  unaware	
  that	
  he	
  identifies	
  as	
   gay	
  and	
  has	
  sex	
  with	
  other	
  men.	
  	
  Jonathan	
  doesn’t	
  have	
  many	
  friends	
  he	
  can	
   talk	
  to	
  about	
  sexual	
  health	
  issues	
  that	
  are	
  important	
  to	
  him.	
  	
  His	
  family	
  has	
  one	
   shared	
  computer,	
  and	
  it	
  is	
  in	
  the	
  living	
  room.	
   	
   	
   Thinking	
  about	
  the	
  lives	
  and	
  circumstances	
  of	
  Jim	
  and	
  John,	
  what	
  do	
  you	
   think	
  might	
  be	
  some	
  features	
  of	
  each	
  of	
  their	
  stories	
  that	
  make	
  it	
  easier	
  or	
   harder	
  for	
  them	
  to	
  access	
  online	
  sexual	
  health	
  information?	
  [Examples	
  of	
   probes:]	
   • For	
  example,	
  how	
  do	
  you	
  think	
  their	
  respective	
  ages	
  might	
  affect	
  how	
   they	
  access	
  sexual	
  health	
  information	
  online	
   • How	
  do	
  you	
  think	
  their	
  different	
  sexual	
  identities	
  might	
  affect	
  how	
  they	
   access	
  online	
  sexual	
  health	
  information	
  differently?	
  	
   	
   15. Thinking	
  about	
  the	
  diversity	
  of	
  young	
  people	
  you	
  know,	
  how	
  comfortable	
  do	
   you	
  think	
  they	
  would	
  feel	
  comfortable	
  accessing	
  sexual	
  health	
  information	
   online?	
  	
  	
   • Now,	
  thinking	
  beyond	
  your	
  peers/friends,	
  to	
  the	
  diversity	
  of	
  young	
   people,	
  can	
  you	
  think	
  of	
  any	
  groups	
  of	
  youth	
  that	
  would	
  be	
  less	
  likely	
  to	
   access	
  online	
  sexual	
  health	
  information?	
  	
  Any	
  that	
  would	
  be	
  very	
  likely?	
   	
   • How	
  do	
  you	
  think	
  the	
  comfort	
  level	
  of	
  young	
  men	
  would	
  compare	
  to	
  that	
   of	
  young	
  women?	
  	
  Why?	
  	
  Who	
  do	
  you	
  think	
  would	
  access	
  it	
  more	
  often?	
   • How	
  easy	
  do	
  you	
  think	
  it	
  is	
  for	
  gay	
  or	
  bisexual	
  youth	
  to	
  access	
  sexual	
   health	
  information	
  online	
  that	
  is	
  relevant	
  to	
  them?	
  	
  How	
  easy	
  do	
  you	
    	
    	
    91	
  	
    • •  • •  think	
  it	
  is	
  for	
  transgender	
  youth	
  to	
  access	
  sexual	
  health	
  information	
   online?	
   How	
  easy	
  do	
  you	
  think	
  it	
  is	
  for	
  youth	
  who	
  are	
  street-­‐involved	
  to	
  access	
   sexual	
  health	
  information	
  online?	
   How	
  easy	
  do	
  you	
  think	
  it	
  is	
  for	
  youth	
  from	
  a	
  variety	
  of	
  cultural	
  or	
  ethnic	
   backgrounds	
  to	
  access	
  sexual	
  health	
  information	
  online?	
  	
  For	
  example,	
   youth	
  who	
  identify	
  as	
  Aboriginal,	
  or	
  youth	
  who	
  may	
  be	
  of	
  a	
  visible	
   minority?	
   What	
  “type”	
  of	
  young	
  person	
  do	
  you	
  think	
  would	
  not	
  visit	
  a	
  sexual	
  health	
   website?	
   Who	
  do	
  you	
  think	
  would	
  be	
  more	
  likely	
  to	
  access	
  sexual	
  health	
   information	
  online,	
  someone	
  who	
  is	
  ‘responsible’	
  or	
  someone	
  who	
  is	
  less	
   ‘responsible’?	
   	
    	
   The	
  next	
  set	
  of	
  questions	
  are	
  about	
  the	
  online	
  STI	
  testing	
  service	
  that	
  will	
  be	
  offered:	
   	
   In	
  addition	
  to	
  the	
  sexual	
  health	
  website	
  this	
  new	
  program	
  being	
  developed	
  will	
   bring	
  STI	
  testing	
  online.	
  Patients	
  will	
  be	
  able	
  to	
  fill	
  out	
  an	
  online	
  risk	
  assessment	
   then	
  download	
  a	
  lab	
  requisition	
  for	
  urine/blood	
  tests	
  at	
  a	
  lab	
  (a	
  lab	
  requisition	
  is	
   the	
  sheet	
  that	
  lets	
  the	
  lab	
  know	
  what	
  tests	
  you	
  need	
  to	
  do).	
  	
  You	
  will	
  also	
  be	
  able	
  to	
   obtain	
  your	
  negative	
  results	
  online,	
  and	
  they	
  will	
  also	
  have	
  online	
  access	
  to	
  sexual	
   health	
  counselors	
  if	
  you	
  have	
  any	
  questions	
  about	
  your	
  results.	
   	
