title: Racial and Sociodemographic Disparities in Internet Access and eHealth Intervention Utilization Among Veteran Smokers.
abstract: BACKGROUND
  Access to the internet at home may be an important barrier to electronic health (eHealth) smoking cessation interventions. The current study explored possible sociodemographic disparities in access to the internet at home among veteran smokers.
  
  
  METHODS
  Data from participants proactively recruited and enrolled in a randomized smoking cessation effectiveness trial (N = 408) that compared a web-based smoking cessation intervention to Veterans Affairs (VA) usual care were used to examine the demographic attributes of smokers with and without internet access at home. Multivariable logistic regression was used to examine associations between demographic factors and home internet access. Data from patients randomized to the internet arm of the study (N = 205) were used to ascertain correlates of utilization of the intervention website.
  
  
  RESULTS
  While the majority of the sample (82 %) endorsed access to the internet at home, veterans who were African-American, older, and not married were significantly less likely to have home internet access. Veterans who were African-American, older, less educated, had longer travel times to the nearest VA facility, and increased nicotine dependence were less likely to access the internet on a daily basis. While several sociodemographic variables (e.g., age, race, education, employment) were related to utilization of a free membership to a commercial, web-based smoking cessation intervention in bivariate analyses, only access to the internet at home was related to use of the smoking cessation site in adjusted results.
  
  
  CONCLUSIONS
  These results highlight gaps in internet access and use among veterans and additionally underscore the importance of improving accessibility of eHealth interventions for low-income, minority, and socially disadvantaged veteran populations.
authors.affiliation: VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), 508 Fulton Street, Durham, NC, 27705, USA. patrick.calhoun2@va.gov.|Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA. patrick.calhoun2@va.gov.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Calhoun
authors.affiliation: VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), 508 Fulton Street, Durham, NC, 27705, USA.|Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710, USA.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Wilson
authors.affiliation: Durham VA Medical Center, Durham, NC, 27705, USA.|Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710, USA.
authors.forename: Terrell A
authors.initials: TA
authors.lastname: Hicks
authors.affiliation: Durham VA Medical Center, Durham, NC, 27705, USA.|Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710, USA.
authors.forename: Shaun P
authors.initials: SP
authors.lastname: Thomas
authors.affiliation: VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), 508 Fulton Street, Durham, NC, 27705, USA.|Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710, USA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Dedert
authors.affiliation: Durham VA Medical Center, Durham, NC, 27705, USA.|Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA.
authors.forename: Lauren P
authors.initials: LP
authors.lastname: Hair
authors.affiliation: Department of Internal Medicine, Yale University, New Haven, CT, USA.|Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Bastian
authors.affiliation: VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), 508 Fulton Street, Durham, NC, 27705, USA.|Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710, USA.
authors.forename: Jean C
authors.initials: JC
authors.lastname: Beckham
keywords: Health disparities; Internet; Racial disparities; Smoking cessation; Veterans; eHealth