Health Communication in the Digital Age: Young Adult Experiences in Sexual Health, Body Image, and Cancer

Abstract

Young adulthood is a developmental stage traditionally characterized by developing autonomy from parents, transitioning from school to work, forming one’s own family, and other similar milestones that shape the trajectory of later life. Shifting norms and deep economic constraints have delayed young adults’ achievements of these milestones in recent decades, leading to unique health challenges in this population. One area in which public health can address the unique needs of young adults is health communication, especially given young adults’ near universal connection to the Internet and social media and the implications of these communication technologies for health. This dissertation focused on health communication issues in young adulthood with particular (but not exclusive) attention to opportunities and challenges posed by the Internet and social media. It used qualitative methods to explore three different health communication topics among three different young adult populations.

In Chapter 1, I examined sexual health information issues among young adult sexual minority cisgender women and non-binary individuals assigned female at birth. Through thematic analysis of in-depth interview data, I identified three broad themes: 1) sources of sexual health information; 2) sexual health information needs; and 3) preferences for sexual health information delivery. Participants discussed and critiqued the Internet, other mass media, health care providers, school-based sex education, family, and peers/partners as sources of sexual health information. They expressed a need for customized, non-heteronormative information pertaining to sexually transmitted infection risk and prevention. They preferred receiving information from health care providers, the Internet, and other mass media, and some also suggested school-based sex education and peer education as methods for delivering information.

In Chapter 2, I investigated how lesbian, gay, bisexual, transgender, and other sexual- and gender-minority (LGBTQ) young adults exhibit media literacy in conversations about body image and appearance ideals. Through thematic analysis of focus group data, I found that participants demonstrated media literacy under five themes: 1) Media convey dominant cultural and LGBTQ appearance ideals; 2) Dominant cultural and LGBTQ appearance ideals conveyed in media shape viewers’ attitudes; 3) Appearance ideals conveyed in media are unrealistic and manipulated; 4) Promotion of appearance ideals is financially motivated; and 5) Learning social media literacy is important. Aside from documenting participants’ media literacy, these findings offered critical insights about the range of appearance ideals experienced by this population and the unique roles of traditional and social media in promoting those ideals.

In Chapter 3, I examined content related to young adult cancer on Instagram to better understand the platform’s role in young adult cancer experiences. I conducted qualitative content analysis of a set of publicly available Instagram posts with the hashtag #youngadultcancer. I found that most posts were posted by individual users, who were typically women cancer survivors. Of the survivors, about half were survivors of breast cancer, with blood cancers, colorectal cancer, and thyroid cancer being the next most common. Groups such as non-profit organizations, community groups, and companies also posted, along with meme accounts. I found that posts had five primary functions: documenting life, publicizing/fundraising, raising awareness, sharing a meme or viral graphic, and selling/promoting. Survivors’ “documenting life” posts, analyzed in greater depth, covered six cancer-related themes: cancer care experienced in the present time, support, philosophy/mindset, cancer care experienced in the past, appearance/body image, and discussion prompts. Overall, I concluded that Instagram is an active site of communication about young adult cancer that offers a glimpse into some survivors’ experiences. I proposed several needs that young adult cancer survivors might meet by using Instagram in relation to cancer.

Together, these findings convey a wide-ranging sampling of the health communication issues faced by today’s young adults and the public health researchers and practitioners who serve them.