   Previous	
  experiences	
  with	
  STI	
  testing	
  services	
  	
   [Appreciative	
  Aspects,	
  and	
  Barriers	
  associated	
  with	
  conventional	
  testing]	
   	
   16. Tell	
  me	
  the	
  story	
  of	
  how	
  you	
  came	
  to	
  be	
  tested	
  for	
  STIs.	
  	
  Start	
  anywhere	
  you	
   want.	
  	
  Remember,	
  you	
  don’t	
  have	
  to	
  answer	
  any	
  questions	
  you	
  don’t	
  want	
  to.	
   	
   17. Thinking	
  back	
  on	
  your	
  experiences	
  accessing	
  testing,	
  what	
  experiences	
  or	
   characteristics	
  of	
  a	
  clinic	
  might	
  encourage	
  you	
  go	
  back	
  to	
  that	
  particular	
   clinic?	
  	
  [Example	
  probes]:	
   • Did	
  the	
  staff	
  at	
  any	
  particular	
  clinic	
  make	
  you	
  feel	
  especially	
  welcome?	
   Tell	
  me	
  about	
  this.	
   • Was	
  it	
  very	
  convenient	
  to	
  get	
  to	
  any	
  particular	
  clinic?	
  	
  Tell	
  me	
  about	
   this.	
   	
   18. Was	
  there	
  anything	
  that	
  would	
  make	
  you	
  not	
  want	
  to	
  go	
  back	
  to	
  a	
  specific	
   clinic	
  for	
  STI	
  testing?	
  	
  [For	
  example:]	
   • Did	
  you	
  ever	
  run	
  into	
  anyone	
  you	
  knew?	
   • Did	
  you	
  have	
  to	
  wait	
  a	
  long	
  time	
  in	
  the	
  waiting	
  room?	
   • Was	
  the	
  clinic	
  inconveniently	
  located?	
   	
    	
    	
    92	
  	
    	
    	
    19. Thinking	
  about	
  the	
  online	
  testing	
  that	
  will	
  be	
  offered,	
  what	
  do	
  you	
  think	
   about	
  this	
  service?	
   • What	
  appeals	
  to	
  you	
  most	
  about	
  this	
  service?	
  	
  	
   • What	
  would	
  motivate	
  you	
  to	
  use	
  this	
  service?	
   • Are	
  there	
  any	
  reasons	
  that	
  would	
  make	
  you	
  not	
  use	
  this	
  service?	
   • Are	
  there	
  any	
  youth	
  or	
  groups	
  of	
  youth	
  that	
  you	
  can	
  think	
  of	
  that	
  would	
   be	
  more	
  likely	
  to	
  use	
  this	
  service?	
  Why?	
   • Are	
  there	
  any	
  youth	
  or	
  groups	
  of	
  youth	
  who	
  you	
  think	
  would	
  be	
  less	
   likely	
  to	
  use	
  this	
  service?	
  Why?	
   • Do	
  you	
  think	
  that	
  the	
  online	
  STI	
  testing	
  service	
  might	
  help	
  promote	
  STI	
   testing	
  in	
  groups	
  who	
  maybe	
  wouldn’t	
  normally	
  go	
  to	
  a	
  doctor’s	
  office	
  or	
   clinic	
  to	
  get	
  tested?	
  	
  If	
  yes,	
  how?	
   	
   20. Would	
  you	
  feel	
  more	
  or	
  less	
  comfortable	
  answering	
  questions	
  about	
  your	
   sexual	
  history	
  online	
  as	
  compared	
  to	
  in	
  person?	
  	
  Why?	
   • Would	
  you	
  trust	
  what	
  the	
  system	
  recommended	
  for	
  you	
  to	
  be	
  tested	
  for?	
  	
   How	
  would	
  that	
  trust	
  compare	
  to	
  a	
  doctor	
  or	
  a	
  nurse’s	
   recommendations?	
   21. What	
  kinds	
  of	
  personal	
  identifiers	
  would	
  you	
  feel	
  comfortable	
  providing	
   when	
  you	
  ordered	
  an	
  STI	
  test	
  online?	
  	
  For	
  example,	
  your	
  full	
  name,	
  date	
  of	
   birth,	
  address,	
  personal	
  health	
  number	
  (e.g.,	
  Care	
  Card)	
    How	
  would	
  needing	
  to	
  provide	
  these	
  identifiers	
  affect	
  how	
  comfortable	
   you	
  feel	
  accessing	
  the	
  service?	
    How	
  comfortable	
  would	
  you	
  feel	
  creating	
  an	
  account	
  linked	
  to	
  your	
   personal	
  identifiers?	
   22. Many	
  people	
  use	
  their	
  handheld	
  devices	
  (such	
  as	
  their	
  mobile	
  phones)	
  to	
   access	
  the	
  internet.	
  	
  What	
  do	
  you	
  think	
  about	
  accessing	
  online	
  STI	
  testing	
  in	
   this	
  way?	
    What	
  about	
  accessing	
  sexual	
  health	
  information	
  in	
  this	
  way?	
    How	
  would	
  it	
  compare	
  to	
  using	
  a	
  computer	
  to	
  access	
  sexual	
  health	
   information?	
   o For	
  example,	
  would	
  it	
  feel	
  more	
  or	
  less	
  private	
  to	
  you?	
    What	
  do	
  you	
  currently	
  use	
  your	
  cell	
  phone/mobile	
  device	
  for?	
  	
