title: Digital Connectedness in the Framingham Heart Study.
abstract: BACKGROUND
  New avenues of data collection such as eHealth and mobile technology have the potential to revolutionize the way large populations can be assessed and managed outside of standard research and clinical settings.
  
  
  RESULTS
  A digital connectedness survey was administered within the Framingham Heart Study from 2014 to 2015. The exposure was usage of the Internet, email, cell phones, and smartphones in relation to demographic and cardiovascular disease risk factors; all results were adjusted for age and sex. Among 8096 living study participants, 6503 (80.3%) completed the digital survey. Among survey responders, 5678 (87.4%) reported regular Internet use. Participants reporting regular Internet use were younger (aged 59.1 versus 76.5 years, P<0.0001), were more likely to be employed (70.3% versus 23.7%, P=0.002), and had more favorable cardiovascular disease risk factors than those who did not use the Internet (all P≤0.05). Overall, 5946 (92.1%) responders reported using cell phones. Among cell phone users, 3907 (67.8%) had smartphones. Smartphone users were younger (aged 55.4 versus 68.5 years, P<0.0001), more likely to be employed (81.1% versus 43.9%, P<0.0001) and to have a college education, and less likely to have hypertension (27.9% versus 55.7%, P=0.0002) than those who did not use smartphones.
  
  
  CONCLUSIONS
  Digital connectedness varies substantially by age; connected persons tend to be younger and better educated and to have more favorable cardiovascular disease risk factor profiles. Less than two-thirds of study participants who completed the survey had a smartphone. The generalizability of studies focused on digitally connected persons may have limitations.
authors.affiliation: National Heart, Lung, and Blood Institute Center for Population Studies, National Institutes of Health, Framingham, MA Division of Endocrinology, Hypertension, and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA foxca@nhlbi.nih.gov.
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Fox
authors.affiliation: National Heart, Lung, and Blood Institute Center for Population Studies, National Institutes of Health, Framingham, MA.
authors.forename: Shih-Jen
authors.initials: SJ
authors.lastname: Hwang
authors.affiliation: Framingham Heart Study, Framingham, MA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Nieto
authors.affiliation: Framingham Heart Study, Framingham, MA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Valentino
authors.affiliation: Framingham Heart Study, Framingham, MA.
authors.forename: Karen
authors.initials: K
authors.lastname: Mutalik
authors.affiliation: Department of Mathematics and Statistics, Boston University, Boston, MA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Massaro
authors.affiliation: Framingham Heart Study, Framingham, MA Department of Epidemiology, Boston University School of Public Health, Boston, MA Section of Cardiology and Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA.
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
authors.affiliation: Framingham Heart Study, Framingham, MA Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA.
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Murabito
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology*; D040421:Cell Phone / Q000706:statistics & numerical data*; D034742:Electronic Mail / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D000068997:Smartphone / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
keywords: cardiovascular risk; eHealth; epidemiology; mHealth; smartphones; technology