Tape #450 - Increasing Rural Women's Access to Health

Now, today for the first time we're actually introducing the National Women Health Information Center. We call it ANWIC which is an information referral center and web site that we've just put together from the Department of Health and Human Services. Women's health has long been neglected even though women represents over half the population. They experience more chronic diseases and disabilities than men do. They see doctors more than men do and they make, believe it or not, 70% of health care decisions in the family. And there is no group of information for women on health issues, but getting to that information is often not easy. The private sector organizations vary in the quality and cost of printed information. Many times you actually have to pay for publications or for information obtained. There is no central health publication directory that is actually maintained by our department and there is no central address of on-line addresses on the website for women's health.

So why is it important for rural women or women in agriculture. For the first place, heart disease morality rates are higher in women living in Appalachia. I want to show you some maps of the United States. These are for white women, age 70 and these show the heart disease morality rate. Look at the brown part of this map if you can and you'll see that it goes up Appalachia. In fact, the highest rates of heart disease death in this country fall on the mountain range, along Appalachia. If you look for black female, its very similar, but its concentrated in the south and it spreads out more in the southern rural areas. But this is a fairly unknown statistic, but it also highlights the need to get women treated for heart disease and diagnose for heart disease and perhaps some prevention going on in Appalachia.

Now the other thing I've been able to find out is the death from unintentional injuries is higher in rural women and I guess we would get that assuming that rural women live on farms and maybe more prone to tractor injuries and some other types of injuries like that. If you look at all the states in the United States and identify those five with the lowest rates of mammography screening, they're located in five rural farming states Arkansas, Iowa, Kentucky, Louisiana, and Mississippi. Those are the five worst states in terms of mammography screening. When you look at the five worst states in terms of overweight. Again you are looking at rural farming states like Louisiana, Mississippi, Missouri, North Dakota and West Virginia.

To take it one step further, what about the lack of health insurance. Which states have the worst. Again we're looking at rural farming states, Arkansas, Louisiana, New Mexico, Oklahoma and Texas. And also we've found that self-rated health is worst in rural women as compared to men. So given this whole cadre of statistics and patterns there is more need than ever to try to get health information out to rural women. So it creates an urgent need for women's health and for women's health clearinghouse like the one we've created and are talking about here today.

Now who funded this? Well this is funded by the Department of Health and Human Services which is a Federal agency in the United States. And are we actually linked any other Federal agency that has information about women's health? We also list and refer people to any women's health organization non-profit in the United States. So this is the most comprehensive source for information on women's health that exist anywhere in this country. What do we have? We have a 1-800-994-WOMAN information referral service. This is a toll free telephone. I won't call it a hotline, but it is an information referral service for any question that you might have. And we have a website. This is kind of easy to remember if you have ventured onto the Internet yet. It's www.forwoman.gov.org. So that's what we are providing. Now what about online health information. Is this really something that women want? Well the USA Today last year actually did a poll and found out that 37% of adult users of the Internet are asking questions about health and that those health questions, women's health is the top question. So this is highly relevant for to have created a women's health website.

And the second question is cancer. That's the most frequently searched category on the Internet. How many women use computers and get on to the website? Well I was surprised at this. It's about 40% based on the most recent statistics. I thought it was an all male computer world, but women are getting trained and getting clever and getting onto the website more than ever.

So whose's our audience? Well obviously we want to target women in the general public. We want to target doctors too. Because we find out that physicians are actually and nurses are fairly big referral source for us. We've been in the pilot phase about two months and we find that physicians are our third most popular referral. So they may be talking with their patients and then saying hey, you know, there's this information line, 1-800 number or there's a website if you want to get more information. Researchers use our website and you'll see why a little bit later and educators as well as planners and policy makers.

So since we've been in kind of a soft launch mode, I can give you a few statistics on who's using the website just locally. US, about 74% of our users from the United States, but we've actually been found by 7% of users internationally. So the word gotten out internationally and I don't know how, cause we haven't advertised it, but some people seem to be finding us.

The ten most active international countries are Canada number one, United Kingdom number 2, Australia. These are English speaking countries of course and then we go down to a few percentage from Brazil and obviously we want to expand this use. Now when do women or users, we don't actually know the sex of our users, but just let assume its women or friends of women. When do they log onto the Internet. Well, it's interesting - it's Tuesday, Wednesday and Thursday. Monday is a down day, Friday is a down day. I was shock to see this. They're not really getting onto the Internet on Saturday and Sunday. So this seems to be a week day phenomenon and what time of day do folks get on. Well, it's not the morning. You see on 10% of the users get on early in the morning. They actually get on in the afternoon and evening and lunch time for the most times. So they do it during the week and do sort of during working hours. There is some dinner time activity and late evening 9 to 11, but that that's not so surprising.

Now how do people find us? Well, in the United States there is a search agent called Excite. So this is exciting that Excite actually leads women to us. And then America On Line is the second most popular way to find us during this pilot phase.

Now what do we do in terms of giving you information? When you call us, we can fax you information back. We actually can mail you information, mail you publications or get our agencies to mail them to you. We accept your e-mail on the Internet so that you can e-mail us a request and say that I'm looking for information on this and we will again e-mail you back a response or e-mail you a publication. So we try to get back to you in as many possible modes that we can. Plus you can call up and we can follow-up that way.

So what's the benefit of this center and actually helps you identify from the loads of information that's out there on women's health, helps you to get to it quickly, its an essential source and it's actually central source for referring people onto health organizations or related groups. So if you are in a group and you'd like us to refer to you, give us your name and we will put you on our website.

Finally, the advantages for rural women are that this is the best way to get up-to-date information on treatment and diagnosis. It's a cheap way to get answers through the telephone. It's an improved link to prevention and screening programs and its cheap. Doesn't cost anything to dial a 1-800 number and one of the things we will talk about later is this is probably the only place where you can get hard to find information on the effects of pesticides and herbicides on health of women.

So with this I'll end with the introduction to our website. It's a living room so I say welcome to our home and welcome to our home site so to speak on the Internet and want to leave you with picture but also with a visual reminder. You will notice there's an apple in the window of our website and may have heard the story of John who actually use to take apple seeds the dominant part of the country and distribute them to farmers all across this country. Well you may not know is that he also distributed literature with the seed. He actually distributed chapters from the Sweden [inaudible] bible and when he went back to a family he would give them another chapter and exchange it and this was his real purpose of distributing apple seeds. So I would love for you to be come the modern day Johnny Appleseed by spreading the modern day version of the apple seed which is the website address for the women's health which is forwoman.org so that we can actually spread women's health information throughout the world. And I'll hope there's brochures and there is a little telephone card in the back that has the website and telephone number on so that you can spread the word to folks that you know about. So we're going to entertain questions after each panelist and I'll be happy to entertain any questions you have right now, then we're going to go on to talk about the telephone service, the website and some of the most frequently asked questions. Yes.

[inaudible]

Well that is interesting. I can also assume that some of the women aren't working in the job site, they're working outside at the home, but its like the day time hours or the nighttime, like 9 to 11 where we find most of our users. So, but people are logging on during work which is useful to know and it probably while during they are at home during the day.

[inaudible]

Yes. We have any publication that's Spanish that's available through the hotline and we have a Spanish speaking, I'm sorry to use the word hotline, information specialist. So we certainly cover that language. Any other questions? Next I'd like to introduce you to Marlin Harris who is the operations manager for our health and service issue and she'll tell you a little bit about what they do when folks call in and who calls.

I'd like to talk about the role of the information specialist. The information specialist is the vital link connecting the public to federal and non-federal organizations and they provide accurate and reliable up-to-date information and referrals for consumers and their families and members of the health community. The information specialists are skilled in accessing the callers. They have to understand what the topic is that the caller wants. Sometimes this is a little difficult because the caller has a couple of things on their mind. So it is the information specialist's role to kind of clarify and to focus on the topic. And they research the questions asked from the callers and in return they provide accurate current information. They must document this accurately and they do this with a very polite, clear delivery and in a concise way.

Referral to women's health organization. Many Federal organizations and private sector organizations produce fact sheets, information packets, research reports, newsletters and other materials on health topics of concern to the American woman as well as offering other support services. ANWIC, the American National Women Information Center collects this information abut these organizations and their available service and product.

Now it is a toll free service and the information specialist responds to inquiries to the ANWIC, 1-800 number from 9 a.m. to 5 p.m. currently and in the future we're going to be scheduling that time change from 9 a.m. to 8 p.m. and that's eastern standard time. Monday through Friday excluding Federal holidays. The information specialist clarifies the information needs and identify the appropriate federal or private sector materials and when appropriate Federal resources are contacted for publications and they can be sent to the caller. The number to call is 1-800-994-WOMAN or 994-9662.

