E-health, the use of interactive technologies (e.g., Internet, CD-ROMs, and voice response systems), is emerging as a promising tool to address the limited capacity of the health care system to provide health behavior change and chronic disease management interventions (Ahern, Kreslake, & Phalen, 2006
). The Internet is one of the most powerful tools e-health has to offer, both for health care recipients to gather information and for health care providers to deliver a variety of behavioral/educational interventions. Almost 80% of Internet users report seeking health information online (Fox, 2006
). Furthermore, 44% of Internet users report searching for exercise or fitness information with an equal percentage reporting that information accessed on the Internet changed the way they think about diet, exercise, or stress management (Fox, 2006
Over the past few years, numerous studies have used online technologies to deliver a variety of health interventions including those targeting mental health issues such as panic disorder (e.g., Carlbring, Ekselius, & Andersson, 2003
) and depression (e.g., Clarke et al., 2005
). Other on-line programs promote weight management and physical activity through Internet interventions (e.g., Napolitano et al., 2003
; Papadaki & Scott, 2005
). The use of e-health modalities in the delivery and/or support of health care interventions has advantages over traditional in-person health services including: reduced cost and increased convenience for users and health care providers alike, overcoming user isolation and stigma, and enabling options for more individual-tailoring (Griffiths, Lindenmeyer, Powell, Lowe, & Thorogood, 2006
). Furthermore, web-based interventions that incorporate peer support have been well-received by participants and found to reduce levels of functional impairment (e.g., Barrera, Glasgow, McKay, Boles, & Feil, 2002
Teens are perhaps the ideal targets for Internet intervention. Nearly three-quarters (73%) of adults in the United States use the Internet; in adolescents that number jumps to 93% (Lenhart, Madden, Macgill, & Smith, 2007
). In addition, the developmental importance of peer support among adolescents (Brown, Eicher, & Petrie, 1986
) makes the use of Internet sites incorporating peer interaction a natural fit for this age group. Finally, it has been widely reported that adolescents are more comfortable with technologies like the Internet and perceive them as more helpful than do adults (Macgill, 2007
). Thus, by adding a website component to a conventional intervention aimed at adolescents, our intervention was structured to take advantage of the fact that the Internet is both highly attractive to teens and widely used by them.
The Youth, Osteoporosis, and Understanding Total Health Project (YOUTH) was a randomized controlled trial testing the efficacy of a health plan-based, 2-year lifestyle intervention to increase bone mineral density (BMD) and prevent bone loss in female adolescents (DeBar et al., 2004
; DeBar et al., 2006
). Both dietary (increased consumption of calcium and fruits and vegetables) and physical activity (high-impact exercise and strength training) behaviors were targeted as a means of increasing BMD among participants. The main intervention components included both group and individual in-person visits as well as coaching telephone calls and the completion of weekly self-monitoring postcards; these study components are described in detail in other publications (DeBar et al., 2004
; 2006). The YOUTH intervention was offered to adolescent HMO members who otherwise had no pre-existing connections with one another. We believed it was important to create a virtual, and real, community-support network in the absence of the shared environment typical of many conventional school-based health promotion programs. All youth randomized to the experimental condition were granted access to a study website designed to foster communication and interaction among participants and project staff, as well as to provide feedback about intervention-related behavioral changes.
In this article, we describe how intervention participants used the study website as one element of a multi-component lifestyle intervention. We describe the components of the website and its development, address issues of site access, and discuss how website use related to general adherence to the overall YOUTH intervention. Finally, we analyze whether website usage improved health behavior (dietary and physical activity) outcomes in this study. These analyses are exploratory, as the overall YOUTH study was powered only to examine principle dietary, bone density, and activity outcomes affected by the overall multi-component intervention. Our study included a randomized control condition of participants who used a parallel site with the same design, look, and feel as the intervention site but that did not include any section emphasizing study-specific lifestyle targets or personalized feedback about behavioral goal attainment. This paper focuses on results from the intervention arm only.