title: Information and Communication Technology Use Among Low-Income Pregnant and Postpartum Women by Race and Ethnicity: A Cross-Sectional Study.
abstract: BACKGROUND
  Pregnancy and the postpartum period provide windows of opportunity to impact perinatal and lifelong preventive health behavior for women and their families, but these opportunities are often missed. Understanding racial/ethnic differences in information and communication technology (ICT) use could inform technology-based interventions in diverse populations.
  
  
  OBJECTIVE
  The objective of the study was to evaluate differences in the use of ICT between racial and ethnic groups as well as by English language proficiency.
  
  
  METHODS
  We conducted a cross-sectional study of 246 women who were aged 18 years or older and pregnant or within 1 year of delivery. They were recruited from 4 hospital-based outpatient clinics and completed a self-administered survey. We used multivariate regression analysis to evaluate the association between race/ethnicity and ICT (mobile phone/short message service [SMS] text message, Internet, and social network) usage by race/ethnicity and perceived English language proficiency after adjusting for age, income, marital status, and insurance status.
  
  
  RESULTS
  In all, 28% (69/246) of participants were Latina, 40% (98/246) were African American, 23% (56/246) were white, and 9% (23/246) from other racial/ethnic groups. Of the Latinas, 84% (58/69) reported limited English language proficiency and 59% (41/69) were uninsured. More than 90% of all participants reported mobile phone use, but more than 25% (65/246) had changed phone numbers 2 or more times in the past year. Compared to white women, African American women were less likely to SMS text message (OR 0.07, 95% CI 0.01-0.63) and Latinas were less likely to use the Internet to find others with similar concerns (OR 0.23, 95% CI 0.08-0.73). Women with limited English language proficiency were less likely to use the Internet overall (OR 0.30, 95% CI 0.09-0.99) or use email (OR 0.22, 95% CI 0.08-0.63) compared to women with adequate English language proficiency.
  
  
  CONCLUSIONS
  Mobile phones are widely available for the delivery of health interventions to low-income, racially diverse pregnant and postpartum women, but disparities in Internet use and SMS text messaging exist. Interventions or programs requiring Web-based apps may have lower uptake unless alternatives are available, such as those adapted for limited English proficiency populations.
authors.affiliation: Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
authors.forename: Nymisha
authors.identifier: http://orcid.org/0000-0002-7251-7434
authors.initials: N
authors.lastname: Chilukuri
authors.forename: Meredith
authors.identifier: http://orcid.org/0000-0001-9923-164X
authors.initials: M
authors.lastname: West
authors.forename: Janice Lynn
authors.identifier: http://orcid.org/0000-0001-5521-707X
authors.initials: JL
authors.lastname: Henderson
authors.forename: Shari
authors.identifier: http://orcid.org/0000-0002-0991-0962
authors.initials: S
authors.lastname: Lawson
authors.forename: Robert
authors.identifier: http://orcid.org/0000-0002-6846-283X
authors.initials: R
authors.lastname: Ehsanipoor
authors.forename: Kathleen
authors.identifier: http://orcid.org/0000-0002-0016-9389
authors.initials: K
authors.lastname: Costigan
authors.forename: Sarah
authors.identifier: http://orcid.org/0000-0001-9612-0979
authors.initials: S
authors.lastname: Polk
authors.forename: Wendy
authors.identifier: http://orcid.org/0000-0001-9828-0706
authors.initials: W
authors.lastname: Bennett
mesh_terms: D000293:Adolescent; D000328:Adult; D040421:Cell Phone / Q000706:statistics & numerical data*; D003142:Communication; D054626:Consumer Health Information / Q000379:methods*; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior; D054624:Health Status Disparities; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D049590:Postpartum Period / Q000208:ethnology* / Q000523:psychology*; D011203:Poverty; D011247:Pregnancy; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Hispanic Americans; Internet; cell phones; health services accessibility; health status disparities; postpartum period; pregnancy; text messaging