Peer-to-Peer Mentoring Among Urban Youth: The Intersection of Health Communication, Media Literacy and Digital Health Vignettes

Introduction

Whether they realize it or not, adolescents living in the twenty-first century are inundated with technology. This population, referred to as the N- (or net-) generation, D- (or digital-) generation, the millennial generation, or “digital natives” is born into technology.1 These youth grow up extremely comfortable with digital media.2 From an early age, they come to anticipate and expect that information will be available to them in digital media forms.3 When it comes to accessing health information, this age group has increasingly turned to online resources.4 Youth between the ages of twelve and seventeen are more likely to use online sources when investigating sensitive health information that is typically difficult to talk about with adults (e.g., drug use, sexual health, and depression).5

Studies show that youth have an easier time negotiating the Internet than their older counterparts. However, there remains skepticism about their ability to assess and integrate information into their life experiences. The extensive amount of health information available on the Internet makes it difficult for youth to choose appropriate sources. Even if youth can comprehend the content, they may not be able to evaluate the usefulness of the information as it pertains to them.6 There is also the question of whether or not youth have the emotional maturity to take the next step and seek advice from family, teachers, friends, or medical experts once they have gathered health information.7 Given these concerns, this paper seeks to understand the intersection of media and health literacy training as a catalyst for self-efficacy and agency among urban youth. It asks whether youth who are provided with health education and media literacy training can be empowered to create health messages that are accessible to their peers.

In this paper we feature formative research that demonstrates the ability of youth to be critical consumers, creators, and disseminators of health media. The discussion of this research introduces the need for an innovative model—one that bridges the gap between empowerment through media and health literacy and the development of agency to affect interpersonal relationships, families, and communities. Empowering urban, at-risk youth to be the creators and producers of digital health vignettes engages them as health specialists. They become involved not only in the assessment and creation of messages but also in raising awareness of health issues in their communities. They become enabled with knowledge and skills that inform their peers and communities as well as spark a larger public conversation.

Background

Social Media Uses

Today’s youth are undergoing a process of socialization that is significantly different from that of older generations.8 Youth between the ages of eight and eighteen consume an average of seven and one-half hours of digital media per day.9 Furthermore, the time youth spend online weekly nearly equates to the time an adult would spend at a full-time job.10 A major portion of that time is spent on social networking platforms. Of youth between the ages of twelve and seventeen, one study found that 73% use social networking sites.11 The same research indicates that 62% of youth this age report that they retrieve news from online sources.12 An additional study found that 57% of teens identify social media platforms as primary sources to gather information and advice.13

Due to their extensive online presence and use of social media, youth already possess capabilities for navigating social media platforms. Scholars contend that the digital native14 possesses advanced digital and social media skills, and demands sophisticated levels of media technology.15 Youth are increasingly using online resources, connecting through social media, and seeking trustworthy information online.16 Due to these habits, the virtual spaces of social networking platforms offer a unique opportunity for sharing and promoting positive health.17

Media Literacy

Media literacy, which refers to the training of individuals in “sharing information in integrated spaces of hyper-media activity,” aims to engage people in more active civic lifestyles.18 The concept is based on developing critical thinking skills and being able to find, interpret, and evaluate relevant information.19 Using that as a foundation, individuals are then able to build skills around creative idea generation, media production and promotion, and leadership through civic engagement.20 Fluency with information technology allows for critical thinking and judgment among media consumers.21 This transition moves young adults from simply being media consumers to becoming engaged citizens. It gives them the capacity to evaluate media around them and to create their own media products with ease.22

Health Communication and Health Literacy

A current trend that is becoming more relevant for health communication researchers to investigate is the intersection of media literacy, health communication and health literacy as it affects youth.23 Scholars have historically looked at these constructs independently. However, the rise of new technology and Internet-use has increased the value of this research.24 Health communication has been studied from varying perspectives. Typically it investigates communication strategies and their impact on individuals’ and communities’ ability to enhance health. This applied research discipline examines topics such as patient-physician communication, health care and health promotion, risk behaviors, and health narratives.25 Often, the goal is to understand health behaviors and motivate behavior changes using messages that target specific populations and health disparities.26

An area in the field of health communication that has been given increasing attention in recent years is health literacy. The term health literacy is typically defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”27 Literature on health literacy is extensive.28 The National Academy of Sciences has reported on literacy in medication usage and the ability to read prescription labels.29 Additional research looks at health literacy and racial and ethnic inequalities in health outcomes.30