Now how do the information specialist respond to the inquiries? They screen the callers, they identify the information needs or the subject and type of information required. They consult the data base to identify the organizations and to address the topics. And also the information specialist consult the organization resources that they have in order to identify available information and resources that the caller is requesting.

In addition, responses to inquiries also share information to callers about the programs from the sponsoring agencies and materials available for Federal information. Then information specialist will contact that agency and order materials that the caller's requesting. For non-federal agencies, callers are given the number and ordering information so that they can make that call independently. The requests are then entered into an inquiry tracking system and if the call is a Federal referral, a fax can be generated to order publications on behalf of the caller.

In summary, the response mechanism insures that referrals are made to other agencies and organizations and with faxes specific requests to Federal agencies to be mailed to the caller and telephone referrals to non-federal agencies are given to callers.

Now we also have a medical disclaimer. At times we might need to inform the caller that we are not medical specialist and that they should seek the care of their physician or health care planner. An example of such a call might be someone who complains of symptoms and wants to know if we could relate to them in a particular or describe a particular disease disorder that they might have and its a good rule of thumb to use the medical disclaimer with calls where information is required by specialists.

We also have a general disclaimer that we use and the primary focus of ANWIC is on information that is available from Federal government. Although we provide referrals to private sector organizations, we really don't endorse these organizations or their products or services. And the National Women's Health Information Center takes no responsibility for and exercising no control over these organizations and we have to relay this information to the caller and we do not take responsibility for the organization you use or accuracy of their information.

We also have a clinical trials disclaimer that we utilize. There is no single source of information on clinical trials. We can assist the caller by referring them to these Federal and private information sources likely to have this information. ANWIC takes no responsibility for and again we tell them that we exercise no control over the accuracy of the information provided by these resources.

ANWIC resource and referral organization data base contains Federal agencies that produce women's information material and education programs. Federal women's health research and service delivery, an education programs, professional organizations with a focus on women's health issues, voluntary organizations with a focus on women's health issues and professional and voluntary organizations that address general health issues concern to women.

In summary, ANWIC provides referrals to Federal information services and programs, voluntary and professional associations as well as academic and other research programs.

This chart is an example of the most frequently referred to agencies and organizations during the month of February, March of 1998 and you can see that the cancer information service and the national institute on aging information center appear to have the highest amount of referrals. The most fax request for publications for March of 98 shows us that the National Institute of Aging followed by the Office of Women's Health appear to have the most requests.

This graph shows the most frequently requested women's health topics for the month of February, March of 1998. As you can see the topic of hormone replacement therapy has the highest number of inquiries.

The next graph is an example of telephone callers by type in February and March of 1998 and shows the general public being the highest over two months followed by the Federal employees population as the next highest caller.

In summary, the role of the National Women's Health Information Center identifies and collects information on issues and programs affecting women's health. It compiles that information and in an extensive data base of Federal agencies and more than 80 Federal clearinghouses and hundreds of private sector resources. And it then disseminates this wealth of women's health information to women, to their families and to health care professionals. Verbally, in print, online, on the worldwide websites related to women's health in the public and private sectors. And thus, it really provides information to help improve the public and the health care professional who needs to have knowledge about women's health issues. Can I answer some questions?

[inaudible]

There are a lot referrals. the age groups? I don't believe we've done that specifically. We haven't yet. I think we will get permission in the future to ask some demographic information of the callers. It does appear with the questions on menopause, breast cancer, hormone replacement therapy and the referrals to aging and cancer that we are getting access to women probably in their 40s and over which is probably one of the groups that needs to get access to this crucial information.

We are hearing from the mature woman on frequently.

Are there any other questions. I wanted to say that it's important to know that there are a lot of websites out there that are pornography and so one of the things that we can spare website users from and callers, hotliners is contamination in some of those areas. I'll give you an example. If you go on the website and you happen to push button forwomen it used to be actually a site with lude pictures. So this is one of the problems of the Internet now especially sorting out some of the woman resources because some of them are not in the direction that you would expect. Our next speaker is Tom Samuelson who is senior computer specialist who actually is the inventor of the website. Usually when you put these websites you need to have some one expert in computers and Tom is that and he is responsible for putting this together. He's going to walk you through what you'll find once you go on the Internet to find women's health information. Tom.

Hi. As Dr. Henez said I'll going through the website, highlighting some of the areas of interest, especially for this conference itself, areas that may be of more interest to women in rural communities looking for that type of information.