  (e.g.,	
   texting,	
  email,	
  accessing	
  the	
  internet)	
   	
   23. How	
  easy	
  would	
  it	
  be	
  for	
  you	
  to	
  download,	
  print	
  out	
  a	
  lab	
  requisition,	
  and	
   bring	
  it	
  to	
  the	
  lab	
  with	
  you?	
   • Do	
  you	
  have	
  a	
  printer	
  at	
  home	
  you	
  could	
  use?	
   • Would	
  you	
  want	
  the	
  form	
  emailed	
  to	
  you	
  or	
  sent	
  to	
  your	
  mobile	
  device?	
   • How	
  would	
  you	
  feel	
  about	
  pre-­‐selecting	
  the	
  lab	
  that	
  you	
  would	
  be	
  going	
   to,	
  is	
  it	
  meant	
  you	
  were	
  able	
  to	
  pick	
  up	
  the	
  lab	
  requisition	
  at	
  the	
  lab	
  you	
   were	
  visiting,	
  and	
  not	
  have	
  to	
  print	
  it	
  out?	
   	
    	
    	
    93	
  	
    	
    24. Have	
  you	
  ever	
  visited	
  a	
  private	
  lab	
  (e.g.,	
  BC	
  Biomedical	
  Laboratories	
  or	
   LifeLabs)?	
   • Was	
  it	
  for	
  STI	
  or	
  HIV	
  testing?	
   • Did	
  you	
  have	
  to	
  show	
  any	
  kind	
  of	
  ID?	
   • What	
  was	
  your	
  experience	
  like?	
   • Would	
  you	
  be	
  willing	
  to	
  return	
  there	
  as	
  part	
  of	
  online	
  testing?	
   25. 	
  When	
  your	
  results	
  are	
  ready,	
  would	
  you	
  want	
  to	
  check	
  for	
  them	
  yourself,	
  or	
   would	
  you	
  like	
  to	
  be	
  notified	
  when	
  they	
  are	
  ready?	
   • How	
  would	
  you	
  prefer	
  to	
  receive	
  your	
  test	
  results	
  (online,	
  email,	
  test,	
   phone,	
  in-­‐person?	
   • How	
  would	
  you	
  not	
  want	
  to	
  be	
  notified?	
   • How	
  comfortable	
  would	
  you	
  feel	
  getting	
  positive	
  results	
  online?	
  	
   Would	
  you	
  rather	
  have	
  these	
  given	
  in	
  person	
  or	
  over	
  the	
  phone?	
    	
   Saliency	
  and	
  Credibility	
   	
   26. What	
  are	
  some	
  features	
  of	
  an	
  online	
  STI	
  testing	
  website	
  that	
  might	
  make	
  you	
   deem	
  it	
  “good	
  quality/expert/trustworthy”?	
  	
  	
   • What	
  are	
  some	
  features	
  that	
  might	
  make	
  you	
  deem	
  it	
  “bad	
   quality/non-­‐expert/untrustworthy”?	
  	
  	
   	
   27. How	
  do	
  you	
  think	
  social	
  media	
  might	
  be	
  used	
  to	
  promote	
  online	
  STI	
  testing?	
   	
   	
   Socio-­‐technical	
  nature	
  of	
  the	
  human-­‐computer	
  interface	
   	
   28. Who	
  do	
  you	
  think	
  would	
  be	
  more	
  likely	
  to	
  use	
  an	
  online	
  STI	
  testing	
  service,	
   men	
  or	
  women?	
  	
  Why?	
   	
   29. How	
  do	
  you	
  think	
  you	
  would	
  feel	
  about	
  yourself	
  if	
  you	
  accessed	
  online	
  STI	
   testing?	
  (e.g.,	
  more	
  responsible/less	
  responsible)	
   	
   	
   Diversity	
   	
   30. We	
  have	
  talked	
  a	
  lot	
  about	
  diversity,	
  and	
  about	
  the	
  different	
  types	
  of	
  people	
   that	
  this	
  online	
  STI	
  testing	
  service	
  could	
  reach.	
  	
  Thinking	
  about	
  everything	
   we’ve	
  talked	
  about,	
  do	
  you	
  have	
  any	
  new	
  ideas	
  on	
  how	
  the	
  service	
  could	
  be	
   designed	
  in	
  a	
  way	
  that	
  promoted	
  testing	
  in	
  groups	
  of	
  young	
  men	
  or	
  women	
   who	
  possibly	
  wouldn’t	
  normally	
  go	
  for	
  testing?	
   • For	
  example:	
    youth	
  who	
  may	
  not	
  feel	
  comfortable	
  answering	
  questions	
  about	
   their	
  sexual	
  history	
    youth	
  who	
  are	
  street-­‐involved	
    	
    	
    94	
  	
       youth	
  from	
  a	
  cultural	
  background	
  where	
  sexual	
  health	
  is	
  not	
  freely	
   discussed	
   youth	
  who	
  identify	
  as	
  LGBT	
    	
   Final	
  thoughts	
   31. Is	
  there	
  any	
  other	
  advice	
  you’d	
  like	
  to	
  share	
  with	
  us	
  about	
  the	
  new	
  online	
   sexual	
  health	
  services	
  program?	
   32. Have	
  your	
  opinions	
  changed	
  from	
  when	
  we	
  first	
  told	
  you	
  about	
  the	
  service,	
   or	
  do	
  you	
  feel	
  the	
  same	
  as	
  your	
  initial	
  reactions?	
   33. Lastly,	
  individual	
  interviews	
  are	
  just	
  one	
  part	
  of	
  this	
  project.	
  	