Given that more than ninety million adults in the United States have low health literacy levels, the complex language used in healthcare has implications for families, communities, and national health systems.31 Health literacy does not simply affect an individual; it has implications for policy, the environment, industry, and disease prevention.32 Additionally, it does not just mean an individual has the reading skills to understand language used by health professionals and in health policy. To be health literate, individuals must be able to analyze general health information—text, charts, symbols, abbreviations, etc.—as it pertains to them specifically. Health literacy implies that individuals and communities can weigh risks and benefits and then make informed decisions and take action.33

Peer-to-Peer Messaging

Peer-to-peer messaging has emerged as a powerful message-design tactic.34 This approach is used in community-based participatory research in which community members are included in all stages of research and in this case, message generation.35 Having youth identify relevant topics and create their own messages guarantees that both the messages and technology are accessible to a teen audience.36 For instance, one study found that peer-to-peer messages were effective toward increasing seat belt usage among minority youth.37 Results found youth responded well to structured health promotion messages and strategies developed by their peers.38

Peer-to-peer messaging increases the credibility of the message. People decide what is credible through a combination of “reliability, accuracy, currency, truthfulness, and trustworthiness” as opposed to just accepting the expertise of one author.39 This concept of “bottom-up assessment of credibility”40 supports the need for engaging youth in the design and distribution of messaging that aims to target youth. Another benefit of this technique is that youth become peer experts on specific issues. Both audience identification and issue familiarity are increased when youth contribute to messages that target other youth.41 Furthermore, “through their [own] media products, young people can come to a critical understanding of social issues, improve their problem-solving skills and technology use, and gain self-confidence, social responsibility, and improved social skills.”42 Peer-to-peer messaging fosters substantial civic engagement since youth are learning about issues facing their communities and then actively working to create solutions and inform their peers.

 

Description and Methodology

Over a six-week summer program, seventy-five Boston youth worked in small, five- to six-person teams to design, film, and edit digital health vignettes. The teens (ages 15–18) were all participants in one of two ongoing health education programs of the Boston Public Health Commission. Teens in the Start Strong Initiative (SSI) focus on teen dating, violence prevention strategies, and healthy relationship skills. Youth in the Peer Leadership Institute (PLI) train to become leaders in their high schools and communities in order to promote positive behavior change. Survey methodology and focus groups were used to understand the social media usage of these youth. During the first weeks of the program, thirty-five youth were recruited to participate in same-sex focus groups and complete paper surveys. The surveys and focus groups allowed youth to speak freely about how they use social media and the type of information they look for online. Finally, to assess the effects of the summer training and leadership responsibilities, six youth completed a post-program survey twelve months later, which sought to determine willingness to share health information on social media and their level of media literacy.

In collaboration with the Emerson Literacy Engagement & Empowerment Project (eLEEP), both programs incorporated a “media literacy course” as one component of summer programming. The course was taught by a film and communications professional, and seven Emerson College students were hired as peer mentors to work with the youth. The course had the following goals (taken directly from the curriculum overview given to students on the first day of class):

  • To be an introduction to media literacy and media creation
  • To produce a public service announcement (PSA) for Start Strong Initiative (SSI) or Q&A fishbowl session (PLI)
  • To provide an outlet of expression
  • To be interactive
  • To be an opportunity to learn more about dating abuse (SSI) or substance abuse prevention (PLI)
  • To develop creativity and,
  • To HAVE FUN!43

The curriculum was designed with six weekly class meetings and additional filming and editing days, all taking place at Emerson College. Week one introduced the concepts of new and traditional media, imaging and branding, and the relationship between messages and audiences. The second class introduced camera equipment and the basics of lighting and audio recording. Youth formed their groups and were given cameras for a scavenger hunt, forcing them to practice the filming techniques they had just learned. During the first two classes, students spent significant time assessing and critiquing existing media, learning how to analyze message creation, delivery, and reception.

The third class, titled “Pre-Production,”44 guided groups in creating storyboards for their digital health vignettes, scouting their filming locations, and shooting their first scenes. Week four was entirely devoted to filming, as each group worked with an eLEEP college mentor to capture footage. The fifth class was the most technical, as youth were introduced to the video editing programs, Final Cut Pro and iMovie, and tasked with editing their footage. Two additional editing days were included, and then a final class allowed for self-critique and the development of social marketing campaigns to promote the vignettes.

