TeenNet: Using the Internet to Engage Youth in Health Promotion

The major sources of adolescent health concerns are largely preventable: e.g. smoking, excessive drinking, suicide, homicide, consequences of sexual behaviours such as STDs and pregnancy, drug abuse, eating disorders, mental illness, and injury and/or disability caused by motor vehicle or recreational accidents. Adolescence is the developmental stage when potential health risk behaviors are either initiated, or the individual passes successfully through this transition period into adulthood where the likelihood of initiation decreases substantially. This means adolescence is the ideal time in the life-course to prevent the onset of risk behaviors and to promote healthy patterns. Today's youth have access to more health information than ever in the past. Yet, health risk behaviors such as cigarette smoking and substance abuse have increased over the past 15 years. For these reasons, youth are a primary target for prevention and health promotion initiatives. The challenge persists: 'how do we engage teens?'

Youth today live in an interactive, highly media-orientated world. Interactive technologies captivate teens, providing enormous potential for exciting and innovative ways of engaging youth in prevention and health promotion activities. The increasing availability of information technology creates an innovative channel with the ability to reach a large number of young people, including those 'turned off' by traditional approaches. Health promotion programs that are interactive and involve peer lead components have been shown to be the most effective. The Web provides an ideal envirorunent for interactivity and peer-to-peer interaction. Yet, 'how can we use information technology effectivelyfor health promotion with youth?'


The TeenNet Project lead by Dr. Harvey Skinner (Department of Public Health Sciences, Faculty of Medicine, University of Toronto) works with a network of collaborating partners directly involved in education and health promotion with youth. The goal of TeenNet is to generate new knowledge and develop practical tools for engaging youth in health promotion using interactive technology.


Guiding Principles

Critical Success Factors

Youth Driven

TeenNet underscores individual choice by teens and the exploration of options regarding health behaviour. TeenNet takes a "teens in action" approach that involves young people from diverse backgrounds in all stages of program development and dissemination.

Youth have been integrally involved in project design, development, implementation and evaluation. During the first three years of the project, 14 youth were employed, including two street-involved youth. In the summer of 1999, six youth worked to develop the Teen Clinic Online. Additionally, over 70 youth from Toronto, North York and Brant County have been involved in 'Reality Checks' (formative evaluation). This is where we piloted storyboards and screenshots with teens. TeenNet has also used Teen Advisory Boards and Quality Control Committees, which consist of teens, parents, teachers, school board members, and health practitioners.


These organizations have extensive experience with and access to teenage populations, including youth not participating in formal education and street involved youth.
Brant County Board of Education Ontario Institute for Studies in Education (OISE UT)
Bloorview MacMillan Centre Ontario Tobacco Research Unit
Centre for Addiction and Mental Health St. Stephen’s Youth and New Media Program
Centre for Health Promotion (UofT) Substance Abuse Program for African-Canadian and Caribbean Youth (SAPACCY), CAMH
Council for A Tobacco Free Ontario Shout Clinic Toronto
Frontier College – Beat The Street Spina Bifida & Hydrocephalus Association of Ontario
Kids Help Phone Toronto Board of Education
FSC Internet Toronto Public Health Department
Hospital for Sick Children, Teen Clinic YMCA

TeenNet Tools

Components related to teen health and lifestyle issues have been developed for use in health settings, classrooms, community and home. In 1996-97, TeenNet worked directly with youth, health practitioners and educators to develop an interactive Website called CyberIsle to assist teens in addressing their physical, emotional, and social health needs. Since 1998, TeenNet has been working with youth and adolescent health practitioners to create a Teen Clinic Online for Cyberlsle and a PractitionerNet for health practitioners and educators.

CyberIsle (http ://lwww.cyberisle.org)

The main components of the Cyberlsle Website include:

Teen Clinic Online

The Teen Clinic Online is a new component ("place") on Cyberlsle currently under development. Using TeenNet's Action Research Model, the project team is working with youth and adolescent healthcare practitioners to investigate and develop a Web-based Clinic that meets teens' needs and engages them in meaningful ways.

