title: Growth and determinants of access in patient e-mail and Internet use.
abstract: OBJECTIVE
  To measure the rate of access to and use of the Internet and e-mail, to determine sociodemographic predictors of access, and to measure the change in Internet and e-mail access over a 1-year interval.
  
  
  METHODS
  Survey study. Comparison of data with those from a similar survey from 1998.
  
  
  METHODS
  Emergency department of a large urban pediatric teaching hospital.
  
  
  METHODS
  Primary caretakers of pediatric patients or the patients themselves if aged 16 years or older.
  
  
  METHODS
  Use of and access to the Internet or e-mail.
  
  
  RESULTS
  We surveyed 214 individuals: 72.8% use or have access to the Internet, e-mail, or both, an increase from 52.2% in the 1998 survey (P<.001), and 48.5% regularly use the Internet or e-mail, compared with 43.1% in 1998 (P = .32). Outside the home, access is primarily at work (52.2%), schools (8.9%), public libraries (11.5%), and friends' and relatives' houses (16.7%). Internet use and access are linearly correlated with income (r = 0.43; P<.001). White patients are more likely to have access (odds ratio, 2.6; 95% confidence interval, 1.3-5.4; P<.001) than black or Asian patients, whereas those of Hispanic ethnicity are less likely to have access (odds ratio, 0.20; 95% confidence interval, 0.09-0.43; P<.001). However, after adjustment for race and Hispanic ethnicity, only income was a significant predictor of family access to the Internet and e-mail.
  
  
  CONCLUSIONS
  During the past year, many patients have gained access to the Internet and e-mail, although rates of regular use have remained steady. This access is often from outside the home. Furthermore, access is directly related to income and is unevenly distributed across racial and ethnic groups.
authors.affiliation: Department of Pediatrics, Harvard Medical School, Boston, Mass, USA.
authors.forename: K D
authors.initials: KD
authors.lastname: Mandl
authors.forename: S
authors.initials: S
authors.lastname: Feit
authors.forename: B M
authors.initials: BM
authors.lastname: Peña
authors.forename: I S
authors.initials: IS
authors.lastname: Kohane
mesh_terms: D000293:Adolescent; D001292:Attitude to Computers; D001900:Boston; D002648:Child; D005260:Female; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010290:Parents; D010361:Patients / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors