Bradford W. Hesse

Social Media Use in the United States: Implications for Health Communication

Background Given the rapid changes in the communication landscape brought about by participative Internet use and social media, it is important to develop a better understanding of these technologies and their impact on health communication. The first step in this effort is to identify the characteristics of current social media users. Up-to-date reporting of current social media use will help monitor the growth of social media and inform health promotion/communication efforts aiming to effectively utilize social media. Objective The purpose of the study is to identify the sociodemographic and health-related factors associated with current adult social media users in the United States. Methods Data came from the 2007 iteration of the Health Information National Trends Study (HINTS, N = 7674). HINTS is a nationally representative cross-sectional survey on health-related communication trends and practices. Survey respondents who reported having accessed the Internet (N = 5078) were asked whether, over the past year, they had (1) participated in an online support group, (2) written in a blog, (3) visited a social networking site. Bivariate and multivariate logistic regression analyses were conducted to identify predictors of each type of social media use. Results Approximately 69% of US adults reported having access to the Internet in 2007. Among Internet users, 5% participated in an online support group, 7% reported blogging, and 23% used a social networking site. Multivariate analysis found that younger age was the only significant predictor of blogging and social networking site participation; a statistically significant linear relationship was observed, with younger categories reporting more frequent use. Younger age, poorer subjective health, and a personal cancer experience predicted support group participation. In general, social media are penetrating the US population independent of education, race/ethnicity, or health care access. Conclusions Recent growth of social media is not uniformly distributed across age groups; therefore, health communication programs utilizing social media must first consider the age of the targeted population to help ensure that messages reach the intended audience. While racial/ethnic and health status–related disparities exist in Internet access, among those with Internet access, these characteristics do not affect social media use. This finding suggests that the new technologies, represented by social media, may be changing the communication pattern throughout the United States.

The Health Information National Trends Survey (HINTS): Development, Design, and Dissemination

Little is known about access, sources, and trust of cancer-related information, or factors that facilitate or hinder communication on a populationwide basis. Through a careful developmental process involving extensive input from many individuals and organizations, the National Cancer Institute(NCI)developed the Health Information National Trends Survey(HINTS)to help fill this gap. This nationally representative telephone survey of 6,369 persons aged ≥ 18 years among the general population was first conducted in 2002–2003, and will be repeated biennially depending on availability of funding. The purpose of creating a population survey to be repeated on a cyclical basis is to track trends in the publics rapidly changing use of newcommunication technologies while charting progress in meeting health communication goals in terms of the publics knowledge, attitudes, and behaviors. The HINTS survey instrument was built upon extant models of health communication and behavior change, taking into account the rapidly changing communication environment. Questions in the survey were drawn from an overall theoretical framework that juxtaposed the“push”aspects of traditional broadcast media against the“pull”aspects of new media. HINTS data will be made widely available for researchers and practitioners; it will help further research in health communication and health promotion and provide useful information for programs, policies, and practices in a variety of settings.

Cancer knowledge and disparities in the information age

Increasing information flow often leads to widening gaps in knowledge between different socioeconomic status (SES) groups as higher SES groups are more likely to acquire this new information at a faster rate than lower SES groups. These gaps in knowledge may offer a partial but robust explanation for differential risk behaviors and health disparities between different social groups. Drawing on the Health Information National Trends Survey (HINTS 2003), a national survey of communication behaviors conducted by the National Cancer Institute (NCI), we examine the relationship between publicity and knowledge gaps on two cancer topics that received different levels of publicity: knowledge about tobacco and sun exposure and their respective links to cancer. Analyses of the HINTS 2003 data suggest that differential knowledge levels of causes of cancer between SES groups are one potential explanation of cancer disparities that have been extensively reported in the literature. It is evident that high income and high education are associated with awareness about causes of major cancers such as lung and skin, and may allow people to protect themselves and minimize their risks. The data also show that heavier media attention could attenuate the knowledge gaps though moderate publicity or lack of news coverage may actually widen them. Last, the findings in this article suggest that it is necessary to take into account the SES variation within different racial and ethnic groups rather than mask them by treating the groups as one.

