title: Search and You Shall Find: Geographic Characteristics Associated With Google Searches During the Affordable Care Act's First Enrollment Period.
abstract: Previous studies indicate that Internet searching was a major source of information for the public during the launch of the Affordable Care Act, but little is known about geographic variation in searching. Our objective was to examine factors associated with health insurance-related Google searches in 199 U.S. metro areas during the first open enrollment period (October 2013 through March 2014), by merging data from Google Trends with metro-area-level and state-level characteristics. Our results indicate substantial geographic variation in the volumes of searching across the United States, and these patterns were related to local uninsurance rates. Specifically, areas with higher uninsurance rates were more likely to search in higher volumes for "Obamacare" and "health insurance," after adjusting for sociodemographic, political, and insurance market characteristics. The enormous political, advocacy, and media attention to the Affordable Care Act's launch may have contributed to heightened Internet search activity, particularly in areas characterized by higher uninsurance.
authors.affiliation: 1 University of Minnesota School of Public Health, Minneapolis, MN, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Gollust
authors.affiliation: 1 University of Minnesota School of Public Health, Minneapolis, MN, USA.
authors.forename: Xuanzi
authors.initials: X
authors.lastname: Qin
authors.affiliation: 1 University of Minnesota School of Public Health, Minneapolis, MN, USA.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Wilcock
authors.affiliation: 2 Wesleyan University, Middletown, CT, USA.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Baum
authors.affiliation: 3 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Colleen L
authors.initials: CL
authors.lastname: Barry
authors.affiliation: 4 Cornell University, Ithaca, NY, USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Niederdeppe
authors.affiliation: 2 Wesleyan University, Middletown, CT, USA.
authors.forename: Erika Franklin
authors.initials: EF
authors.lastname: Fowler
authors.affiliation: 1 University of Minnesota School of Public Health, Minneapolis, MN, USA.
authors.forename: Pinar
authors.initials: P
authors.lastname: Karaca-Mandic
mesh_terms: D005843:Geography; D018166:Health Care Reform / Q000706:statistics & numerical data*; D062265:Health Insurance Exchanges / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D020407:Internet; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D058991:Patient Protection and Affordable Care Act / Q000706:statistics & numerical data*; D014481:United States
keywords: Affordable Care Act; Internet; health insurance; health policy