title: Circumcision on the web: a comparison of quality, content, and bias online.
abstract: OBJECTIVE
  In 2012, the American Academy of Pediatrics (AAP) newborn circumcision policy statement expressed that although benefits outweigh risks, final decisions lie with parents. Although health information on the Internet is plentiful, the quality and availability of information on circumcision, including dissemination of AAP and AUA policy statements, is unknown. We analyzed English and Spanish circumcision websites to evaluate their overall quality, detail, accuracy, and bias.
  
  
  METHODS
  In April 2013, three search engines were queried for English and Spanish circumcision websites, which were analyzed utilizing the DISCERN Plus scale for content quality as well as additional study-specific criteria.
  
  
  RESULTS
  We analyzed 214 websites (141 English, 73 Spanish). Most websites in both languages had very good content quality and were neutral regarding circumcision. Regardless of language, only 21% of sites mentioned the updated AAP guidelines. Surprisingly, the AUA circumcision policy statement did not appear in the top results. Spanish sites were more likely to give good descriptions of circumcision procedures than English sites (p < 0.04), less likely to cite sources (p < 0.01), and more likely to describe benefits (p = 0.02)..
  
  
  CONCLUSIONS
  Newborn circumcision information on the Internet is of very good quality, but different English and Spanish characteristics possibly reflect cultural bias, which may explain the disparate rates of circumcision between different groups in the USA. The AAP's circumcision policy statement was referenced by a minority (20%) of websites, and AUA's policy statement was not even part of the top results. The AUA should have a more active role in providing accurate and comprehensive online information to parents regarding circumcision.
authors.affiliation: Department of Urology, Mount Sinai Medical Center, New York, NY, USA. Electronic address: Karl.coutinho@mountsinai.org.
authors.forename: Karl
authors.initials: K
authors.lastname: Coutinho
authors.affiliation: Ichan School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: kris.stensland@gmail.com.
authors.forename: Kristian
authors.initials: K
authors.lastname: Stensland
authors.affiliation: Department of Pediatric Urology, Kravis Children's Hospital at Mount Sinai, New York, NY, USA. Electronic address: grace.hyun@mountsinai.org.
authors.forename: Grace
authors.initials: G
authors.lastname: Hyun
mesh_terms: D015982:Bias; D002944:Circumcision, Male / Q000009:adverse effects / Q000193:education* / Q000706:statistics & numerical data; D006266:Health Education / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D033181:Information Dissemination / Q000379:methods; D020407:Internet / Q000592:standards* / Q000706:statistics & numerical data; D007802:Language; D008297:Male; D010290:Parents / Q000193:education; D017410:Practice Guidelines as Topic
keywords: Circumcision; Health information; Informatics; Online; Spanish; Websites