Results

Media Literacy

            To assess the media literacy skills gained by participants, the post-program survey included several questions to determine the acquisition of skills related to technology and critical analysis. When asked to provide a description of skills learned through the eLEEP project, participants wrote the following:

  • “how to interpret messages”
  • “how to create an effective PSA through different camera angles and symbolism”
  • “to be more open minded and also to be creative also to put a movie together [sic]” (See table 2.1.)

Additionally, five of the six respondents answered “yes” to this question: “Based on the training about what a ‘message’ is and how to interpret the messages we see around us – do you find yourself looking at messages around you differently?” (See table 2.2.)

The post-program survey also asked youth to give an example of how they analyzed a message based on their media literacy training. One youth answered, “I now can predict the audience of a PSA by the messages being portrayed,” and another wrote, “I know most commercial are geared toward my age group so they do things that they believe we like [sic]” (see table 2.3). Additional survey responses indicated that students acquired both technological skills required to create digital media and skills for the critical analysis of media (see tables 2.4, 2.5). Although the post-program survey only included results from six respondents, there were overwhelming similarities in both the quantitative and qualitative responses. This data indicates that through eLEEP, students gained creative and technical skills, as well as the ability to analyze messages and use their own messages to promote civic engagement.

Vignettes

A. “Drugs in Our Community” digital health vignette45

“Drugs in our community” is an interview-style vignette in which teens respond to questions about drug and alcohol use. This video is powerful because it shows teens themselves discrediting the notion that drugs and dealers are cool. While most youth are accustomed to adults warning of the dangers of drugs, that is not a message often heard from peers. Aside from the strength of the messaging and the scripting, these youth recognized their own power as messengers. Not only do these teens give honest answers about drugs in their communities, they also urge viewers to become civically engaged and work to improve their communities.

B. “In Our Own Words: Making Sense of Drug Use” digital health vignette46

“In Our Own Words” offers a cameo of Boston teens speaking about drug use in their communities. Commentary about the realities and dangers of substance abuse alternate with teens declaring their personal and professional aspirations. The message splicing and quick camera transitions highlight how vulnerable the hopes and dreams of youth are to the presence of drugs in their communities. The teens are the messengers in this video, which gives the piece more appeal to a young audience.

C. “Health Dating Relationships” digital health vignette47

This vignette differs from the narrative/documentary style of the previous two and portrays a made-up but believable dating scenario. This public service announcement aims to inform teens that controlling, obsessive, and irrational behavior has no place in a healthy dating relationship. The video demonstrates the intersection of health awareness, media literacy, and civic engagement. The storyline demonstrates a clear understanding that certain behaviors are harmful to relationships and that youth need to make conscious decisions to end unhealthy relationships. The use of multiple camera angles, advanced lighting techniques, and frame splicing proves that these teens have acquired a command of digital technology skills. In combination with these technological skills, the consideration of the video’s audience—teens—in the creation of the message and the style of its delivery demonstrates media literacy skills. Finally, the video ends with a call to action.

These vignettes were showcased to over 100 adults during external training throughout the year and over 140 teens affiliated with BPHC. Each digital health vignette portrays the unique perspectives and learning skills among group members. Taken as a suite of vignettes, they provide important insight on the wide range of youth viewpoints. They also offer suggestions regarding the specific styles and designs of messages that are attractive and meaningful to youth.

Self-Confidence and Agency

One common theme in the survey and focus group responses was a discomfort with posting information about healthy behaviors on personal social media accounts. Teens acknowledged they used social media sites for their personal knowledge and behavior choices. However, the majority of teens in our program declared they were not comfortable sharing this same knowledge on their own social media sites because of potential negative judgment from peers.

A handful of teens did report using social media to promote positive health messages. For instance, a sixteen-year-old West Indian/African American male stated, “I use Facebook to talk about my relationship. I post pictures of me and my partner and post statuses.” Another seventeen-year-old African American female teen noted that she used “Facebook to talk about the wrongs of domestic violence and for talking to friends about their relationships.” Lastly, a fifteen-year-old African American male commented, “I never did, but if I was to I would help people and my friends talk about their health and relationships [sic].”

