Darrell M. West

Where's the Revolution? Digital Technology and Health Care in the Internet Age

Despite the growing use of online resources, it is unclear how many Americans are using the World Wide Web for different health-related purposes and whether factors promoting use of the Internet in health care correspond with those affecting more traditional in-person and telemedicine encounters. This research uses a national public opinion survey to examine the degree to which health care consumers communicate through conventional, face-to-face consultation, telemedicine, or digital technology, and the relationship between these means of communication and respondent characteristics. Results indicate that few people are using digital technology to get information, communicate with health personnel, or make online medical purchases. Furthermore, less well educated, lower-income individuals living in rural areas tend to use the health care Internet less than others. Several policy measures need to be undertaken in order to accelerate the appropriate use of digital technology by health care consumers of all kinds. These include improving education and technological literacy and providing access to low-cost digital technology. Without a consumer complement to prevailing efforts to spur health information technology development and implementation on the part of providers, the promise of the digital revolution will continue to be limited to certain better-connected segments of the population.

Trading Security for Seats: Strategic Considerations in the Redistricting Process

In this paper, we examine redistricting in the 1982 House elections, paying particular attention to the strategic elements of redistricting. We argue that past reliance on aggregate approaches has hindered district-level studies of strategic processes and effects. To overcome this problem, we propose a method that uses individual districts as the unit of analysis. After showing how our district-level approach works, we apply it to the 1982 House elections and demonstrate its relevance for the strategic dimensions of redistricting. Leaders appeared to trade security for seats in their redistricting decisions; these tradeoffs have important consequences for future elections.

The Political Bases of Citizen Contacting: A Cross-National Analysis

This article examines a mode of political participation that frequently has been overlooked—individual efforts to obtain assistance from government officials. Using the seven-nation data set of Verba, Nie, and Kim, we develop and empirically evaluate alternatiave models of citizen contacting. Our first model draws on variations in the distribution of social and economic resources to explain the likelihood of contacting. The second focuses on differences in political ties to locate those most likely to contact government officials. We find greater support for the political ties model. Persons active in political parties and election campaigns are the most likely to engage in citizen contacting. Without political ties, few poor or uneducated persons would ask officials for assistance. We conclude by noting the more general theoretical and normative implications of our study.

Characteristics associated with use of public and private web sites as sources of health care information : Results from a national survey

Objective:We sought to determine the frequency with which Americans access health information from governmental (public sector) and nongovernmental (private sector) web sites and to identify similarities and differences in the characteristics associated with use of each type. Methods:Data derive from 928 individuals who responded to a November 2005 national survey. In addition to forms of health communication, we asked about age, gender, race, income, education, insurance, lifestyle, residence, satisfaction, literacy, and health. We report the extent of web site use stratified by sponsorship type—public and private. We also use χ2 tests to examine bivariate associations. Logistic regression and multiple imputation of missing data were used to examine the correlates of use in a multivariate context. Results:More than twice as many respondents visited private web sites (29.6%) than public web sites (13.2%). However, just 23.6% and 18.9% of private and public web site visitors, respectively, reported doing so once a month or more. Both public and private web site visitors were more likely to be better-educated respondents (odds ratio [OR] = 0.83, OR = 1.57) reporting greater concerns about health care access (OR = 1.28, OR = 1.20) than nonvisitors. Younger individuals (OR = 0.83) living in urban areas (OR = 1.59) with stronger health literacy (OR = 1.24) and reporting greater concerns about health care affordability (OR = 1.59) were more likely to visit privately sponsored web sites but nonpublicly sponsored ones. Conclusion:Relatively low utilization levels necessitate a concerted effort to improve the quality, accessibility, and relevance of Internet health information. Efforts to close the digital divide must recognize differences in user characteristics across governmental and nongovernmental web site providers.

Political Advertising and News Coverage in the 1992 California U.S. Senate Campaigns

This research investigates the advertising and news environment during the 1992 California U.S. Senate campaigns. I examine how people used campaign media--ads and news--in evaluating candidates. Content analysis explores the messages in television ads and news coverage. How citizens assess candidates recognition, favorability, electability, and the vote is addressed through local public opinion surveys in the nominating and general election stages. The results reveal that the impact of ads varies considerably with several elements of the political context: the stage and competitiveness of the campaign, strategic interactions among the candidates, and coverage by the news media. One cannot fully understand ads unless the context of electoral judgments is included in the analysis.

Health information Websites: characteristics of US users by race and ethnicity

We conducted a national public opinion survey of adults aged 18 years or older in the continental US to determine their use of health Websites. Of the 928 individuals contacted, 868 (94%) reported their race/ethnicity. More non-Hispanic Whites reported using the Internet (34%) than African Americans (31%) and Hispanics (20%). We used logistic regression to estimate adjusted odds ratios describing the relationship between Website usage and covariates across the racial/ethnic subgroups. Whereas better perceived health was associated with greater Website use among Hispanics and Whites, stronger health literacy was associated with greater use among Hispanics. No African American or Hispanic respondent aged 65 years or older reported going online. The relationship between education and use was more than twice as strong for African Americans and Hispanics than other groups. That some minority groups are less likely to use the World Wide Web for health information may further compound existing disparities. One place where this problem may be addressed is in the nations schools.

Polling effects in election campaigns

The effects of polls on public opinion and voting behavior have begun to attract considerable attention. However, aside from experimental studies and research on exit polls, the impact of preelection polls has not received adequate analysis. This paper investigates whether exposure to polls released during the campaign influences voter choices and how the electoral context of referendum versus candidate elections makes a difference in terms of polling effects. These questions were addressed in a cross-election comparison of the 1980 presidential campaign and a 1986 state referendum on the right-to-life issue. Basically, I found significant effects during the referendum, but weak effects in the presidential general election.

MANAGING CITIZEN FEARS Public Attitudes toward Urban Terrorism

The authors examine public attitudes toward urban terrorism, focusing on whether emotion or reason is a more important determinant of how people feel. Using the results of a public opinion survey in a large, northeastern city, the authors find that both emotion and reason affect people’s reactions to terrorist attacks. However, this relationship is affected by personal conversation. The more people talk about terrorism, the greater the chance reason rather than fear will dictate reactions. These results have important ramifications for how urban officials deal with homeland security and assuage citizens whose excessive concerns about terrorism have led to costly security expenditures.

CITIZEN EVALUATIONS OF LOCAL POLICE Personal Experience or Symbolic Attitudes

The sources of public assessments of government policy long have been the object of controversy between those proposing personal experience versus a symbolic attitudes model based on more general political and social beliefs. However, much of the research focuses on national policy issues that are not concrete and are removed from the daily experiences of many Americans. The authors use attitudes about local police to examine whether public assessments are linked more to people’s direct experience with crime and the police or whether such impressions are associated with more abstract attitudes about politics and law enforcement. They find that personal experience mattered more than symbolic attitudes when it came to views about police courtesy and fairness. However, both personal experience and symbolic attitudes were important in regard to opinions about crime seriousness and assessments of overall police performance. These results have important implications for how citizens evaluate local government services.

Television Advertising in Election Campaigns

Few topics have generated more interest recently than the widespread use of television ads in election campaigns. Commercials have become one of the dominant means of candidate communication in contemporary races. Citizens are bombarded with millions of dollars in spot ads during the political season. The 1990 elections alone generated