Melinda Goldner

Rural-Urban Differences in General and Health-Related Internet Use

Literature has shown that people living in rural areas are less likely to have access to the Internet for demographic and technological reasons; however, less information is available regarding rural—urban differences in online health-information seeking. Data from the National Cancer Institute’s nationally representative 2005 Health Information National Trends Survey (N = 5,586) are used to examine these relationships. Logistic regression results show that those in rural areas use the Internet less than those who live in urban areas. Among individuals who have used the Internet, those in rural areas are less likely to use the Internet for health purposes. The persistence of a digital divide between rural and urban residents in online health searching is attributable to factors such as educational level, income, and diffusion of broadband. The article discusses the impact of these differences.

HOW HEALTH STATUS IMPACTS THE TYPES OF INFORMATION CONSUMERS SEEK ONLINE

A few studies examine what types of health information people seek online, yet we know little about how this varies by health status. To examine this question we used data collected from a random sample of 2,038 adults for the Pew Internet and American Life Project, which asked respondents in the United States whether they searched for 16 different types of information. These 16 topics were grouped into three broad areas, including medical conditions and treatments, health issues (e.g. diet and smoking cessation), and providers and payment (e.g. a particular hospital). To build on prior literature, two measures of health status were used: a self-report and the presence of a medical condition. The data suggest that health status impacts the types of health or medical information people seek on the Internet. Self-reported health status was not significantly related to any of the topics; however, respondents diagnosed with a disability or chronic disease were more likely to seek medical information on 13 of the 16 topics addressed. These include specific diseases or medical conditions, medical treatments or procedures, experimental treatments or medicines, alternative treatments or medicines, pharmaceutical or over-the-counter drugs, diet, immunizations, smoking cessation, depression, sexual health, environmental health hazards, a particular physician or hospital, and Medicaid/Medicare (governmental health programs in the United States for the poor and elderly). These results suggest that individuals in the United States who have a medical condition are more likely than healthy individuals to research most health topics online. The Internet can provide consumers with a wealth of information on issues of health and illness, yet healthcare providers need to educate consumers to be cautious given the range in quality.

Caregiving Outside of the Home: The Effects of Race on Depression

Objective . This research examines the conditions that determine whether Blacks experience lower or higher levels of depression while caregiving outside of the home, as compared to Whites. Some prior literature has found that African Americans report a lesser caregiver burden despite an increased likelihood that they will acquire this role, and decreased resources to do so. Others have found that African Americans experience the same caregiver burden and distress as Whites. Given these mixed findings, we use the stress process model to examine whether African American caregivers experience lower or higher levels of depression when they provide care outside of the home. Design . A sample of care workers who provide care to others outside of the home was drawn from the 1992–4 National Survey of Families and Households. The final sample included 275 (11%) Blacks, and 2,218 (89%) Whites (not of Hispanic origin). The primary statistical method for predicting differences in caregivers’ depressive symptomatology was OLS regression analysis with progressive adjustment. Results . We examined sociodemographics, family structure, resources, and stressors and found that African Americans, those with lower socioeconomic status, the unmarried, spending more weeks caregiving, having a physical impairment, and surprisingly receiving more help from parents are associated with higher depressive symptomatology. Stronger religious beliefs decreased depressive symptomatology for Blacks. The race effect was, in part, explained by family structure, amount of caregiving, and impairment of care worker. Conclusion . Contrary to prior literature, we found that Blacks are more depressed than White caregivers in large part because of lower socioeconomic status and greater stressors, and higher levels of physical impairment. Yet, strength in religious belief has a stress-buffering effect for African Americans. We suggest that policies that attempt to eliminate racial disparities in socioeconomic status and health could benefit these caregivers.

THE ASSOCIATION AMONG GENDER, COMPUTER USE AND ONLINE HEALTH SEARCHING, AND MENTAL HEALTH

Research investigating the impacts of computer and Internet use is increasing; however, few sociologists explore how this use may impact on mental health outcomes. The authors use data from the 2004 General Social Survey to examine the relationship among gender, computer and Internet use for health purposes and mental health. Their findings are mixed in that computer and Internet use are both positively and negatively related to mental health. They find evidence that there may be a selection bias occurring in which those with the greatest well-being problems are the ones searching online for health information. When computer and the Internet use variables were included in the models, the effect of gender on likelihood of experiencing poor mental health was attenuated, which suggests that particular types of Internet use may mediate gender disparities in mental health.