Cancer-Related Information Seeking: Hints from the 2003 Health Information National Trends Survey (HINTS)

Few nationally representative surveys have assessed the cancer-related information seeking behavior of the American public. Data for our analysis were from the 2003 Health Information National Trends Survey (HINTS). The goals of our analysis were to characterize cancer information seekers (3,011) and nonseekers (3,348) in terms of sociodemographic, health care access, and health status variables, and to describe the nature of the cancer-related information being sought by information seekers. Significant and independent associations with seeking status were identified for gender, age, race, income, education, personal and family history of cancer, and having a usual source of health care. Information seekers were less likely to be male (OR = .51); aged 65 or older (OR = .40); Hispanic (OR = .60); to have a usual source of health care (OR = .70); and more likely to have incomes greater than

Frustrated and Confused: The American Public Rates its Cancer-Related Information-Seeking Experiences

50,000 (OR = 1.50), some college (OR = 1.87) or a college degree (OR = 2.95), a prior cancer diagnosis (OR = 3.57), or a family history of cancer (OR = 2.17). Among cancer information seekers, the most frequently searched topic was cancer site-specific information (50.2%). Individuals who reported searching for cancer site-specific information were most frequently looking for information about breast cancer (23.8%), prostate cancer (11.5%), and skin cancer (11.3%). The HINTS survey provides a unique opportunity to explore the characteristics of information seekers and nonseekers and the content of information being sought by the public in a nationally representative sample; understanding gained from this effort provides generalizable and policy-relevant information about the American publics information needs.

Surveys of Physicians and Electronic Health Information

BACKGROUNDEnsuring access to high-quality cancer-related information is important for the success of cancer prevention and control efforts.OBJECTIVEWe conducted a population-based assessment of the barriers faced by people searching for cancer information.DESIGNCross-sectional data from the National Cancer Institute’s 2003 Health Information National Trends Survey.PARTICIPANTSA nationally representative sample of individuals in the USA (n = 6,369).MEASUREMENTSWe assessed whether respondents had ever sought cancer-related information and examined ratings of their information-seeking experiences and beliefs regarding causes of cancer and its prevention. Linear and logistic regression models were estimated to determine predictors of negative experiences and associations between experiences and cancer beliefs.RESULTSNearly one half (44.9%) of Americans had searched for cancer information. Many reported negative experiences, including the search process requiring a lot of effort (47.7%), expressing frustration (41.3%), and concerns about the quality of the information found (57.7%). Respondents lacking health insurance or a high school education experienced the greatest difficulty. Compared to those reporting the most positive experiences, information seekers reporting more negative experiences were more likely to report that almost everything caused cancer [odds ratio (OR) 2.0, 95% confidence interval (CI) 1.5–2.6], that not much can be done to prevent cancer (OR 2.7, 95% CI 1.9–3.8), and that it is hard to know which cancer prevention recommendations to follow (OR 3.2, 95% CI 2.3–4.5).CONCLUSIONSWhile a significant proportion of the American public searches for cancer information, suboptimal experiences are common. Facilitation of information seeking will be critical for promoting informed decision making in cancer prevention and control.

Cancer patients' information needs across the cancer care continuum: evidence from the cancer information service.

Despite a decades worth of exposure to health information on the Internet, the publics trust in physicians as their preferred source of health information increased from 2002 to 2008.

