“The Hookup’ Text Messaging Service: Who’s Using It and What Do They Think About It?” was presented at Sex::Tech 2011 by Raymond Perry, MD, MSHS and Rebecca Braun, MPH of UCLA and CFHC.

2. “The Hookup” Text Messaging
Service: Who‟s Using It and What
Do They Think About It?
Raymond Perry, MD, MSHS (UCLA)
Rebecca Braun, MPH (CFHC)
April 1, 2011

3. What is the Hookup?
 Statewide sexual health text messaging service
 Collaborative development between CFHC and
ISIS, Inc.
 In operation since April 2009
 Target audience: 13-24 year olds in California
 Sends weekly tips related to sexual health
promotion and disease prevention
 Offers a clinic locator service and link to follow-
up information at www.teensource.org

4. The Hookup– Example Messages
Many STDs don‟t Condom broke? Scared to talk to ur
have symptoms. If ur Emergency parents about sex?
having sex, get contraception can It might not be so
tested to know. Txt prevent pregnancy if bad. Some ideas on
CLINIC +ur zipcode taken w/in 5 days- how to start at
4 clinics. ASAP is best. Txt www.teensource.org
www.teensource.org CLINIC + ur zipcode.

5. Subscribers-to-Date: the Numbers
 As of Feb 2011, 4727 subscribers since launch
 1556 opt-outs  3171 current subscribers
 1884 clinic requests for 337 zip codes
(represents 45 counties)
 Counties with highest representation: Alameda,
Los Angeles, San Diego, Orange, Riverside,
San Bernadino

6. We need to know more
about our subscribers…
 Jan 2011: opt-in text-based survey sent in place
of weekly message to all current subscribers
 Demographics (age, gender, location)
 Marketing methods
 Associated behavioral change
 n = 799 (27% response rate)

7. We want to know a little about u!
 80% female, 20% male
 87% in the target population
 5% Under 15
 47% 15 to 17
 22% 18 to 19
 14% 20 to 24
 Broad geographic range within California
 57% southern, 33% northern, 10% central

8. How’d u get hooked up
with the Hookup?

9. How has the
Hookup changed u?
not having sex and how to check condoms and when
Sexual Behaviors 208 (44%) you do have sex be real careful
Information /
Awareness 141 (30%) more 411 on how to love n take care of myself
Unkown 58 (12%) it hasn't really changed me I just like getting the tips
i got addresses to clinics near me where i was able to
Resources 28 (6%) pick up Plan B emergency contraceptive yesterday
Other 17 (4%) drug test last week
found a fun way to discuss STDs and safe sex with
Social Behaviors 15 (3%) friends
Attitudes 6 (1%) changed the way I look at sex

10. More about what teens think…
a Qualitative Study
 4 focus groups in 2 Los Angeles teen clinics
 Participants subscribed to the Hookup upon
enrollment in the project
 Focus groups took place 1 month later
 4 text messages were sent during that time

11. Focus Group Participants
 Teen staff members, Gender Male 5 (19%)
Female 21 (81%)
outreach volunteers,
Age Range 15-20 yrs
and patients at the Average 16.4 1.4 yrs
clinics Race/ Latino 13 (50%)
Ethnicity Black 9 (35%)
 26 total participants Asian 2 (8%)
White 1 (4%)
Multiracial 1 (4%)
Text 1-10 1 (5%)
Messaging 11-50 6 (29%)
Frequency 51-100 5 (24%)
(per day)
>100 9 (43%)

12. Themes from Focus Groups
 Message Content
• Helpful
• Educational
• Simple
• Sociable
 Service Modality
• Convenience
• Cost issues
• Privacy issues
 Suggestions for Marketing and Improvement

13. Message Content=
HELPFUL
“Most kids already don‟t “[The messages give]
have common sense, so useful information for
it‟s like hard for them to some people. Some
link up an idea. And people really are
when you have the idea oblivious to the fact of
in a simple format, it‟s like what could happen to
„oh, of course‟.” them with sexual acts.
It‟s a way to protect
themselves and what
they need to do.”

14. Message Content=
EDUCATIONAL
“They‟re teaching things that you
don‟t already know about the sexual
stuff.”
“It‟ll make them [teens] interested
in it…make them want to research
it or learn more about it.”

15. Message Content=
SIMPLE
“The content of the messages was
very simple. It wasn‟t long and
elaborate.”
“[The messages] were simple and
informative…they didn‟t use a lot of
big words.”

16. Message Content=
SOCIABLE
“Me and my friends talk
about sex a lot… But it‟s “I‟d get the text
good that you can throw and I was like,
out facts and real solid „here‟s a tip‟.
information, instead of And I‟d read it
just experiences or like out loud.”
whatever you think you
know..”

17. Text Messaging Modality=
CONVENIENT WEEKLY
MESSAGES
“It was helpful because in the middle of the week we
usually forget, and then it was easier for us to
understand because it was in text message form.”
“It‟s smart because…kids are
always on their phones.”

18. Text Messaging Modality=
CONVENIENT CLINIC
LOCATOR
“Like if you have an “One of my friends
emergency or called me asking if I
something and you knew where the
can't go home, you rush closest teen clinic
and look for clinic, so was. And I didn't know
like you just text it on the answer. And this
your phone and you‟re would've been a great
like, oh, okay.” tool to give them or to
use for them.”

19. Text Messaging Modality=
COST ISSUES
“[If] like you have unlimited text, well, if you ** Participants
stated that, in
have like a certain amount of text general, most
messaging you‟re allowed to have, well, of their peers
have unlimited
it's not gonna affect it...” texting plans.
“If I didn't have unlimited texts, it
would prevent me from signing up
just because I would be like, oh, like
there is cost.”

20. Text Messaging Modality=
PRIVACY ISSUES
“..maybe it's a way for them to learn things without
anybody finding out. So nobody knows that they're
doing it and it's helping them.”
“I think it might be a good thing because a lot of
parents don't really go through their kid's phones.
…their phones is like their private thing, and
they're so like conscious and aware of where their
phone is at all times.”

21. Text Messaging Modality=
PRIVACY ISSUES
“If someone else “To have other
sees that message, friends find out that
they think, „what you you're getting like
getting?‟ You know messages about
what I mean? They sexual stuff…they
might be a little bit [subscribing teens]
self conscious about get embarrassed.”
it.”

22. Other Suggestions
 Marketing
 TV
 Internet
 Radio
 Malls/ Movies
 Schools
 Incorporate into school lessons or activities
 Teen involvement in message development

23. Summary
 Text messaging is a sensible approach to
reaching teens with health-related messages,
especially for sensitive topics like sexual health
 Text messaging fits into teens‟ daily lives, has
few cost barriers, and allows a desirable level of
privacy
 Messages that are tailored to what is relevant to
teens‟ lives are helpful and well-received

24. Next Steps
 Evaluation of the effectiveness of the messages
 Randomized study in a school setting
 Assess knowledge, attitudes, self-efficacy, and
behavioral impact of the Hookup on high school
students
 Plan to expand the study to involve more
schools next year

25. Acknowledgements
 California Family Health Council
 ISIS, Inc
 UCLA
 Robert Wood Johnson Foundation Clinical
Scholars Program

26. Questions and Comments???
THANK YOU!