The goal of the Teen Clinic Online is to provide youth with tools to make effective use of information technology to explore options and make decisions regarding their health. The Teen Clinic Online will provide youth with tools and self-directed leaning components to assist them:

The Teen Clinic Online also seeks to link technology with the health care system and related services (e.g. community organizations) by providing youth with information on how and when to contact a health professional, and how to negotiate this relationships. Through brainstorming sessions, rapid prototyping and pilot testing of prototypes, youth working with the project team have guided the development of the graphical layout, navigation, components and content for the Teen Clinic Online component of Cyberlsle.


Parallel to Cyberlste Websites for teens, TeenNet is developing a Practitioner Website (PractitionerNet). This is a place where practitioners (teachers, health professional, youth workers, those in social services) can meet, share ideas, access relevant hot links and resources, and gain an understanding of the TeenNet project and how to effectively use Cyberlsle with youth. Once developed this site will have its own Internet address or URL (www.practitionemet.org).

The PractitionerNet will provide comprehensive resources, discussion groups and a continuing education module for practitioners on how they can use information technology (specifically the Teen Clinic Online) for clinical prevention and health care in their work with youth. The workshops will also provide practitioners with opportunities to address the issues of changing practitioner behaviors and patient outcomes.

The workshops will be developed for accreditation by the Continuing Education Program, Faculty of Medicine, University of Toronto, and will consist of both online and face-to-face components. In developing training for adolescent health practitioners, the project team will use a Continuing Professional Development (CPD) model. CPD programs involve learners (in this case, health care practitioners) directly in the negotiation and design of their leaming programs.

Process and Implementation Evaluation

TeenNet has actively conducted process evaluation in four key areas:

Community Involvement: Teens have been integrally in TeenNet from the onset. Between 1995 and 1997, TeenNet employed 14 youth, including two street-involved youth, and used 20 youth in a Teen Advisory Group on the development of Cyberisle. Between 1998-99, TeenNet employed 6 youth, and used 3 Teen Advisory Groups to develop the Teen Clinic Online. School personnel, community organizations, health professionals, and school board members were also consulted.

Reality Checks (Formative Evaluation): Before converting components into Web fonnats, TeenNet conducts Reality Checks with groups of teens. In these pilots, teens reword questions, delete inappropriate comments, design a layout format, suggest graphical icons and rename sections.

Quality Review Committee: A group consisting of teens, teachers, health professionals, academics, and parents are responsible for setting guidelines and assessing the quality of all hotlinks on Cyberlsle.

Qualitative Evaluation: Cyberlsie was evaluated in 1996 and 1997 by two different sets of teens using short answer questionnaires, one-on-one interviews and focus groups. Teen Clinic Online was similarly evaluated in November, 1999 and will be re-evaluated in 2000.

Cyberlsle Qualitative Results

In 1996, Cyberlsle was pilot tested with 31 teens in Toronto, North York and Brant County. Teens were given 30 minutes to explore Cyberlsle. They then completed a short-answer questionnaire and participated in structured one-on-one interviews where they were asked to comment on navigation, design and layout. Teens' comments were collated then fed back to the technical team, who reconstructed parts of Cyberlsie according to the evaluation results. In 1997, a second pilot was held with 41 teens (21 male, 20 female), including 5 teens with physical disabilities. Teens came from both rural and urban locations and diverse cultural backgrounds. The teens were given 45 minutes to explore Cyberlsle, and then filled in a short answer questionnaire, followed by a one-hour focus group.

What Teen's think about Cyberlsle: What Teen's think about the TeenNet project: Smokers indicated that the Makin' Cents game on Cyberlsle would encourage then to think about quitting smoking:

CyberIsle meets teen health information needs:

"Yes ... because instead of going to their family doctor, or something it's another thing ... not being humiliated or anything or being conscious of oneself so it's better just to go on to this (CyberIsle) and get information off the Net. "

Teens felt CyberIsle was a better way to learn compared to school health classes: Teens like the anonymity of Hot Talk:

"... if you can't talk to one of your friends or a parent ... and you don't really know who you're talking to sometimes it's better that way 'cause you just say what you feel.. you can compare your thoughts with somebody else... if they have something to say then they'll talk back to you and it could help you. "It's really good. I think it's good way to get your point across to other people."

