Asking teens to chart life events helps explain risky decisions

ANN ARBOR—Kristy Martyn started out using a detailed timeline of teen-aged girls’ lives as an easy way to track their demographics for research purposes.

She was surprised to find that the one-page chart, which includes information on a teen’s friends, activities and role models, also served as a good predictor of when teens would engage in risky behaviors such as substance use or unprotected sex. She also began to see it as a way to encourage teens to reflect on their lives and make healthier choices.

It’s a valuable tool for self reflection,” said Martyn, assistant professor at the U-M School of Nursing. “We think that one of the reasons teen-agers take risks is because they don’t think through their choices.”

Girls complete the chart, which looks something like a spreadsheet, by writing down information about each year of their lives starting at age 10. Ages run across the top, with categories including   “friends” and “activities” down the side. Teens also fill in boxes indicating their substance use and sexual activity, as well as who they dated that year.

Martyn said the whole process typically takes about 15 minutes. The result is an exercise that helps teens examine how they are spending their time, and an easy way for a primary care provider to see trends and danger signs.

Martyn has completed two studies using the charts – the first looking at about 40 teen-aged girls in Michigan and the second working with Latina girls in the San Antonio area. She is submitting a grant application this fall for a bigger, broader study of nearly 350 teens, testing the charts’ effectiveness in helping to shape their attitudes and behaviors.

Three months after using the charts, 68 percent of the girls who were sexually active reported either abstaining from sex or refraining from unprotected sex since charting their lives.

Girls who charted their lives were able to see how their choices were interrelated, she said. “I can see how my life changed right here, when my sister’s friends introduced me to weed,” one girl said. “My whole life on paper,” another mused.

Though Martyn, a nurse practitioner, has been most interested in working with teen-age girls because of her initial interest in how some girls get into trouble while others don’t, she said the same technique is applicable to working with boys.

Filling out the form can be less threatening than having an adult ask questions about the teen’s behavior, Martyn said. It also helps the teens remember various aspects of their behavior that they might otherwise neglect in conversation.

When teens give the completed form to a health care provider, Martyn said it helps the two engage in a more equitable conversation. Instead of putting the teen on the spot about what she has or has not done, they can move into a discussion about why the teen might want to reconsider some decisions or how better achieve her goals.

Martyn will present the results of her work at a Gallup Research Center symposium in October and a State of the Science conference at the National Institutes of Health, also in October.

In her initial work with this technique, Martyn talked to a 20-year-old woman who wrote on her chart that she did not want to have sex until she was ready. Martyn asked her how she had kept to that ideal, and the woman said every time the topic came up with boys, she asked for a glass of ice water. Martyn said she might not have gotten to a conversation about techniques for avoiding sex if she had not seen the girl’s chart, which showed many boyfriends but no intercourse.

Besides helping health care providers work with teens, Martyn still sees the chart as an effective way of gathering information for research on teen behavior. The original chart was developed at U-M’s Institute for Social Research for gathering population-level information.

In Martyn’s next study, she proposes asking girls to fill out the chart, as well as a survey on attitudes and intentions for the next three months. After using the chart to talk to them about life choices, Martyn’s team will survey the girls three months later to look for any changes in attitudes and actual behaviors. Martyn will look to correlate life events with behaviors.

For more in formation on Martyn, visit: www.nursing.umich.edu/faculty/martyn_kristy.html

A chart is available at: http://www.umich.edu/news/Releases/2004/Sep04/samples.pdf