The ANWIC website of course is a 24-hour service. It's available at www.forwoman.org soon it will also be available at www.forwoman.gov and forwomen.gov. Some of the features of the site include news in women's health, research in women's health, research in women's health on information on meetings and conferences. This conference is listed on the website. As Dr. Henez and Marlene have mentioned information tailored for consumers, for researchers, for health care providers and some information useful for policy makers dealing with women's health issues as well.

Here we've got the home page for the website again. The maker navigation areas on the website are on the text labels on the right. They're little hard to read on this slide, but they are also listed below and so as it says there is the welcome area. Has message from Dr. Wanda Jones, the Director of Public Health Services Offices on Women's Health. A message from the President of the United States. You'll also find in there some questions and answers about this service itself. What you can expect from the website, from the phone number, a little information on how the service came to be. The FAQ or frequently asked questions area contains a list of some of the most commonly asked women's health questions. The list was compiled both through research, through feedback from the 800 number, information specialists, from statistics into the websites. We were able to look at terms that people had searched on, how frequently they searched those terms and come up with some questions that we can provide some brief answers to and some suggestions and places to go. Jenny will be going into more detail later and she'll show you some examples.

There is also a health information section. One of the larger sections of the site where a lot of resources, general resources for women's health, resources for physicians on searchable data base. All of these things are in there. [Laughter]

The web's new section is a good place to start if you come back to website frequently as we would hope you would. You can start in the what's new section and see what's been added to the website. Almost anything new will appear in that section first. [inaudible] office that will lead you to the home page of the Public Health Services Office on Women's Health. It is a component of the ANWIC website, but also a website on its on. And finally a site map which is shown, which I will be able to show you in a minute as another way to navigate through the site. When you type in www.forwoman.org or .gov, this is the screen you will see first. You have a choice to navigate the website with the graphic. Some of those graphics are a little bit large, they could be a problem for people who may have a slow connection to the Internet and so there is an option to use the text only version. That version has also been optimize for people who may have visual disabilities that need a version that's been cleaned up with any graphics. We use fewer tables in that version. All the things that could interfere with verbal readers for the blind have been removed from that area of the website. And so we are trying to offer a clean version for folks who may need verbal readers as well as anyone who just wants to see a little faster and may not be as concerned with seeing the graphics.

This is the site map for the ANWIC. Again you see there is the home page at the very top. That is where you choose your version. From that point down, you'll see that everything is parallel. Everything that's in the graphic version is also available in the text version. We can't guarantee that links that we have links to outside resources from the text only version will text only. But we do try to keep what's on our own server a clean up graphic there.

I've already gone into some of the main areas within each of the categories on the website. You can see the welcome message. The long row there is the main areas in the website. Now we are going to take a look at the health information area. This is the health information section of the ANWIC or reference library. Four main areas are available through this page. A searchable data base, a selection of references related to women's health, references specifically intended for professionals on things that are perhaps more technical than what’s in the normal reference library and we will go into some of these and listed of current events in women's health.

I want to stop here for a minute to talk about this searchable data base. We don't have a slide of that. We've just redesigned that and I hope that the display would still be open this afternoon so you'd have a chance to look at it, but we're not there anymore. But someone asked earlier about Spanish publications and if you are looking for that kind of material, the searchable data base is where you want to go. You can enter that area and you choose from a pull down list of health topics one of which is called Spanish publications and that will pull up a list of the publications that we do have in Spanish. They'll also pop up in other areas, but if you're trying to hone in Spanish publications that would be where you would want to go.

This is the resources page. These are resources for women's health professionals page. Some of the things of note on this page are midline where current abstracts of medical research are available. Midline service of the National Library of Medicine in the last year have been made free of charge. It has a much wider access now then it had in the past. There are other National libraries medicine resources, the Food and Drug Administration can be accessed through this page as well as their Center for Food Safety and Applied Nutrition. Lot of information there is very helpful. And the Global Health Network was another one I wanted to mention. That website which is a place you can go to find information about women's health around the world. It's made an attempt to collect links to the Federal women's initiatives in different countries throughout the world who are able to get online with things.

This is a further listing of health professional resources. On this page you can access FDA's list of mammography facilities. If you are in a rural area and you're not sure where to go for mammography, who is properly certified that page is updated constantly by the Food and Drug Administration and will put you in touch with that type of service. You'll also find information there about what to look for in mammography facility, how you know that's its a good facility. Other resources in this area. There are lists of journals, access to the National Cancer Information Centers, data bases of cancer information.