  We’re	
  looking	
   at	
  engaging	
  youth	
  in	
  a	
  variety	
  of	
  ways,	
  including	
  a	
  youth	
  working	
  group,	
  and	
   a	
  youth	
  roundtable.	
  	
  You	
  don’t	
  have	
  to	
  commit	
  to	
  anything	
  now,	
  but	
  would	
   you	
  be	
  willing	
  to	
  be	
  contacted	
  at	
  a	
  later	
  date	
  to	
  see	
  if	
  you’re	
  interested?	
  	
   There	
  is	
  an	
  honorarium	
  involved	
  in	
  the	
  other	
  parts	
  of	
  the	
  project	
  as	
  well.	
   	
   	
   	
    	
    	
    95	
  	
    Appendix	
  2:	
  Focus	
  group	
  guide	
  for	
  youth	
   Online	
  STI	
  Testing	
  &	
  Youth	
   Focus	
  Group	
  Guide	
   	
   Review	
  the	
  informed	
  consent	
  and	
  focus	
  group	
  structure:	
  This	
  session	
  will	
  be	
   audio	
  taped	
  and	
  will	
  last	
  about	
  1	
  to	
  1.5	
  hours.	
  We’ll	
  begin	
  our	
  focus	
  group	
  by	
   completing	
  a	
  brief	
  survey	
  (5	
  minutes).	
  Then	
  I	
  will	
  ask	
  you	
  some	
  questions	
  about	
   your	
  experiences	
  with	
  STI	
  testing.	
  While	
  we’re	
  talking,	
  I’ll	
  ask	
  you	
  about	
  your	
   experiences	
  with	
  STI	
  testing	
  services,	
  as	
  well	
  as	
  what	
  you	
  think	
  about	
  using	
  online	
   sexual	
  health	
  services.	
  During	
  the	
  interview,	
  I’ll	
  be	
  taking	
  a	
  few	
  notes	
  about	
  the	
   events	
  and	
  experiences	
  you	
  describe	
  to	
  me.	
  	
  	
   	
   Part	
  0	
  –	
  Survey	
  	
   Part	
  1	
  -­‐	
  Self	
  Introduction	
  (~	
  5	
  min)	
   	
   Purpose:	
  To	
  help	
  the	
  participants	
  to	
  learn	
  about	
  each	
  other	
  and	
  become	
  more	
   comfortable	
  with	
  sharing	
  their	
  opinions	
  later	
  on	
  during	
  the	
  group	
  discussions.	
  	
   	
   1.	
  Please	
  introduce	
  yourself	
  to	
  the	
  group	
  and	
  tell	
  the	
  group	
  something	
  about	
   yourself.	
  	
  	
   	
   2.	
  Where	
  did	
  you	
  hear	
  about	
  our	
  study?	
   	
   3.	
  Can	
  you	
  tell	
  my	
  why	
  you	
  decided	
  to	
  volunteer	
  for	
  our	
  study	
  today?	
   	
   Part	
  2	
  -­‐	
  Source	
  of	
  Sexual	
  Health	
  Information	
  (~	
  20	
  min)	
   	
   Purpose:	
  First,	
  to	
  identify	
  what	
  methods	
  or	
  strategies	
  the	
  participants	
  are	
   currently	
  using	
  to	
  access	
  sexual	
  health	
  information.	
  	
  Second,	
  to	
  identify	
  the	
  types	
   of	
  problems	
  they	
  encounter	
  while	
  accessing	
  sexual	
  health	
  information.	
  	
   	
   (We	
  could	
  collect	
  information	
  on	
  the	
  type	
  of	
  channels	
  they	
  use	
  to	
  access	
   sexual	
  health	
  information	
  on	
  the	
  survey.	
  During	
  the	
  focus	
  group	
  we	
  could	
   discuss	
  the	
  answers	
  they	
  provide.)	
   	
   1. Where	
  do	
  you	
  prefer	
  to	
  get	
  your	
  sexual	
  health	
  information	
  from?	
   • Who	
  are	
  you	
  most	
  comfortable	
  asking	
  questions	
  to?	
   • Whose	
  information	
  do	
  you	
  trust	
  the	
  most?	
   	
   2. Have	
  you	
  ever	
  looked	
  for	
  sexual	
  health	
  information	
  online?	
  	
  	
   • How	
  is	
  this	
  done,	
  please	
  describe	
  the	
  search	
  strategies	
  you	
  use.	
   • What	
  information	
  do	
  you	
  look	
  for?	
  	
  Are	
  you	
  able	
  to	
  find	
  it?	
   • What	
  sexual	
  health	
  information	
  is	
  difficult	
  to	
  find	
  online?	
  Is	
  there	
   anything	
  you’d	
  like	
  to	
  see	
  more	
  of	
  online?	
    	