Participation in the eLEEP program and media literacy course gave youth a collective voice. Working in groups with peers who shared this health knowledge increased their confidence both in the message and in themselves as messengers. For the youth, creating a short video as part of a film crew was a point of pride. The platform of working through Boston Public Health Commission programs gave the youth an authoritative place from which to share their messages. When asked in the post-program survey whether or not youth felt they possessed agency, all respondents indicated “yes” or “sometimes” (see table 2.6). Several examples of how the youth perceived themselves to have agency are evident in statements such as “I feel I have agency because I can turn behaviors on or off when I feel the situation requires it or not.” Another youth wrote, “When I set a goal in school I know exactly how I’m going to accomplish it,” and a third simply indicated that “using a condom” gives him agency. Throughout the summer, participants showed greater health awareness, improved comfort with media literacy, and increased confidence in themselves as agents.

Discussion

Given that both eLEEP and the collaboration between eLEEP and the Boston Public Health Commission were pilot programs during the summer of 2012, there are several research and programmatic takeaways.

Programmatic Takeaways

One interesting topic for discussion of the program design is the timeframe in which students completed the media literacy course. Students were asked to intake an immense amount of information and then use newly acquired skills to create digital vignettes in only a six-week period. Additionally, students only devoted one half-day per week to this project. The researchers saw this as both a benefit and challenge. The benefit of forcing youth to process information and put new skills to work immediately was that they didn’t have the time to question themselves. Knowing that they needed to get down to business from the first class was certainly a motivating factor for the participants.

On the other hand, youth could have benefitted from additional practice filming, editing, and designing marketing plans. In fact, although the curriculum planned for the final class to be used to create and execute a social marketing campaign, the time was mostly spent editing videos. We believe a peer-review process could also have improved the students and their vignettes. Including a round of in-class presentations and allowing peers to offer constructive criticism may improve not only the quality of the vignettes but also the youths’ self-confidence. After this initial critique, groups would then have an opportunity to incorporate this feedback through further editing and production.

In addition to increasing the number of hours in the media literacy course, the program could also benefit from longevity. If the collaboration were expanded to include summer and school year programming, the impact would be stronger and longer-lasting. If youth are only engaging in this type of programming during the summer, they may not be retaining all of the information they receive. Additionally, media literacy, like any skill, must be practiced in order to see improvement. Continual programming would offer youth the chance to practice and improve this skill. A future goal entails having youth create an online manual with their digital health vignettes.48 This would provide a tool for youth to access accurate information on topics such as healthy dating relationships, substance use, and other youth health issues.

Research Takeaways

In terms of research, we collected substantial information through surveys and focus groups that will help to inform future inquiry. However, one limitation to the research is the fact that both researchers were heavily involved in program operations. This dual-role and the priority of delivering program services made collecting research difficult. While we completed focus groups and a written survey from participants at the beginning of the program, we were only able to gather official exit surveys from six of the youth. While the responses from this post-program survey are insightful and lend support for new research directions, the low sample size is a research limitation. Additional assessment of participants’ progress and growth came from observations of the Boston Public Health Commission professionals, media literacy instructor, and Emerson students. Due to the time constraints of the program and the fact that this was a pilot program, these observations were not collected in a systematic manner.

Initial participant surveys provided significant information regarding the social media habits of youth. While the participants in this particular program all reside in Boston neighborhoods, they are representative of the similar urban populations in the United States. Our participants come from neighborhoods in Boston that have large populations of immigrants and people of color.49 These teens represent the cultural diversity of Boston. The majority of students reported their race and ethnicity as African American, Hispanic, Haitian, and Cape Verdean, Asian Pacific Islander, African, or West Indian (Guyanese); two youth classified themselves as white. In considering the applicability of these results to other U.S. cities, it is important to note that the majority of participants come from neighborhoods where adult residents have low levels of educational achievement and over 18% of families live below the federal poverty level.50 The population of Boston is split accordingly: 47% White, 8.9% Asian, 22.4% Black, 17.5% Latino, 2.4% two or more races, and 1.8% “other” (includes American Indians/Alaskan Natives, and additional races).51 On average, families of color have household incomes lower than the Boston median income, while only White families have an average annual income that is greater than the city’s average.52

Understanding how youth use social media is crucial in designing programs and materials that will be appealing to that audience. Results from pre-program survey responses show that the top four social media platforms among these youth are Facebook, YouTube, Twitter, and Instagram (see table 1.1) and provide data on the frequency with which youth check various platforms (see table 1.2). However, social media trends are always changing, and this research will become outdated rapidly. Researchers and practitioners must constantly evaluate these trends and seek feedback from youth to make sure appropriate technologies are being used.

