Matthias A. Kirch

Trust in the Internet as a Health Resource Among Older Adults: Analysis of Data from a Nationally Representative Survey

Background Distrust in the Internet as a source of health information remains common among older adults. The influence of this distrust on Internet use for health-related purposes, however, is unclear. Objective The objective of our study was to explore how older adults’ trust in the Internet influences their online health-related activities, and to identify potential targets for improving health-related Internet resources for older adults. Methods Data were obtained from a nationally representative, random digit-dial telephone survey of 1450 adults 50 years of age and older in the United States. A model was developed to conceptualize the hypothesized relationships among individual characteristics, distrust, and avoidance of the Internet as a health resource. Multivariate logistic regression analyses were conducted to examine the association between trust in online health information and use of the Internet for health-related purposes. Additional multivariate logistic regression analyses were conducted to identify the key characteristics associated with trust in online health information, adding sequentially the variables hypothesized to account for distrust among older adults: sociodemographic and health characteristics, inexperience and technical difficulties with the Internet, negative feelings toward the Internet, and lack of awareness about the sources providing the health information found online. Results The mean (SD) age of the study population was 63.7 (10.6) years. Of the 823 (56.8%) Internet users, 628 (76.3%) reported using the Internet as a health resource. Trust in the Internet as a source of health information was associated with using the Internet for a number of health activities, including searching for information about a specific health condition (adjusted OR 4.43, P < .001), purchasing prescription drugs (adjusted OR 2.61, P = .03), and talking with a health care provider about information found online (adjusted OR 2.54, P = .002). Older adults (age ≥65 years) were less likely to trust the Internet as a source of health information (OR 0.63, P = .04), even after adjusting for other sociodemographic characteristics and health and function. This age effect was only slightly attenuated (adjusted OR 0.69, P = .13) after adjusting for inexperience and technical difficulties with the Internet, but it disappeared entirely (adjusted OR 0.96, P = .91) after adjusting for other hypothesized contributors to distrust (including finding the Internet confusing because it provides “too much information,” and lacking awareness about the source providing health information found online). Conclusions Website design features that clearly identify the source and credibility of information and minimize confusion may build trust among older adults and offer an opportunity to increase the utility of the Internet as a health resource for this population.

Smoker self-identification versus recent smoking among college students.

BACKGROUND College students who engage in occasional or social cigarette smoking are less likely to identify themselves as smokers and to attempt to quit. This analysis aimed to determine: (1) the correlates of denying being a smoker among students reporting smoking in the past 30 days and (2) if denying this label was related to not attempting to quit smoking in the past 12 months. METHODS A total of 9931 students at 14 colleges completed a random sample survey in 2007. RESULTS Of 2255 students reporting having smoked a cigarette in the past 30 days, 50.7% responded No to Do you consider yourself a smoker. Logistic regression indicated that, after controlling for the number of smoking days in the past 30, being younger (OR=0.94, p<0.001); being male (OR=1.59, p=0.009); attending a 4-year (versus 2-year) college (OR=1.73, p=0.004); and consuming alcohol in the previous 30 days (OR=2.14, p=0.03) were correlates of denying being a smoker. Logistic regression indicated that denial was related to not attempting to quit in the past 12 months (OR=1.72, p<0.001), after controlling for the number of smoking days, age, gender, type of school, and other health factors. CONCLUSIONS Half of college smokers deny being smokers, particularly those who are younger, male, attending 4-year colleges, and alcohol consumers. Denying being a smoker was associated with not attempting to quit smoking. Therefore, traditional methods of ascertaining smoking status may not be valid in this population. Healthcare providers should more specifically ask students about recent smoking behavior. Further research is needed to develop interventions targeting smoking among this population.

Failure to report attempts to quit smoking

INTRODUCTION Accurately assessing quit attempt history is important to develop population estimates of cessation and to increase our understanding of smoking trajectories. Thus, the current study investigated failure to report quit attempts as a function of length of quit attempt by time since quit attempt over the past year. METHODS The present study used data from the Smoking Toolkit Study, a series of population-based surveys of smokers and recent ex-smokers in England aged 16 years and older. Among the 11,772 smokers identified at baseline (24.4% of the total sample), this study focused on the 4234 participants (36.0% of current smokers) who reported between one and three quit attempts in the past year. RESULTS There was a strong trend for quit attempts that lasted for shorter periods of time to fail to be reported. After three months, 90.1% of those lasting less than one day, 63.7% of those lasting between a day a one week, and 38.9% of those lasting between one week and one month failed to be reported. CONCLUSION A large proportion of unsuccessful quit attempts fail to be reported, particularly if they only last a short time or occurred longer ago. Therefore, population estimates of quit attempts based on retrospective data may be considerable underestimates and estimates of the success of quit attempts may be overestimates. Future research is needed to establish whether there is differential reporting of quit attempts as a function of features of attempts such as use of cessation aids.