Health-related Internet use among cancer survivors: data from the Health Information National Trends Survey, 2003–2008

ABSTRACT This study examines the information needs of cancer patients who contacted the National Cancer Institutes (NCIs) Cancer Information Service (CIS) via a toll-free telephone number. Records from 19,030 calls received from cancer patients between September 2002 and August 2003 were analyzed to determine differences in subjects of interaction (main topics of inquiry and discussion) for subgroups of patients based on demographic characteristics and stage along the cancer care continuum (pretreatment, in-treatment, post-treatment, recurrence). Females were more likely than males to inquire about cancer screening/diagnosis, support services, psychosocial issues, and general cancer site information, but they were less likely to seek specific cancer treatment information. Older patients were more likely than younger patients to seek specific treatment information, but they were less interested in support services, psychosocial issues, and prevention/risk factors. Compared with White callers, Hispanics and most minorities were more likely to seek support service information, and African Americans were more likely to have questions related to psychosocial issues. Compared with patients in treatment, patients in recurrence were more likely to seek specific treatment information; patients not in treatment were more likely to seek medical referral information; and patients in post-treatment were more likely to seek screening/diagnosis and prevention/risk factor information. Findings will help the CIS and other cancer-focused organizations address the distinct information needs of different subsets of cancer patients.

SELF-SELECTED AND RANDOMLY SELECTED RESPONDENTS IN A COMPUTER NETWORK SURVEY

IntroductionIncreasing prevalence of Internet and new technologies are changing the communication pattern for patients and caregivers across the cancer care continuum. To date, little is known on how cancer survivors in the USA utilize the Internet for health-related purposes. This knowledge is crucial in developing effective communication programs to achieve quality and equitable cancer care.MethodsData from 2003, 2005, and 2008 iterations of the NCI-sponsored Health Information National Trends Survey(HINTS) were analyzed to: (1) compare health-related Internet use (hereafter HRIU) between individuals with and without a cancer diagnosis, (2) report trends, prevalence, and user profiles of HRIU, including support group participation, emailing provider, buying medicine online, and cancer information seeking on the Internet. Descriptive analyses and weighted multivariate logistic regression analyses were performed.ResultsWhile Internet penetration is growing over the years across the USA, cancer survivors access the Internet at a lower rate than general population (49.4% to 56.4% vs. 63.1% to 66.3%). Once on the Internet, they are more likely to use it for health-related purposes. Disparities in Internet access persists, as higher likelihood of Internet access is associated with younger age, higher education, non-Hispanic White race/ethnicity, metropolitan residence, and better self-rated health. On the other hand, among Internet-accessing survivors, socio-demographic, and health factors do not play a significant role in determining the pattern of HRIU.ConclusionsThe study identifies an increasing trend in HRIU among survivors, though the digital divide remains in Internet access. The findings also point to opportunities for narrowing the divide and using Internet to better serve survivors’ needs, as individuals from wide-ranging backgrounds and experiences are equally engaging in health-related activities on the Internet.Implications for survivorsTo increase equity and effectiveness in communication and cancer care, Internet access, functions, and technology literacy are important factors to be considered.

Temporal aspects of computer-mediated communication

A computer survey collects data directly from respondents. Usually respondents type responses on a personal computer (Synodinos and Brennan 1988), but networks permit remote data collection and this may become a routine research tool. Computer network surveys can improve response rates and increase self-disclosure (Kiesler and Sproull 1986; Martin and Nagao 1989; Sproull 1986; Waterton and Duffy 1984). They also can encourage self-selection. People can learn of a survey through an electronic bulletin board or distribution list and complete the survey electronically as easily as they reply to their electronic mail. Computer surveys convey little social information, so respondents experience less evaluation anxiety than when they respond in other forms of survey administration (Erdman, Klein, and Greist 1985; Servan-Schreiber and Binik 1989; Sproull and Kiesler 1986). During our administration of a computer network survey of 300 oceanographers, an additional 104 persons spontaneously asked to participate. Although they are unrepresentative, surveys using selfselected respondents are common and sometimes are the only kind available (Wainer 1986). Using comparisons of the random sample with the self-selected group, we sought to understand this motivated responding and the biases entailed. Motivation to respond or self-select seems due partly to ease of response and partly to a desire to give voice (e.g., Goyder 1987). If such respondents care about their responses, they will give more information with fewer mistakes (Petty and Cacioppo 1984). If involved with an issue or in the community,