This now, we are into the reference library. These resources here are intended more for women as consumers. They're not quite as technical in nature. Some of the areas that can be accessed through here. The Merck manual. A good place to start if you'll looking for just a basic definition of health terms. You can access lists of medical dictionaries and journals through this page, one of the most popular areas on the websites. We have an inventory here of Federal research projects related to women's health and the environment. I'll have some details on that in a minute to show you. And that contains many studies that would be very useful and helpful for women looking at health issues in rural communities. This is a further listing of general reference library. We have a group of international health resources. Resources for people traveling abroad and some access to some general government information, the US budget, the Commerce Business Daily. Some of these may be more helpful if you are a professional, but there are areas to find out what's going on in the government in regards to women's health or other research.

And finally, the last slide I have here are the reference library. These are some selected publications that we put on we've linked to online. Many more than these are available through the 800 number and through the searchable data base, but these are something that we felt were worth pulling to the front. Many of these are here because they are newest things that have come out of the government. One of note just came out about a month ago. When you are in the sun choose your cover. It's related to skin cancer. Skin cancer prevention for people who have a lot of exposure to the sun whether through job or recreation. And actually one more slide in the reference library. These are a group of other information resources on here's information about dietary guidelines, the Canadian Women's Health Network and other resources like that.

On the first page of the reference library I pointed out the women's health and the environment Federal inventory of activities. This is a searchable data base in ANWIC and I've got two records here and one to follow that have been printed out from there. You can't see the actual search interface but some of the things you will find in here on the agricultural health study. This collaborate study between NCI, the National Institute of the Environmental Health Sciences and the Environmental Protection Agency studies farm families, their cancer and disease risk from exposure to agricultural pesticides and other chemicals that they would come into contact with in an agricultural setting. This is an on-going study and there are other things related to this in this same data base. Here another detail record from that data base. The feasibility of cancer studies among migrant and seasonal farm workers. This was undertaken by the National Cancer Institute working with the migrant health program is the feasibility study. It talks about how to study cancer risk in this population and is a good place to start if you were researcher looking to start a type of research program. This kind of something that would have to come before that.

[another speaker] I want to add here that the important thing about this data base is there is a name and telephone number of the project officer on all on of these references which is usually impossible to find when you are trying to find out whose doing these types investigation and this is unique in this data base. So that you know, one click and you're able to find out who you should call to see what are the results of this study and where is it.

(Tom Samuelson continues) Ok, we are into a new section now. This is the Current Events section which is available through the first graphic base that I showed you. On this page you can access women's health news and that connects you actually to a service we contracted Women's Health Weekly. We have access to their online publication there free for our users. That brings news and women health as well as abstracts of current women's health research and that is updated monthly. News from the Department of Health and Human Services. Here we placed the press releases that come out of the Department. This section is updated several times a week. The calendar of women's health conferences and meetings is a listing of women's health events basically that are not necessarily Federal government sponsored. Those include some Federal events, but you will find events from academic, associations from colleges.

The next link, the Federal women's events is a place to look for what's happening in the government, what kind of events are the government sponsoring. And on the last one on this page the women health related legislation, United States Congress. Here we update weekly new legislation coming through Congress. Whether its been introduced or has been passed related to women's health. This is the home page of the Office on Women's Health. The searchable data base is available through this page as well as information on the office itself and on a link called Federal Women's Health Network where information about women's health on coordination across the government is available. This page gives some detail about the office on women health. You can access history of the office, lists of office events and programs, their national center of excellence in women's health program. All of this information is found here [another speaker] The probably the most important thing is the funding opportunities on the office.

[Tom resumes] Ok That was the walk through website. I've got a couple of pages here just of some statistical information based on the web statistics from April. Users seem to really like the medical dictionaries and reference libraries sections.

[Another speaker] Tom why do you think that is?

[Tom] I think that actually a slide that we'll see in a minute is going to show that the Internet is not really replacing other media and I know that in my own use of the Internet, I'll see something on the television that I need more information on, a term that I need a definition of and the ANWIC website is a good place to find that kind of basic information as well as a stepping board to find more detailed information. I think we may be being used in that manner.

On this page again generated from the web statistics shows how long people are spending on different pages on the website. Hopefully, this can be an indication of the topics people find the most interesting. Diabetics, home health care, cancer and violence are all among the top among the pages people spend the most time reading.