Future Research

            While many of our initial questions were addressed during this pilot program, the observations we made have inspired new directions for future research. We would like to further research and document the empowerment process that takes place among youth in this program. Increasing participant response on a comparative survey that measures levels of confidence and agency pre- and post-programming would provide direct feedback. Gathering the teens’ own reflections on their growth and learning process could help improve the program for future youth.

When we approached this project, we saw the combination of health literacy and media literacy as part of a larger model for health communication and civic engagement. This model uses health education programs to train youth as peer experts in specific health issues. The next phase of the model involves peer experts incorporating these healthy behaviors in their personal lives and relationships, the ultimate goal being that the trained peer experts take their original health messages back to their communities and affect wider behavior change. Ultimately, we would like to research this model in its entirety. We would like to track the effectiveness of a model that uses a grassroots, community-based approach to health communication.

We are currently using two aspects of the data collected from this phase of the project to design further research. The first is the discomfort youth have in posting health behavior messaging from their personal social media accounts. Despite the fact that the youth we worked with are comfortable speaking about health issues among each other and with program staff, and despite their being proud of the videos they created, they do not want to post this information from their personal accounts. The second aspect is the student responses to two of the post-program survey questions. When asked whether they look for health information via social media, 43% of respondents indicated, “I don’t search for that information, but when I come across it, I will read/look at it,” and an additional 43% responded that they actively look for health information on social media (see table 2.7). As a follow-up question, when asked whether these social media sites have enough information on health issues, 43% of students responded, “No, not at all,” and 57% indicated that “it has some, but not enough” information (see table 2.8). This information has prompted us to pursue research to understand the feasibility of having youth create and use proxy accounts to circulate health messages.

Conclusions

This research examined one joint project between a public health agency and an institution devoted to communication and media literacy. Together these two organizations are working to actualize a new model of health communication. Rooted in critical thinking skills, this project challenged youth to improve health behaviors as well as engage in community health issues. In providing them with the education and tools to create appealing health messages, the program empowered youth and increased their self-confidence and agency. This pilot program delivered tangible results in the form of the digital health vignettes, as well the less tangible contributions to individual and collective youth development.

Simply having information about healthy behaviors doesn’t empower youth to harness that knowledge and foster civic engagement. Empowerment comes from learning new media literacy skills and using them to transform their knowledge into a public message that can be shared with peers. In this day and age, effective health communication must be not only accurate but also available on the preferred media platforms of youth. Health communication must involve a combination of health and media literacy.

Effective health communication creates an informed public that plays an active role in creating healthy environments and affecting health policy. The result of successful health communication is widespread civic engagement on health issues. The benefit of training youth to be informed leaders and communicators does not end at public health gains. Building these capabilities in the youth population will ensure that civic engagement and dialogue play increasingly prominent roles in political, economic, and social agendas.

As new media technologies are developed, the possibilities to craft and share messages increase dramatically. Additionally, the credibility of peer-to-peer messaging grows while the trust in traditional top-down communication decreases. Future research can help public health organizations develop programming that takes advantage of these new media forms to engage youth as civic leaders from an early age.

*This research would like to give a special thanks to the phenomenal teen peer leaders from the Boston Public Health Commission’s Start Strong Initiative, Peer Leadership Initiative, and Bird Street Project for their honesty, transparency, and roles as community leaders and civic citizens.

 


Tables

Tables within the first set indicate information gathered in the pre-program survey (N=35); tables within the second set (untitled) indicate information gathered in the post-program survey (N=6 ;*7 respondents where noted).

Table 1.1 Pre-Program Survey Results: Usage Among Social Media Platforms

Table 1.1 – Pre-Program Survey Results: Usage Among Social Media Platforms

Table 1.2 - Pre-Program Survey Results: Amount of “Checks” per Day by Platform

Table 1.2 – Pre-Program Survey Results: Amount of “Checks” per Day by Platform

Table 2.1

Table 2.1

Table 2.2

Table 2.2

Table 2.3

Table 2.3

Table 2.4

Table 2.4

Table 2.5

Table 2.5

Table 2.6

Table 2.6

Table 2.7

Table 2.7

Table 2.8

Table 2.8


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Notes    (↵ returns to text)

