title: Disparities in health-related internet use by US veterans: results from a national survey.
abstract: BACKGROUND
  The internet can contribute to improved access to information and services among underserved populations. Little is known about veterans' use of the internet for health, and how it is affected by socio-demographic characteristics. This knowledge gap is acute given the US Department of Veterans Affairs' (VA's) deployment of a major patient portal/personal health record system.
  
  
  OBJECTIVE
  To assess the frequency and correlates of veterans' use of the internet and identify personal characteristics impeding veterans' health-related internet use.
  
  
  METHODS
  Survey of 12 878 randomly selected adults from a panel of 60 000 US households. Veterans were oversampled.
  
  
  RESULTS
  Of the 3408 veterans responding, 54% had used the internet and 29% had used the internet specifically for health. In multi-variable analyses, general internet use was positively associated with younger age (OR = 0.03, CI = 0.01-0.06, oldest versus youngest group), higher income (OR = 3.12, CI = 2.10-4.63, > or =$75 000 versus <$25 000), more education (OR = 4.2, CI = 2.92-6.02, most versus least educated group), and better health (OR = 0.59, CI = 0.42-83, fair/poor versus very good/excellent). Health-related internet use was positively associated with more education (OR = 2.32, CI = 1.45-3.74, most versus least educated group), urban location (OR = 2.41, CI = 1.66-3.50), and worse health (OR = 1.85, CI = 1.16-2.95, fair/poor versus very good/excellent).
  
  
  CONCLUSIONS
  In the first large, systematic survey of veterans' internet use we found that more education and urban location were strongly, and positively, associated with veterans' health-related internet use, even after controlling for multiple socio-demographic characteristics. Interventions may be needed for less educated and rural veterans, e.g. by providers discussing internet use with their patients, or by the VA training veterans in health-related internet use.
authors.affiliation: Research Health Scientist at the Center for Health Quality, Outcomes and Economic Research(CHQOER), Department of Veterans Affairs(VA) Bedford Medical Center, Bedford, MA, USA. keith.mcinnes@va.gov
authors.forename: D Keith
authors.initials: DK
authors.lastname: McInnes
authors.forename: Allen L
authors.initials: AL
authors.lastname: Gifford
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Kazis
authors.forename: Todd H
authors.initials: TH
authors.lastname: Wagner
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001292:Attitude to Computers; D054626:Consumer Health Information / Q000379:methods*; D005260:Female; D006304:Health Status; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*