Thematic analysis of Hot Talk - Ongoing

Preliminary qualitative analysis of Hot Talk has been conducted. Eight discussion topics are currently active in Hot Talk (Smoking, Relationships, Drugs, Parents, School, Weight, Music and Sex) with several sub topics and conversations developed by teens in each topic area. The following is a few examples of current discussions:

Butt Out - smoking discussion:

"What is it with smoking? Personally I think it is totally disgusting. I don't see one positive thing about being smelly, having yellow fingers & teeth, and dying of cancer or any other related disease. Then again it makes you look ssoooooooo... cool!

"As a smoker I see it differently. We are all going to die at sometime or another. I just choose to light up. Everyone has a right to their own opinion.

What do you do and what do you think? - Drug discussion

“smoking is the best drugs are the best. I laugh at all you people"
"I respect your right to your opinion, but didn't you think before you wrote. Smoking and drugs don't have to be bad things but your message just furthers the stereotype of the ignorant drug addict without a brain. Get a clue!"

I feel like tearing out my spleen cause I'm a teen - depression & suicide discussions

"Do you just h8 life and want to die? Are you hi on drugs? Do you hang around with lowlifes? Do you have no friends? Have you ever slit your wrist? Please write about it here, coz I h8 life too, Good Luck!!! "
"All of you listen up! I used to hate my life to. Then I had Cancer. Trust me, the only time that you realise how precious life is when it is threatened. I fought for my life and survived. I still have problems but hey, who doesn't !e-mail me if ya need any more advice and please consider what I said. "
" I can relate. I'm a I7f who hates her body, fights with her family, and has thought about suicide a lot. But, if you really think about it, what's the point? What will you prove? ... You can't win, at least when you're alive, you can learn and control aspects of what happens to you... Get some professional help, if at all possible, or check out another Website, www.teenadvice.org to talk with teen operators.

Street-Involved Youth: Prospects of using the web for health promotion:

In April 1998, TeenNet explored the possibility of using the web for drug education with street-involved and low socioeconomic youth. Street-involved or street-connected youth refers to people under the age of 25 who participate in street life. Many are homeless, but some may live in shelters, hostels, with friends or relatives and some may still live a home, but all participate in street life.
Twenty youth (13 female, 5 male, 2 transgender) who attended Shout Clinic (a downtown Toronto clinic which provides comprehensive health services to street-involved youth) were interviewed for approximately 15 minutes and asked questions related to: what drugs they take (both medical and recreational), what specific information they want to know about those drugs, where they currently obtain drug information, and questions related to Internet usage. Even though this was a small sample, the study showed a willingness to use the Internet for accessing drug information:


TeenNet was initially funded by Health Canada and under the Ontario Tobacco Strategy. Additional funding was obtained through the Sociobehavioural Cancer Research Network, the North York Community Health Promotion Unit and the Hospital for Sick Children Foundation. Currently, TeenNet is funded through the Health Canada's Health lnfostructure Program (HISP), National Health and Research Development Program and the Ontario Ministry of Health and Long Term Care Renewed Tobacco Strategy.

TeenNet is managing partner for the Canadian Health Network's Youth Affiliate consortium funded through Health Canada.

Project Investigators

Harvey Skinner Ph.D.
Irv Rootman Ph.D.
Eudice Goldberg MD
David Kom, MD
Blake Poland Ph.D.
Larry Hershfield Ph.D.

Project Staff

Oonagh Maley, TeenNet Project Coordinatoor
Shawn Chirrey, CHN Youth Affiliate Coordinator
Louise Smith, TeenNet Research Assistant
Sherry Biscope, Youth and Technology Project Coordinator
Cameron Norman, PhD Candidate
Mabel Soo, Youth Web Designer
Charlotte Lombardo, Masters Candidate
Asma Khanam, Co-Op Student (High School)

For More Information

Harvey A. Skinner, Ph.D.
Professor and Chair
Department of Public Health Sciences
University of Toronto
Toronto, Ontario M5S IA8
Telephone (416) 978-8989
Fax (416) 978-2087
Email: harvey.skinner@utoronto.ca

Oonagh Maley, MIST
TeenNet Project Coordinator
Department of Public Health Sciences
University of Toronto
Toronto, Ontario M5S IA8
Telephone (416) 978-7543
Fax (416) 978-2087
Email: oonagh.maley@utoronto.ca