This chart here is a survey of people who use the Internet. Not just the public as a whole. To show how much time in each week that they spend using different types of media, the Internet has become the top choice, 31% of time spent is on the Internet. This chart here gives [END OF SIDE 1 OF TAPE]

SIDE 2

[ANOTHER SPEAKER] Do you have some information on there that is related to men? I believe we have impotence on there, maybe even prostrate cancer and some topics that are of interest to men because women are interested of course of the outcomes of their male counterpart. I often thought there I want to introduce the Deputy Assistant Secretary for Women's Health, Wanda Jones, if she will raise her hand. She's probably going to fire me today but I often thought that we should have an Office of Men Health and we should be the ones arguing for it because there are a list of unique issues that men are asking about or need to ask about and there is really no source like this. This is very sophisticated expensive source of information for women and often times every now and then on the hotline or comments we get the question well what about men's health. [inaudible] Yes. In fact we ought to actually have a little feature what about men's health one day under what's new and you know try to refer men to some or women to some of the resources that we have on men. I think that's a good point and I know that in this country there is a lot of interest in movement to try to target families and talk about family health. We also have things on there for kids. We talk about adolescence health. Some topics like eating disorders and family planning, attention deficit disorders is a very popular topic. So we are spreading around to family health. Yes. [inaudible]

The first set of frequently asked questions were done by someone from the Office on Women's Health. She use to be the Communications Director in our office and I believe what she did was she compiled she did research using various Federal publications from the National Institutes of Health and from other private organizations such as the American Heart Association. What we're also doing with the new frequently asked questions that we are trying to develop an ad to our list. We have a program called the National Center of Excellence in Woman's Health and currently there 12 economic sites across the United States who have been designated at these centers and they are the premiere woman's health center. So we've asked them to develop some new questions and answers. We have also asked some of the interns in our office to develop some for us.

[another speaker] I do have to say that all the Q’s&As actually have Federal approval so that the original questions and answers came from approved Federal publications and whenever we develop the new questions and answers they actually have to go through a Federal clearance process. So they get the stamp of approval as being accurate and legitimate, so we are providing information that the government has agreed to. That this is the answer to the question and sometimes we can't give answers. You know, we just have offer the pros and cons on the issues because there isn't a legitimate answer right now. I think that if you read if you got to read any of the Q’s&As on hormone replacement therapy it kind of, you know, gives you the pros and gives you the cons and let you make that decision. Yes.

[inaudible] Laughter. [inaudible]

Well that is something that we just only discussed as you can guess that is something I've been concerned with too being a younger woman. You know, there are definitely issues that I'm interested in but then there are also issues that I'm not so interested in and I'd like to know. But that is something we've been discussing and we've been trying to figure out a way that we can come up with a better way to track younger woman [inaudible]. We're working right now on developing an eating disorder site which will not necessarily target only younger women because it's really an issue that affects all types of people because it affects you know the people who influence young woman such as parents and coaches and teachers and things and people like that. And we maybe in the future maybe actually have a section just for younger women. Just like you mentioned where you have an icon or link to a different page. That's something we're still working on.

[another speaker] Occasionally, we've had some callers that have been questionable age because of the voice, but and the calls have been mostly about eating disorders. So I think it would be probably helpful to tract that and to keep kind of a tally. And also eating disorders are the problems that are categorized if you heard the diagnosis of anorexia or bulimia. Those are problems that young adolescent have with the distortion of their image. They think they're, and these are very very thin coquettic young adolescents who I guess due to the media and also the classic image of the tall very slim fashion model want to constantly reach that image and so it becomes into a disease and a lot of times there are family problems also that are causing a lot of this disorder.

I think it will get tricky when we start getting questions related to contraception which would be an obvious question of teenagers and above. And I think that is worth thinking about for the future.

[another speaker] Actually there two frequent asked questions pages that are being developed right now. One is on knee injuries that will target, you know, young girls who are very active and athletic and we're also working on another one on the date rape drug because that's definitely something that is of interest to especially high school and college age women.

[another speaker] For younger than adolescent girls category we have a link to a new page that is called Youth Info. It's youth.hhs.gov and so we probably won't pursue a lot along those lines to not duplicate what they have there, but that's on the reference library page as well.

Are there any other questions? Thank you all coming, we again hope you spread the seeds of this information.