title: Predictors of eHealth usage: insights on the digital divide from the Health Information National Trends Survey 2012.
abstract: BACKGROUND
  Recent eHealth developments have elevated the importance of assessing the extent to which technology has empowered patients and improved health, particularly among the most vulnerable populations. With noted disparities across racial and social groups in chronic health outcomes, such as cancer, obesity, and diabetes, it is essential that researchers examine any differences in the implementation, uptake, and impact of eHealth strategies across groups that bear a disproportionate burden of disease.
  
  
  OBJECTIVE
  The goal was to examine eHealth use by sociodemographic factors, such as race/ethnicity, socioeconomic status (SES), age, and sex.
  
  
  METHODS
  We drew data from National Cancer Institute's 2012 Health Information National Trends Survey (HINTS) (N=3959) which is publicly available online. We estimated multivariable logistic regression models to assess sociodemographic predictors of eHealth use among adult Internet users (N=2358) across 3 health communication domains (health care, health information-seeking, and user-generated content/sharing).
  
  
  RESULTS
  Among online adults, we saw no evidence of a digital use divide by race/ethnicity. However, there were significant differences in use by SES, particularly for health care and health information-seeking items. Patients with lower levels of education had significantly lower odds of going online to look for a health care provider (high school or less: OR 0.50, 95% CI 0.33-0.76) using email or the Internet to communicate with a doctor (high school or less: OR 0.46, 95% CI 0.29-0.72), tracking their personal health information online (high school or less: OR 0.53, 95% CI 0.32-0.84), using a website to help track diet, weight, and physical activity (high school or less: OR 0.64, 95% CI 0.42-0.98; some college: OR 0.67, 95% CI 0.49-0.93), or downloading health information to a mobile device (some college: OR 0.54, 95% CI 0.33-0.89). Being female was a consistent predictor of eHealth use across health care and user-generated content/sharing domains, whereas age was primarily influential for health information-seeking.
  
  
  CONCLUSIONS
  This study illustrates that lower SES, older, and male online US adults were less likely to engage in a number of eHealth activities compared to their counterparts. Future studies should assess issues of health literacy and eHealth literacy and their influence on eHealth engagement across social groups. Clinical care and public health communication efforts attempting to leverage Web 2.0 and 3.0 platforms should acknowledge differential eHealth usage to better address communication inequalities and persistent disparities in health.
authors.affiliation: Harvard School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, United States. emily_kontos@dfci.harvard.edu.
authors.forename: Emily
authors.identifier: http://orcid.org/0000-0003-3002-1382
authors.initials: E
authors.lastname: Kontos
authors.forename: Kelly D
authors.identifier: http://orcid.org/0000-0002-2151-2983
authors.initials: KD
authors.lastname: Blake
authors.forename: Wen-Ying Sylvia
authors.identifier: http://orcid.org/0000-0002-9140-6094
authors.initials: WY
authors.lastname: Chou
authors.forename: Abby
authors.identifier: http://orcid.org/0000-0002-3384-5873
authors.initials: A
authors.lastname: Prestin
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005006:Ethnicity; D005260:Female; D057220:Health Literacy; D006801:Humans; D020407:Internet; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D012959:Socioeconomic Factors; D017216:Telemedicine / Q000706:statistics & numerical data* / Q000639:trends; D014481:United States; D055815:Young Adult
keywords: Internet; communication barriers; consumer health information; health communication