  1. Marc Prensky, “Digital Native, Digital Immigrants: Part I,” On the Horizon 9, no. 5 (October 2001): 1.
  2. Jenny Preece, and Maloney-Krichmar, Diane, “Online Communities: Design, Theory, and Practice,” Journal of Computer-Mediated Communication 10, no. 4 (2005), http://jcmc.indiana.edu/vol10/issue4/preece.html.
  3. Deb Levine, “Using Technology, New Media, and Mobile for Sexual and Reproductive Health,” Sexuality Research & Social Policy 8, no. 1 (2011): 18-26.
  4. Amanda Lenhart et al., “Social Media and Young Adults,” Pew Internet & American Life Project (Washington, DC: Pew Research Center, 2010), http://www.pewinternet.org/Reports/2010/Social-Media-and-Young-Adults.aspx.
  5. Ibid.
  6. Nicola J. Gray et al., “Health Information-Seeking Behaviour in Adolescence: The Place of the Internet” Social Science Medicine 60, no. 7 (April 2005), http://www.ncbi.nlm.nih.gov/pubmed/15652680.
  7. George Ettel III et al., “How Do Adolescents Access Health Information? And Do They Ask Their Physicians?” The Permanente Journal 16, no. 1 (2012): 35-8, http://www.thepermanentejournal.org/issues/2012/winter/4265-electronic-health-records.html.
  8. Prensky, “Digital Native, Digital Immigrants.”
  9. Victoria J. Rideout, Ulla G. Foehr, and Donald F. Roberts, Generation M2: Media in the Lives of 8- to 18-Year-Olds (Menlo Park, CA: Henry J. Kaiser Family Foundation, 2010): 11, http://kaiserfamilyfoundation.files.wordpress.com/2013/04/8010.pdf.
  10. Lenhart et al., “Social Media and Young Adults,” [372].
  11. Ibid.
  12. Ibid.
  13. Nielsen, State of the Media: The Social Media Report (The Nielson Company, 2012), [7]. http://blog.nielsen.com/nielsenwire/social/.
  14. Prensky, “Digital Native, Digital Immigrants,” 1.
  15. Levine, “Using Technology,” 18-26.
  16. Soo Young Rieh et al., A Diary of Credibility Assessment in Everyday Life Information Activities on the Web: Preliminary Findings (Pittsburgh, PA: ASIST, 2010).
  17. Ellen M. Selkie, Meghan Benson, and Megan Moreno. “Adolescents’ Views Regarding Uses of Social Networking Websites and Text Messaging for Adolescent Sexual Health Education,” American Journal of Health Education 42, no. 4 (July 2011): 205-212.
  18. Paul Mihailidis, “Exploring Global Perspective on Identity, Community and Media Literacy in a Networked Age,” Journal of Digital and Media Literacy 1 (2013): 2, http://www.jodml.org/2013/02/01/perspectives-identity-media-literacy/.
  19. Ibid.
  20. Ibid.
  21. Paul Mihailidis, “Connecting Culture Through Global Media Literacy,” Afterimage: The Journal of Media Arts and Cultural Criticism 37, no. 2 (September/October 2009): 37-43.
  22. Elizabeth Thoman and Tessa Jolls, “Media Literacy: A National Priority for a Changing World,” American Behavioral Scientist 48, no. 1 (September 2004): 18-29; Donna E. Alvermann, Jennifer S. Moon, and Margaret C. Hagood, “Popular Culture in the Classroom: Teaching and Researching Critical Media Literacy,” in Literacy Study Series (Newark, DE: International Reading Association, 1999); Renee Hobbs and Amy Jensen, “The Past, Present, and Future of Media Literacy Education,” Journal of Media Literacy Education 1, no. 1 (2009): 1-11.
  23. Angela F. Cooke-Jackson, “Harnessing Collective Social Media Engagement in a Health Communication Course,” Communication Teacher 27, no. 3 (2013): 165-71, doi:10.1080/17404622.2013.782415.
  24. Office of Disease Prevention and Health Promotion, “Health Communication and Health Information Technology,” HealthyPeople.gov (U.S. Department of Health and Human Services), http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=18.
  25. Gary L. Kreps, Ellen W. Bonaguro, and Jim L. Query, “The History and Development of the Field of Health Communication,” in Health Communication Research: A Guide to Developments and Direction, ed. L.D. Jackson and B.K. Duffy (Westport, CT: Greenwood Press, 1998).
  26. “Clear Communication: A NIH Health Literacy Initiative,” National Institutes of Health, last reviewed September 11, 2013, http://www.nih.gov/clearcommunication/.
