This document summarizes research on attracting and retaining teens aged 13-17 from California on a health-focused online social network. The research involved surveying 692 teens who were invited to participate in the online intervention, of which 165 became active users. Various recruitment strategies were tested, with holiday cards having the highest success rate at 8.8%. The site included social features and health-focused activities and themes. While some strategies engaged teens, high turnover remained a challenge without constant new content and events to engage youth in the short-term.

1. Attracting and Retaining Teens on a Health-Focused Online Social Network: What Works? Nedra Kline Weinreich, MS Weinreich Communications National Conference on Health Communication, Marketing and Media 2011

2. Project partners NIH/NICHD Grant #5R01HD059756-02

3. Our target audience Adolescents 13–17 years old, living in California Insurance coverage under Medi-Cal or Healthy Families Program managed by Health Net

5. Individual

6. Environmental

7. Appointments

8. Ability to overcome-Knowledge, attitudes, self-efficacy -Confidentiality -Self-care practices -Perceptions of wellness -Cues to action -Ability to access information -Different media -Confidence in analyzing -Trust and comfort level -Ability to request a different doctor Navigation of system Rights & responsibility Preventive care Information seeking Provider-patient relationship Health Literacy 4

9. Research design Survey + Healthcare Utilization Data

10. Recruitment to intervention Total teen participation on site N=692 Invited intervention participants N=691 Active intervention accounts N=165 Non-intervention accounts N= 527 24% enrollment rate

11. 7

12. 8

14. Status Updates

15. Photos

16. Videos

17. Blogs

18. Games (single + multiplayer)

19. Trivia

20. Shared Goals

21. Instant Messaging

22. Chat (rooms + events)

23. Opinion Prompts

24. Polls

25. Internal Messages

26. eCards

27. Friends

28. Contests/Missions

29. Articles

30. Facebook Integration

32. Sex / STDs / Pregnancy

33. Stress / Depression

34. Infectious Disease

35. Obesity / Weight

36. Fitness / Sports

37. Violence / Gangs

38. Relationships / Family

39. Driving

40. Safety / Injury

42. Conceptual framework Social Activity Theme Activity Domain Activity

43. Enrollment onto the website Outreach: Tailored email Email + SMS SMS Facebook messages Follow-up: Christmas cards Participant created Valentines cards

44. Success rates per enrollment strategy* Email 2.7% SMS 3.1% Cards**6.3% Holiday Card – 8.8% Valentine Card – 3.8% Average Touches for Registration Visit = 4.8 * Total Unique Registration Visits = 268 ** Only 1 Touch

45. Member demographics (Study participants only)

46. User site activity by points % of members Points (100 pts ~ 1 hour) [Points are designed to be a summative measure of site activity (time online, activities performed, engagement, etc.)]

48. Site activity for T2Xpression Awards The 3 most popular days coincided with T2Xpression Awards

49. Music incentive SMS Free music-you pick! Join Teen2xtreme-UCLA/Health Net's teen-only network-and get free music while supplies last. Your custom link: http://teen2xtreme.com/1823

50. Free music incentive – SMS campaign Sent 1277 free music incentive SMS messages prompting invited members to register 31 incentives redeemed (2.4%) Incentive = $5 Amazon music certificate Challenges Rising above the din of other “free” offers Hard to communicate that it is for any song

51. Whooping cough campaign Teen Health Alert: Must have whooping cough shot (Tdap) to go back to school. It's a new law! Text INFO for help from http://t2x.me or DONE if you got the shot.

52. Recent class experience: Expert Chat Topic: Mononucleosis (infectious disease) Length of planned student activities: 2 hrs Activities include: Highlighted video (CLUB Episode 2), Poll of the Day, What do you Think, Test Your Knowledge Game, Expert Chat New accounts created: 106 Users who visited site after class activities were finished: 11 (10.4%)

53. CLUB Homepage

54. Ask Allison Blog

55. CLUB Episode 1 Experience – Interaction between CLUB Members and General Teen Members

56. Research project timeline delayed by IRB issues with innovative programs Recruitment and retention requires multiple touchpoints Engaging youth on the site requires constant attention and new content/activities Competing with many other websites and constraints on their time Not a self-selected group Challenges

57. Playing coy about the purpose of the site Waiting for organic growth to magically occur Lumping together older and younger teens Links to/from Facebook accounts Random incentives – “Free music!” Ignoring the short-term users in favor of the regulars What Has NOT Worked

58. What HAS Worked Keep it teens-only – safe, no adults Volume: 90%-10%-1% rule Create micro-experiences/events e.g., T2Xpression art contest, themed class curricula, health expert chats, ongoing transmedia story Bring real-world groups online Provide pathways through the content Text messaging – recruitment, Tdap campaign

59. Teen2xtreme team Sharon Nessim, HN P.I. Elaine Robinson-Frank Diana Carr Maya Gumatay Kelly KonoVinia Pangan Carol Spencer Hoa Su Nancy Wongvipat Kalev Deborah Glik, P.I. Michael Prelip, P.I. AbdelmonemAfifi Philip Massey Elaine Quiter Gabriel Stover Brian Calimlim Michael Fiore ElissaVaidman Nedra Kline Weinreich

60. Contact Nedra Kline Weinreich Weinreich Communications weinreich@social-marketing.com www.social-marketing.com 310.286.2721 Twitter @Nedra