Differences in Tobacco Use Among Two-Year and Four-Year College Students in Minnesota

Abstract Objective: This study compares tobacco use rates among two-year and four-year college students and explores the demographic variables that predicted that behavior. Participants: 9,931 students at 14 two-year and four-year colleges in Minnesota participated. Methods: Students at 11 schools completed an online survey, and students at 3 schools completed a paper survey in 2007. Results: After controlling for sex, age, ethnicity, relationship status, hours of work per week, and number of school credits, attending a two-year college predicted current and daily smoking (odds ratio [OR]) = 1.70, 95% confidence interval [CI] = 1.52–1.89; OR = 3.47, 95% CI = 2.94–4.11) and smokeless tobacco use (OR = 1.65, 95% CI = 1.32–2.06; OR = 1.64, 95% CI = 1.06–2.53). Conclusions: Although two-year college students comprise approximately two fifths of the college student population, surveys of college student tobacco use have focused nearly exclusively on four-year college students. Two-year college students should represent a priority population for tobacco control because attending a two-year college predicts increased tobacco use.

Ethnic group differences in the relationship between depressive symptoms and smoking

Objectives. A relationship between depression and smoking has been documented; however, little attention has focused on ethnic variability in how this relationship is manifested. Thus, we examined the interaction between ethnicity and significant depressive symptoms on smoking status. Design. A random digit dial survey (Minnesota Needs Assessment Survey) that oversampled ethnic minorities assessed demographics, smoking status, and depressive symptoms (Patient Health Questionnaire-2 [PHQ-2]). We examined the prevalence of current smoking between individuals with and without depressive symptoms within ethnic group and the interaction of depressive symptoms by ethnic group on smoking status. Results. Of 16,981 participants, 20.8% were current smokers, and 7.7% reported significant depressive symptoms on the PHQ-2 (score ≥3). Ethnic differences were observed in smoking rates (Asians 17.2%, Latinos 19.0%, Whites 20.4%, African-Americans 23.4%, American Indians 51.2%) and depressive symptoms (Asians 4.9%, Latinos 13.1%, Whites 7.0%, African-Americans 19.1%, American Indians 12.5%). Depressive symptoms were associated with a higher prevalence of smoking among Whites (34.5% vs. 19.4%), African-Americans (43.6% vs. 18.9%), and American Indians (81.9% vs. 47.1%), but not among Latinos (14.5% vs. 19.7%) or Asians (19.6% vs. 17.1%). The interaction between ethnicity and depressive symptomatology on current smoking was significant (p=0.02) among Latinos relative to Whites, controlling for other demographics. Conclusion. The relationship between depressive symptoms and smoking differs by ethnicity, particularly for Latinos. Understanding these differences may contribute to the development of culturally specific interventions.

Cost Conversations Between Primary Care Providers and Patients with Expanded Medicaid Coverage

Patients face increasing out-of-pocket (OOP) costs for healthcare, which have been associated with medication non-adherence and poor health outcomes. While lowincome patients may frequently have concerns about OOP costs—even if they have insurance with generous covered benefits—they may not raise cost concerns with physicians. Little is known about cost conversations between primary care providers (PCPs) and low-income patients. Our objective was to determine the frequency, predictors, and PCPs’ perceptions of the impact of cost conversations with low-income patients in an expanded Medicaid program in Michigan (BHealthy Michigan Plan^ [HMP]), a state program for adults ages 19– 64 with incomes ≤ 138% of the federal poverty level (FPL) and includes limited cost-sharing for beneficiaries (≤ 2% of income).

Pilot Study of Personalized Video Visit Summaries for Patients With Cancer

PURPOSE The treatment of cancer is complex, which can overwhelm patients and lead to poor comprehension and recall of the specifics of the cancer stage, prognosis, and treatment plan. We hypothesized that an oncologist can feasibly record and deliver a custom video summary of the consultation that covers the diagnosis, recommended testing, treatment plan, and follow-up in < 5 minutes. The video summary allows the patient to review and share the most important part of a cancer consultation with family and caregivers. METHODS At the conclusion of the office visit, oncologists recorded the most important points of the consultation, including the diagnosis and management plan as a short video summary. Patients were then e-mailed a link to a secure Website to view and share the video. Patients and invited guests were asked to respond to an optional survey of 15 multiple-choice and four open-ended questions after viewing the video online. RESULTS Three physicians recorded and sent 58 video visit summaries to patients seen in multidisciplinary GI cancer clinics. Forty-one patients logged into the secure site, and 38 viewed their video. Fourteen patients shared their video and invited a total of 46 visitors, of whom 36 viewed the videos. Twenty-six patients completed the survey, with an average overall video satisfaction score of 9 on a scale of 1 to 10, with 10 being most positive. CONCLUSION Video visit summaries provide a personalized education tool that patients and caregivers find highly useful while navigating complex cancer care. We are exploring the incorporation of video visit summaries into the electronic medical record to enhance patient and caregiver understanding of their specific disease and treatment.

Association of Access to Family Planning Services With Medicaid Expansion Among Female Enrollees in Michigan

Key Points Question Did Medicaid expansion in Michigan improve access to birth control and family planning services? Findings In this survey study of 1166 female Medicaid expansion enrollees of reproductive age in Michigan (sample weighted to 113 565 women), 35.5% reported increased access to birth control and family planning services. Those most likely to report increased access were women aged 19 to 24 (39.8%) and 25 to 34 (41.4%) years, women without health insurance coverage in the year preceding Medicaid expansion enrollment (42.6%), and women with a recent visit to a primary care clinician (36.8%). Meaning Results suggest that Medicaid expansion is associated with improved access to family planning services, which may enable low-income women to maintain optimal reproductive health.