    	
    96	
  	
    •  Have	
  you	
  ever	
  tried	
  to	
  find	
  a	
  way	
  to	
  get	
  an	
  STI	
  test	
  online	
  (e.g.,	
   referral	
  to	
  local	
  clinic,	
  mail	
  order	
  ‘kit’)?	
  	
  What	
  did	
  you	
  find?	
    	
   3. Are	
  there	
  any	
  sexual	
  health	
  websites	
  you	
  really	
  like?	
  	
   	
   4. What	
  would	
  make	
  you	
  return	
  to	
  a	
  sexual	
  health	
  website,	
  once	
  you’ve	
   visited	
  it?	
   	
   	
   Part	
  3	
  –	
  Evaluation	
  of	
  Existing	
  Sexual	
  Health	
  Websites	
  (~	
  30	
  min)	
   	
   Purpose:	
  To	
  identify	
  what	
  is	
  working	
  well	
  and	
  what	
  isn’t	
  working	
  well	
  in	
  terms	
   of	
  how	
  the	
  existing	
  websites	
  are	
  reaching	
  and	
  appealing	
  the	
  youth	
  population.	
   	
   Saliency	
  and	
  Credibility	
  of	
  website	
   	
   1. Okay,	
  thinking	
  about	
  a	
  few	
  of	
  the	
  things	
  we	
  talked	
  about,	
  I’d	
  like	
  to	
  show	
  you	
   some	
  existing	
  sexual	
  health	
  websites	
  and	
  ask	
  for	
  your	
  thoughts	
  on	
  them.	
  	
  For	
   each	
  of	
  them,	
  I’d	
  like	
  to	
  know:	
   • What	
  do	
  you	
  like	
  about	
  it?	
   • What	
  don’t	
  you	
  like	
  about	
  it?	
   • How	
  well	
  would	
  you	
  trust	
  information	
  on	
  this	
  website?	
  	
  Why?	
   • Who	
  do	
  you	
  think	
  this	
  website	
  is	
  targeted	
  towards?	
  	
   Males/females/both?	
  	
  Teenagers/adults/both?	
   	
  	
  	
  	
  	
  	
  List	
  of	
  5	
  websites:	
   a. http://www.stdresource.com	
  	
   b. http://www.sexualityandu.ca	
  	
   c. http://www.optionsforsexualhealth.org	
  	
   d. http://www.scarleteen.com	
  	
   • Which	
  website	
  is	
  your	
  favourite?	
   	
   2. Would	
  you	
  find	
  any	
  of	
  these	
  features	
  helpful	
  on	
  a	
  sexual	
  health	
  website	
   (would	
  you	
  actually	
  use	
  them)?	
  	
  Why	
  or	
  why	
  not?	
  Email	
  a	
  question	
  to	
  a	
  nurse	
   to	
  answer	
   • Post	
  a	
  question	
  to	
  a	
  message	
  board	
  or	
  forum	
  for	
  a	
  nurse	
  to	
  answer	
   • Post	
  a	
  question	
  to	
  a	
  message	
  board	
  or	
  forum	
  for	
  other	
  forum	
  users	
  to	
   answer	
   • Instant	
  messaging	
  or	
  chat	
  with	
  a	
  nurse	
   • Follow	
  a	
  blog	
  with	
  sexual	
  health	
  advice	
  and	
  information	
   • Listen	
  to	
  podcasts	
  on	
  sexual	
  health	
  topics	
   • Watch	
  videos	
  on	
  sexual	
  health	
  topics	
  	
   • FAQ	
  section	
  on	
  sexual	
  health	
  topics	
   	
   	
   	
   	
    	
    97	
  	
    Socio-­‐technical	
  nature	
  of	
  the	
  human-­‐computer	
  interface	
   	
    	
    1. Next,	
  I’d	
  like	
  to	
  show	
  you	
  some	
  samples	
  of	
  text	
  from	
  a	
  few	
  sexual	
  health	
   websites.	
  	
  I’d	
  like	
  you	
  to	
  have	
  a	
  look	
  at	
  them,	
  and	
  then	
  give	
  me	
  some	
  of	
  your	
   opinions	
  on	
  the	
  different	
  words	
  used.	
  	
  I’m	
  really	
  interested	
  in	
  you	
  responses	
   to	
  the	
  different	
  phrasing	
  used.	
  	
  How	
  would	
  you	
  feel	
  about	
  seeing	
  each	
  of	
   these	
  writing	
  styles	
  on	
  a	
  sexual	
  health	
  website?	
  	
  	
   2. Now	
  I’d	
  like	
  to	
  show	
  you	
  some	
  examples	
  of	
  some	
  images	
  used	
  on	
  a	
  few	
   sexual	
  health	
  websites.	
  	
  I’d	
  like	
  you	
  to	
  have	
  a	
  look	
  at	
  them,	
  and	
  give	
  me	
  your	
   opinions	
  on	
  them.	
  	
  How	
  would	
  you	
  feel	
  about	
  seeing	
  each	
  of	
  these	
  images	
  on	
   a	
  sexual	
  health	
  website?	
  	
  	
    	
   Part	
  4	
  –	
  Diversity	
  (10	
  min)	
   	
   34. In	
  our	
  previous	
  studies,	
  we’ve	
  talked	
  with	
  a	
  diverse	
  group	
  of	
  youth	
  about	
   accessing	
  sexual	
  health	
  services	
  and	
  sexual	
  health	
  information.	
  	
