title: Digital technology ownership, usage, and factors predicting downloading health apps among caucasian, filipino, korean, and latino americans: the digital link to health survey.
abstract: BACKGROUND
  Interventions using mobile health (mHealth) apps have been effective in promoting healthy lifestyle behavior change and hold promise in improving health outcomes to thereby reduce health disparities among diverse racial/ethnic populations, particularly Latino and Asian American subgroups (Filipinos and Koreans) at high risk for diabetes and cardiovascular disease. Latinos and Asian Americans are avid digital technology owners and users. However, limited datasets exist regarding digital technology ownership and use, especially among specific racial/ethnic subgroups. Such information is needed to inform development of culturally tailored mHealth tools for use with lifestyle interventions promoting healthy behaviors for these at-risk racial/ethnic populations.
  
  
  OBJECTIVE
  The intent of the study was to examine (1) digital technology ownership and usage, and (2) factors predicting downloading health apps for Caucasian, Filipino, Korean, and Latino American subgroups.
  
  
  METHODS
  A cross-sectional survey conducted in August 2013 through December 2013 recruited 904 participants (Caucasians n=172, Filipinos n=250, Koreans n=234, and Latinos n=248), age >18 years, from California community events, clinics, churches, and online. English, Spanish, and Korean surveys were administered via paper or online. Descriptive statistics characterized the sociodemographics and digital technology ownership/usage of the 904 participants. Differences among groups in categorical variables were examined using chi-square statistics. Logistic regression was used to determine factors predicting downloading health apps.
  
  
  RESULTS
  Overall, mean age was 44 years (SD 16.1), with 64.3% (581/904) female. Only 44.7% (404/904) of all participants reported English as their primary language (Caucasian 98.3%, 169/172; Filipino 67.6%, 169/250; Korean 9.4%, 22/234, and Latino 17.7%, 44/248. Overall, mobile phone ownership was 92.8% (839/904). Compared to all groups, Koreans were more likely to own a mobile phone (82.8%, 194/234), computer (91.4%, 214/234), or tablet (55.2%, 129/234), whereas Latinos (67.5%, 167/248; 65.3%, 162/248; 24.4%, 61/248, respectively) were least likely. Internet access via mobile phones (90.5%, 818/904) was higher than computers (78.6%, 711/904). Odds of downloading health apps increased with college (OR 2.62, 95% CI 1.44-4.80) or graduate school (OR 2.93, 95% CI 1.43-6.00) compared to some high school; and family history of heart attack (OR 2.02, 95% CI 1.16-3.51). Odds of downloading health apps were reduced with: race/ethnicity, Latino (OR 0.37, 95% CI 0.20-0.69), and Korean (OR 0.52, 95% CI 0.31-0.88) compared to Caucasians; increasing age (OR 0.96, 95% CI 0.95-0.97); and completing paper surveys (OR 0.50, 95% CI 0.34-0.75).
  
  
  CONCLUSIONS
  This survey study uniquely targeted specific racial/ethnic subgroups. Results indicated that despite a narrowing racial/ethnic "digital divide", some disparities still exist, particularly among racial/ethnic groups with less education and whose primary language is not English. Findings will be used to inform development and evaluation of culturally tailored mHealth apps for use with interventions promoting healthy behavior change for Filipinos, Koreans, and Latinos.
authors.affiliation: University of California San Francisco, Institute for Health & Aging, Department of Social and Behavioral Sciences, San Francisco, CA, United States. Melinda.Bender@ucsf.edu.
authors.forename: Melinda S
authors.identifier: http://orcid.org/0000-0002-1018-3387
authors.initials: MS
authors.lastname: Bender
authors.forename: JiWon
authors.identifier: http://orcid.org/0000-0002-9405-6464
authors.initials: J
authors.lastname: Choi
authors.forename: Shoshana
authors.identifier: http://orcid.org/0000-0001-7559-4681
authors.initials: S
authors.lastname: Arai
authors.forename: Steven M
authors.identifier: http://orcid.org/0000-0002-3731-683X
authors.initials: SM
authors.lastname: Paul
authors.forename: Prisila
authors.identifier: http://orcid.org/0000-0003-1289-7452
authors.initials: P
authors.lastname: Gonzalez
authors.forename: Yoshimi
authors.identifier: http://orcid.org/0000-0002-2245-9264
authors.initials: Y
authors.lastname: Fukuoka
keywords: Filipinos; Koreans; Latinos; cross-sectional survey; digital technology; mHealth; mobile health apps