  27. Office of Disease Prevention and Health Promotion.
  28. Ibid.
  29. Committee on Health Literacy, “Health Literacy: A Prescription to End Confusion,” Institute of Medicine of the National Academies (April 8, 2004), http://www.iom.edu/reports/2004/health-literacy-a-prescription-to-end-confusion.aspx.
  30. Brian D. Smedley, Adrienne Y. Stith, and Alan R. Nelson, eds, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (Washington DC: The National Academies Press, 2003).
  31. Ibid.
  32. Christina Zarcadoolas, Andrew Pleasant, and David S. Greer, “Understanding Health Literacy: An Expanded Model,” Health Promotion International 20, no. 2 (2005): 195-203.
  33. “Clear Communication: A NIH Health Literacy Initiative”; Office of Disease Prevention and Health Promotion; Zarcadoolas, “Understanding Health Literacy: An Expanded Model.”
  34. Mary Hampton et al., “A Process Evaluation of the Youth Educating about Health (Year) Program: A Peer-Designed and Peer-Led Sexual Health Education Program,” The Canadian Journal of Human Sexuality 14, no. 3 (2005): 129-141; Karen J. Coleman et al., “Teen Peer Educators and Diabetes Knowledge of Low-Income Fifth Grade Students,” Journal of Community Health 36, no. 1(2011): 23-6.
  35. Chaebong Nam and Ann Peterson Bishop, This Is the Real Me: A Community Informatics Researcher Joins the Barrio Arts, Culture, and Communication Academy in a Health Information Campaign, iConference ’11: Proceedings of the 2011 iConference, (New York City: Association for Computing Machinery, 2011), http://dl.acm.org/citation.cfm?id=1940812.
  36. Ibid; Levine, “Using Technology, New Media, and Mobile for Sexual and Reproductive Health.”
  37. P. Juarez et al., “A Conceptual Framework for Reducing Risky Teen Driving Behaviors among Minority Youth,” Injury Prevention 12, Supplement 1 (June 2006): i49-i55, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563442/.
  38. Ibid.
  39. Rieh et al., A Diary of Credibility Assessment in Everyday Life Information Activities on the Web: Preliminary Findings, 9.
  40. Ibid.
  41. Robin L. Nabi, “Discrete Emotions and Persuasion,” in The Persuasion Handbook: Developments in Theory and Practice, eds. James Price Dillard and Michael Pfau (Thousand Oakes, CA: Sage Publications, Inc., 2002).
  42. Nam and Bishop, This Is the Real Me, [372].
  43. Emerson Literacy Engagement & Empowerment Project, “Summer 2012 Start Strong Initiative Media Literacy Course,” (curriculum, Emerson University, Boston, MA, June 2012); Emerson Literacy Engagement & Empowerment Project, Summer 2012 Peer Leadership Institute Media Literacy Course (curriculum, Emerson University, Boston, MA, June 2012).
  44. Ibid.
  45. “Drugs in Our Community,” audiovisual file, [August, 2012], https://vimeo.com/56054826.
  46. “Making Sense of Drug Use,” audiovisual file, [August 2012], https://vimeo.com/56052709.
  47. “Love Is Not a Game,” audiovisual file, [August, 2012], https://vimeo.com/56052338.
  48. Cooke-Jackson, “Harnessing Collective Social Media Engagement in a Health Communication Course.”
  49. Boston Public Health Commission, Health of Boston 2012 (Boston: Boston Public Health Commission Research and Evaluation Office, 2013), 31, http://www.bphc.org/healthdata/health-of-boston-report/Documents/HOB-2012-2013/HOB12-13_FullReport.pdf.
  50. Ibid., 9.
  51. Ibid., 31.
  52. Boston Public Health Commission, Health of Boston 2012 (Boston: Boston Public Health Commission Research and Evaluation Office, 2013), 279, http://www.bphc.org/healthdata/health-of-boston-report/Documents/HOB-2012-2013/HOB12-13_FullReport.pdf.
Angela Cooke Jackson & Kaitlin Barnes

About Angela Cooke Jackson & Kaitlin Barnes

Dr. Angela Cooke-Jackson is an Assistant Professor of Health and Intercultural Communication in the Communication Studies Department at Emerson College. Kaitlin Barnes is a 2012 graduate of the Communication Management Masters program at Emerson College.

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