  We’ve	
  heard	
   from	
  a	
  lot	
  of	
  different	
  youth	
  that	
  accessing	
  these	
  things	
  isn’t	
  always	
   straightforward	
  or	
  easy,	
  for	
  a	
  variety	
  of	
  reasons.	
  	
  We’d	
  like	
  to	
  share	
  with	
  you	
   two	
  stories	
  of	
  youth	
  who	
  both	
  have	
  a	
  need	
  to	
  access	
  sexual	
  health	
  services	
   and	
  information.	
   	
   Jim	
  is	
  a	
  20-­‐year-­‐old	
  male	
  who	
  identifies	
  as	
  heterosexual.	
  	
  Jim	
  grew	
  up	
  in	
  a	
   household	
  where	
  sexual	
  health	
  was	
  openly	
  discussed,	
  and	
  his	
  parents	
  were	
  not	
   troubled	
  by	
  the	
  fact	
  that	
  he	
  is	
  sexually	
  active	
  and	
  not	
  married.	
  	
  Jim	
  attends	
   university	
  and	
  lives	
  in	
  a	
  student	
  residence,	
  where	
  he	
  has	
  his	
  own	
  room	
  and	
  a	
   personal	
  laptop	
  computer.	
  	
  He	
  openly	
  discusses	
  sexual	
  health	
  issues	
  with	
  his	
   friends,	
  and	
  has	
  even	
  heard	
  of	
  a	
  few	
  good	
  websites	
  on	
  the	
  subject	
  from	
  them.	
  	
  	
   	
   Our	
  second	
  story	
  is	
  about	
  John.	
  	
  John	
  is	
  a	
  17-­‐year	
  old	
  young	
  man	
  who	
  attends	
   high	
  school	
  in	
  Vancouver	
  and	
  lives	
  at	
  home.	
  	
  John’s	
  parents	
  are	
  very	
   conservative,	
  and	
  sexuality	
  was	
  never	
  discussed	
  as	
  Jonathan	
  was	
  growing	
  up.	
  	
   They	
  don’t	
  believe	
  in	
  sex	
  before	
  marriage,	
  and	
  are	
  unaware	
  that	
  he	
  identifies	
  as	
   gay	
  and	
  has	
  sex	
  with	
  other	
  men.	
  	
  Jonathan	
  doesn’t	
  have	
  many	
  friends	
  he	
  can	
   talk	
  to	
  about	
  sexual	
  health	
  issues	
  that	
  are	
  important	
  to	
  him.	
  	
  His	
  family	
  has	
  one	
   shared	
  computer,	
  and	
  it	
  is	
  in	
  the	
  living	
  room.	
   	
   	
   Thinking	
  about	
  the	
  lives	
  and	
  circumstances	
  of	
  Jim	
  and	
  John,	
  what	
  do	
  you	
   think	
  might	
  be	
  some	
  features	
  of	
  each	
  of	
  their	
  stories	
  that	
  make	
  it	
  easier	
  or	
   harder	
  for	
  them	
  to	
  access	
  online	
  sexual	
  health	
  information?	
  [Examples	
  of	
   probes:]	
   • For	
  example,	
  how	
  do	
  you	
  think	
  their	
  respective	
  ages	
  might	
  affect	
  how	
   they	
  access	
  sexual	
  health	
  information	
  online	
    	
    	
    98	
  	
    •  How	
  do	
  you	
  think	
  their	
  different	
  sexual	
  identities	
  might	
  affect	
  how	
  they	
   access	
  online	
  sexual	
  health	
  information	
  differently?	
  	
    	
   35. Thinking	
  about	
  the	
  diversity	
  of	
  young	
  people	
  you	
  know,	
  how	
  comfortable	
  do	
   you	
  think	
  they	
  would	
  feel	
  comfortable	
  accessing	
  sexual	
  health	
  information	
   online?	
  	
  	
   • Now,	
  thinking	
  beyond	
  your	
  peers/friends,	
  to	
  the	
  diversity	
  of	
  young	
   people,	
  can	
  you	
  think	
  of	
  any	
  groups	
  of	
  youth	
  that	
  would	
  be	
  less	
  likely	
  to	
   access	
  online	
  sexual	
  health	
  information?	
  	
  Any	
  that	
  would	
  be	
  very	
  likely?	
   	
   	
   Part	
  5	
  –	
  Previous	
  STI	
  testing	
  experiences	
  (~	
  15	
  min)	
   	
   Purpose:	
  To	
  learn	
  about	
  the	
  types	
  of	
  STI	
  testing	
  experiences	
  the	
  participants	
   have	
  had.	
  To	
  identify	
  the	
  issues	
  (including	
  diversity	
  issues)	
  they	
  encounter	
  and	
   the	
  types	
  of	
  improvement	
  they	
  might	
  like	
  to	
  see	
  in	
  the	
  context	
  of	
  STI	
  testing.	
  	
   	
   1. If	
  somebody	
  feels	
  comfortable	
  starting	
  us	
  off,	
  could	
  you	
  share	
  your	
  STI	
   testing	
  experiences?	
  	
  Start	
  anywhere	
  you	
  want.	
  	