Patterns of Online Health Searching 2002–2010: Implications for Social Capital, Health Disparities and the De-Professionalization of Medical Knowledge

Abstract Purpose Since 2000, there has been a dramatic increase in the number of individuals using the Internet, including for health purposes. Internet usage has increased from 46% of adults in 2000 to 79% in 2010. The purpose of this chapter is to examine changes in one type of Internet usage: online health searching. We examine the impact of traditional digital inequality factors on online health searching, and whether these patterns have changed over time. Methodology Using data from five surveys ranging from 2002 to 2010 (n = 5,967 for all five surveys combined), we examine changing patterns of online health searching over the past decade. Findings Effects vary by inequality factor and time period examined. Despite the diffusion of the Internet, most of these gaps persist, and even strengthen, over time. Gender, age, and education gaps persist over time and appear to be increasing. An exception to this is the importance of broadband connection. Research limitations Since these data were collected, the use of mobile devices to access the Internet has increased. Research is needed on types of access and devices used for online health activities. Implications Larger scale inequalities play important roles in online health searching. Providing access and skills in evaluating online health information is needed for older and less educated groups. The results of this study have implications for the de-professionalization of medical knowledge. Originality This is the first study to examine digital inequality factors in online health information seeking over the breadth of this time period.

The Intersection of Gender and Place in Online Health Activities

This study examines how rurality and gender are related to online health activities. Rural women face greater health risks and yet have access to a weaker health system infrastructure, which has resulted in a health disadvantage. New health information technologies may ameliorate some of these disparities; thus, the authors examine the relevance of gender and place in going online to search for health information, buy medicines, participate in health-related support groups, communicate with physicians, or maintain a personal health record. Analyzing data from the National Cancer Institutes 2007 Health Information National Trends Survey, the authors found that the relations between rurality and gender vary, depending on the specific type of online health activity, and that gender may be a more salient factor than rurality in determining whether individuals engage in particular types of online health activities. This study contributes to the literature by examining how gender and place are related to online health activities, a combined area neglected in past research, and advancing research on gender and technology. This research highlights the importance of expanding high-speed access in rural locations, increasing technological and health literacy, and tailoring the Internet to specific populations.

Complementary and Alternative Medicine at the NIH

The summer issue of the Complementary and Alternative Medicine at the NIH Newsletter (Volume VII, Number 3) summarizes the activities of the National Center for Complementary and Alternative Medicine (NCCAM). The issue reviews current research on pain management, cancer, St. Johns Wort and cardiovascular diseases and outlines the NCCAM Advisory Council five-year strategic plan.

Cam At the NIH

This summary reviews the Summer 2006 newsletter of the National Center for Complementary and Alternative Medicine (NCCAM) (Volume 13, Number 2). It provides highlights from the North American Research Conference on Complementary and Integrative Medicine, discusses probiotics (also known as “friendly bacteria”), and introduces data from the 2002 National Health Interview Survey. It also addresses several NCCAM-funded studies on adolescent usage of CAM, black cohosh, turmeric, and vitamins C and E. This newsletter also discusses a new collaboration with China, as well as a variety of new resources, such as three new NCCAM publications that examine herbs, Tai Chi, and online medical sources (in Spanish). Finally, this issue introduces several new members.

Video Reviews : Spontaneous Healing (72 minutes). 1996. Inner Dimension, 200 Madison Avenue, 24th Floor, New York, NY 10016

Dr. Weil quickly goes through the main aspects of his eight-week program, but many details are missing. For example, he tells viewers that they should stretch, but never describes or demonstrates useful stretching exercises. He recommends that viewers eat more soy products, but says little about how to prepare it. Though there is some repetition by the end, it is still difficult to keep up with his pace by the discussion from Week 2 on. Finally in Week 6 he clarifies that you should continue with the elements of the other weeks, and simply add the new components he discusses. It would have been helpful to hear this point earlier in the video. Much later in the video he says &dquo;again&dquo; to reward yourself with flowers, but he had not mentioned this before. The student thought this would have been useful information earlier in order to help people maintain the program. It would also be helpful to have some information put up on the screen, such as names of supplements, since many viewers will be unfamiliar with them. For these reasons, the video provides merely an introduction to the book, not a replacement for it. It is hard to imagine fully implementing his program without the book. We think the video is best suited to people with prior knowledge of complementary and alternative medicine (CAM). Some of the weaknesses of this video, such as a lack of explanation and of evidence for why spiritual and emotional changes are important are clearly made up for in the next video.

Video Review : Integrative Medicine (19 minutes). 1999. Aquarius Health Care Videos, 5 Powderhouse Lane, P.O. Box 1159, Sherborn, MA 01770. Internet: www. aquariusproductions.com.

Dr. Andrew Weil discusses the integration of western and alternative medicine in this short video. Dr. John J. Ferry, Jr. asks Dr. Weil a series of questions. They discuss why integrative medicine is increasingly prevalent, whether people of all economic backgrounds will have access to these techniques, how to change people’s health habits and lower their stress, why we have a public debate concerning death and dying, what elements integrative medicine should incorporate to be effective, and how to train physicians about integrative medicine. Each of these topics is covered only briefly, since the entire video runs only 19 minutes. Though it provides a nice introduction to