  Remember,	
  you	
  don’t	
  have	
  to	
   answer	
  any	
  questions	
  you	
  don’t	
  want	
  to.	
   	
   36. Thinking	
  back	
  on	
  your	
  experiences	
  accessing	
  testing,	
  what	
  experiences	
  or	
   characteristics	
  of	
  a	
  clinic	
  might	
  encourage	
  you	
  go	
  back	
  to	
  that	
  particular	
   clinic?	
  	
  [Example	
  probes]:	
   • Did	
  the	
  staff	
  at	
  any	
  particular	
  clinic	
  make	
  you	
  feel	
  especially	
  welcome?	
   Tell	
  me	
  about	
  this.	
   • Was	
  it	
  very	
  convenient	
  to	
  get	
  to	
  any	
  particular	
  clinic?	
  	
  Tell	
  me	
  about	
   this.	
   	
   37. Was	
  there	
  anything	
  that	
  would	
  make	
  you	
  not	
  want	
  to	
  go	
  back	
  to	
  a	
  specific	
   clinic	
  for	
  STI	
  testing?	
  	
  [For	
  example:]	
   • Did	
  you	
  ever	
  run	
  into	
  anyone	
  you	
  knew?	
   • Did	
  you	
  have	
  to	
  wait	
  a	
  long	
  time	
  in	
  the	
  waiting	
  room?	
   • Was	
  the	
  clinic	
  inconveniently	
  located?	
   	
   	
   Part	
  6	
  –	
  Online	
  STI	
  testing	
  (	
  ~	
  25	
  min)	
   	
   Purpose:	
  To	
  elicit	
  the	
  participant’s	
  attitude	
  toward	
  online	
  STI	
  testing	
  service	
   and	
  gather	
  any	
  recommendations	
  they	
  may	
  have	
  for	
  improving	
  or	
  making	
  the	
   service	
  more	
  fitting	
  for	
  their	
  needs.	
  	
   	
   Description	
  of	
  Online	
  Sexual	
  Health	
  Services	
  Program:	
  A	
  new	
  program	
  is	
   being	
  developed	
  to	
  address	
  some	
  of	
  the	
  difficulties	
  young	
  people	
  might	
  have	
  in	
   getting	
  tested	
  for	
  STIs	
  and	
  in	
  getting	
  answers	
  to	
  their	
  sexual	
  health	
  questions.	
    	
    	
    99	
  	
    First	
  of	
  all,	
  we	
  are	
  developing	
  a	
  website	
  where	
  young	
  people	
  can	
  access	
  sexual	
   health	
  information,	
  as	
  well	
  as	
  chat	
  online	
  anonymously	
  with	
  a	
  nurse,	
  one-­‐on-­‐ one.	
  	
  Furthermore,	
  a	
  new	
  program	
  is	
  being	
  developed	
  to	
  bring	
  STI	
  testing	
  online.	
   Patients	
  will	
  first	
  fill	
  out	
  an	
  online	
  risk	
  assessment	
  and	
  then	
  download	
  a	
  lab	
   requisition	
  for	
  urine/blood	
  tests	
  at	
  a	
  lab	
  (a	
  lab	
  requisition	
  is	
  the	
  sheet	
  that	
  lets	
   the	
  lab	
  know	
  what	
  tests	
  you	
  need	
  to	
  do).	
  	
  You	
  will	
  also	
  be	
  able	
  to	
  obtain	
  your	
   negative	
  results	
  online,	
  and	
  they	
  will	
  also	
  have	
  online	
  access	
  to	
  sexual	
  health	
   counselors	
  if	
  you	
  have	
  any	
  questions	
  about	
  your	
  results.	
  	
   	
   1. What	
  do	
  you	
  think	
  about	
  the	
  online	
  testing	
  service?	
   • What	
  appeals	
  to	
  you	
  most	
  about	
  this	
  service?	
  	
  	
   • What	
  would	
  motivate	
  you	
  to	
  use	
  this	
  service?	
   • Are	
  there	
  any	
  reasons	
  that	
  would	
  make	
  you	
  not	
  use	
  this	
  service?	
   • How	
  do	
  you	
  think	
  the	
  online	
  STI	
  testing	
  service	
  might	
  help	
  promote	
   STI	
  testing	
  in	
  groups	
  who	
  maybe	
  wouldn’t	
  normally	
  go	
  to	
  a	
  doctor’s	
   office	
  or	
  clinic	
  to	
  get	
  tested?	
   	
   2. How	
  comfortable	
  do	
  you	
  feel	
  about	
  answering	
  questions	
  about	
  your	
  sexual	
   history	
  online?	
  What	
  about	
  in	
  comparison	
  to	
  answering	
  it	
  in	
  person?	
  	
  	
   	
    	
    3. Are	
  there	
  any	
  kind	
  of	
  personal	
  identifiers	
  you	
  would	
  feel	
  uncomfortable	
   providing	
  when	
  you	
  ordered	
  an	
  STI	
  test	
  online?	
  	
  	
   • How	
  would	
  the	
  need	
  to	
  provide	
  identifiers	
  such	
  as	
  your	
  full	
  name,	
   date	
  of	
  birth,	
  address,	
  personal	
  health	
  number	
  (e.g.,	
  Care	
  Card)	
  affect	
   how	
  comfortable	
  you	
  feel	
  accessing	
  the	
  online	
  STI	
  testing	
  service?	
   • How	
  comfortable	
  would	
  you	
  feel	
  about	
  creating	
  an	
  account	
  linked	
  to	
   your	
  personal	
  identifiers?	
   4. Many	
  people	
  use	
  their	
  handheld	
  devices	
  (such	
  as	
  their	
  mobile	
  phones)	
  to	
   access	
  the	
  internet.	
  	
  What	
  do	
  you	
  think	
  about	
  accessing	
  online	
  STI	
  testing	
  in	
   this	
  way?	
   • What	
  about	
  accessing	
  sexual	
  health	
  information	
  in	
  this	
  way?	
   • How	
  would	
  it	
  compare	
  to	
  using	
  a	
  computer	
  to	
  access	
  sexual	
  health	
   information?	
  Would	
  it	
  feel	
  more	
  or	
  less	
  private	
  to	
  you?	
   • What	
  do	
  you	
  currently	
  use	
  your	
  cell	
  phone/mobile	
  device	
  for?	
  	
  (e.g.,	
   texting,	
  email,	
  accessing	
  the	
  internet)	
   	
   5. How	
  easy	
  would	
  it	
  be	
  for	
  you	
  to	
  download,	
  print	
  out	
  a	
  lab	
  requisition,	
  and	
   bring	
  it	
  to	
  the	
  lab	
  with	
  you?	
  Do	
  you	
  have	
  a	
  printer	
  at	
  home	
  you	
  could	
  use?	
   • Would	
  you	
  want	
  the	
  form	
  emailed	
  to	
  you	
  or	
  sent	
  to	
  your	
  mobile	
   device?	
   • How	
  would	
  you	
  feel	
  about	
  pre-­‐selecting	
  the	
  lab	
  that	
  you	
  would	
  be	
   going	
  to,	
  is	
  it	
  meant	
  you	
  were	
  able	
  to	
  pick	
  up	
  the	
  lab	
  requisition	
  at	
  the	
   lab	
  you	
  were	
  visiting,	
  and	
  not	
  have	
  to	
  print	
  it	
  out?	
   • Would	
  you	
  be	
  willing	
  to	
  go	
  to	
  a	
  private	
  lab	
  as	
  part	
  of	
  online	
  testing?	
    	
    	
    100	
  	
    	
   6. How	
  would	
  you	
  prefer	
  to	
  receive	
  your	
  test	
  results	
  (online,	
  email,	
  test,	
  phone,	
   in-­‐person?	
  How	
  would	
  you	
  not	
  want	
  to	
  be	
  notified?	
   	
   7. How	
  comfortable	
  would	
  you	
  feel	
  getting	
  positive	
  results	
  online?	
  	
  Would	
  you	
   rather	
  have	
  these	
  given	
  in	
  person	
  or	
  over	
  the	
  phone?	
   	
    8. I’d	
  like	
  to	
  show	
  you	
  an	
  example	
  of	
  social	
  media	
  being	
  used	
  to	
  promote	
  sexual	
   health.	
  	
  So	
  by	
  social	
  media,	
  we	
  mean	
  youtube,	
  twitter,	
  facebook	
  and	
  other	
   things	
  like	
  that.	
  	
  Do	
  you	
  think	
  social	
  media	
  could	
  be	
  used	
  to	
  promote	
  online	
   STI	
  testing?	
  If	
  so,	
  how?	
  If	
  not,	
  why?	
    	
    9. How	
  do	
  you	
  think	
  gender	
  matters	
  in	
  terms	
  of	
  willingness	
  to	
  use	
  an	
  online	
  STI	
   testing	
  service?	
  Please	
  explain.	
   	
   10. How	
  you	
  think	
  accessing	
  online	
  STI	
  testing	
  could	
  affect	
  how	
  you	
  perceive	
   yourself?	
  	
   	
   Diversity	
   	
   11. Out	
  of	
  the	
  vulnerable	
  groups	
  we’ve	
  talk	
  about,	
  who	
  do	
  you	
  think	
  would	
  be	
   most	
  likely	
  to	
  use	
  online	
  STI	
  testing?	
  	
  Who	
  do	
  you	
  think	
  would	
  be	
  least	
  likely?	
  	
   Why?	
  How	
  could	
  we	
  improve	
  the	
  service	
  for	
  those	
  who	
  would	
  be	
  least	
  likely?	
   	
   Part	
  7	
  -­‐	
  Final	
  thoughts	
  (5	
  min)	
   	
   12. Is	
  there	
  any	
  other	
  advice	
  you’d	
  like	
  to	
  share	
  with	
  us	
  about	
  the	
  new	
  online	
   sexual	
  health	
  services	
  program?	
   13. Have	
  your	
  opinions	
  changed	
  from	
  when	
  we	
  first	
  told	
  you	
  about	
  the	
  service,	
   or	
  do	
  you	
  feel	
  the	
  same	
  as	
  your	
  initial	
  reactions?	
   	
   14. Lastly,	
  ask	
  about	
  willingness	
  to	
  participate	
  in	
  youth	
  working	
  group,	
  and	
  a	
   youth	
  roundtable.	
  (Contact	
  information,	
  Honorarium)	
   	
   	
   	
    	
    	
    101	
  	
    

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