Health Information–Seeking Behaviors,Health Indicators,and Health Risks

Objectives. We examined how different types of health information–seeking behaviors (HISBs)—no use, illness information only, wellness information only, and illness and wellness information combined—are associated with health risk factors and health indicators to determine possible motives for health information seeking.Methods. A sample of 559 Seattle–Tacoma area adults completed an Internet-based survey in summer 2006. The survey assessed types of HISB, physical and mental health indicators, health risks, and several covariates. Covariate-adjusted linear and logistic regression models were computed.Results. Almost half (49.4%) of the sample reported HISBs. Most HISBs (40.6%) involved seeking a combination of illness and wellness information, but both illness-only (28.6%) and wellness-only (30.8%) HISBs were also widespread. Wellness-only information seekers reported the most positive health assessments and the lowest occurrence of health risk factors. An opposite pattern emerged for illness-only information seekers.Conclusions. Our findings reveal a unique pattern of linkages between the type of health information sought (wellness, illness, and so on) and health self-assessment among adult Internet users in western Washington State. These associations suggest that distinct health motives may underlie HISB, a phenomenon frequently overlooked in previous research.Internet access is a widely available technology in the United States.^1,2 Among the variety of online activities, searching for and using health information appear to be particularly prevalent, undertaken by between 40% and 70% of US adults.^1,3–7 Hoping to take advantage of the Internet''s potential,⁸ public health practitioners, clinicians, and researchers have contributed to an emerging literature detailing characteristics of individuals engaging in health information–seeking behaviors (HISBs), exploring motives for engaging in HISBs, and documenting the types of health and medical information being sought.^9–11Previous HISB research has primarily examined how patients seek and use health information across diverse health care contexts, yielding the recurrent observation that individuals striving to deal with stressful health challenges—such as a recent illness diagnosis or chronic disease management—were strongly motivated to engage in Internet HISBs.^9,10,12–14 Several population-based studies,^9,15–21 many of which have also conceptualized HISB primarily as “a key coping strategy in health-promotive activities and psychosocial adjustment to illness,”^22(p1006) have yielded corresponding evidence. It should be recognized, however, that a cluster of these studies^17–19,21 were informed by a common evidentiary resource (i.e., 2000–2002 Pew Internet and American Life Project data), potentially exaggerating the apparent consistency of the “disease and illness” motivation for HISB.Although informative, the predominant focus in previous research on a “disease and illness” motive for HISB has left the hypothesis that healthy individuals may pursue information to maximize positive health outcomes essentially unexplored.²³ A small but growing body of findings suggests, however, that many individuals actively seek out wellness information (e.g., information promoting a healthy lifestyle). Specifically, emerging evidence reveals a positive association between a self-reported “health-conscious” or “health-active” orientation and engaging in wellness information–seeking behavior.^20,24–27 Indeed, since 2000, the proportion of American adults reporting that they have looked online for diet, exercise, or fitness information has increased substantially and generally exceeds the proportion seeking online information about disease and illness topics (e.g., cancer, arthritis, diabetes).^28,29Pandey et al. have asked, “Is it a disease or an affliction that motivates the use of the internet, or is it that the well and the healthy use the internet in a proactive manner?”^23(p180) As this question highlights, the nearly exclusive focus in previous research on Internet HISB as a response to health-threatening situations has left questions regarding the potential positive health outcomes motivating HISB unanswered.²² We aimed to fill this knowledge gap and further expand understanding of linkages between HISB and health perceptions and behaviors. Specifically, we compared mental and physical health indicators and health risk factors across 4 discrete categories of Internet HISBs—no use, illness content only, wellness content only, and illness and wellness content combined—among a sample of adults in the Seattle–Tacoma, Washington area to explore motivations of HISB.     

Digital Natives Versus Digital Immigrants: Influence of Online Health Information Seeking on the Doctor–Patient Relationship

Ubiquitous Internet access currently revolutionizes the way people acquire information by creating a complex, worldwide information network. The impact of Internet use on the doctor–patient relationship is a moving target that varies across sociodemographic strata and nations. To increase scientific knowledge on the patient–Web–physician triangle in Austria, this study reports findings regarding prevailing online health information-seeking behavior and the respective impact on doctor–patient interactions among a nonprobability convenience sample of Internet users. To investigate digital age group-specific influences, we analyzed whether digital natives and digital immigrants differed in their perspectives. The questionnaire-based online survey collected sociodemographic data and online health information-seeking behavior from a sample of 562 respondents (59% females, mean age 37 ± 15 years, 54% digital natives). Most respondents (79%) referred to the Internet to seek health information, making it the most commonly used source for health information, even more prevalent then the doctor. We found similar predictors for using the Internet as a source for health-related information across digital age groups. Thus, the overall generational gap seems to be small among regular Internet users in Austria. However, study participants expressed a rather skeptical attitude toward electronic exchange of health data between health care professionals and patients, as well as toward reliability of online health information. To improve adoption of electronic doctor–patient communication and patient empowerment, public education and awareness programs are required to promote consumer-centered health care provision and patient empowerment.     

What Are Americans Seeing? Examining the Message Frames of Local Television Health News Stories

While local television news is the number-one source among Americans for health information, little attention has been given to what viewers are actually watching in these newscasts. Toward this end, a content analysis of local television health news stories (n?=?416) was conducted, to examine how local health news stories utilize gain and loss message frames, and whether there are differences in story topics, location, length, presence of self-efficacy methods, and conflict, according to the message frames. Results showed that health news stories that dealt with advancements in treatment or philanthropic events were mainly reported using gain frames, while loss frame health news stories most frequently reported on statistics and trends. The majority of the health news stories were less than 30 seconds among all frames, and conflict appeared more often for the loss frames than gain frames. Furthermore, while efficacy information was mostly absent across all types of frames, gain frames were more likely than loss frames to present efficacy methods. Finally, efficacy information appeared most frequently in health-related statistical reports and prevention messages, while discrimination and health-policy stories had the least efficacy information in them.     

A Time Series Analysis of Cancer-Related Information Seeking: Hints From the Health Information National Trends Survey (HINTS) 2003–2014

Recent technological changes, such as the growth of the Internet, have made cancer information widely available. However, it remains unknown whether changes in access have resulted in concomitant changes in information seeking behavior. Previous work explored the cancer information seeking behaviors of the general population using the 2003 Health Information National Trends Survey (HINTS). This article aims to reproduce, replicate, and extend that existing analysis using the original dataset and five additional iterations of HINTS (2007, 2011, 2012, 2013, 2014). This approach builds on the earlier work by quantifying the magnitude of change in information seeking behaviors. Bivariate comparison of the 2003 and 2014 data revealed very similar results; however, the multivariate model including all years of data indicated differences between the original and extended models: individuals age 65 and older were no longer less likely to seek cancer information than the 18–35 reference population, and Hispanics were also no longer less likely to be cancer information seekers. The results of our analysis indicate an overall shift in cancer information seeking behaviors and also illuminate the impact of increased Internet usage over the past decade, suggesting specific demographic groups that may benefit from cancer information seeking encouragement.     

Patterns of Reasons for Taiwanese Adults’ Health Information–Seeking Efforts: A Latent Class Analysis Approach

The aims of this study were to use latent class analysis (LCA) to identify subgroups of adults in Taiwan based on their reasons for seeking health information and to explore predictors of subgroup membership. A questionnaire survey of 752 adults from 25 communities in Taiwan was conducted. LCA was used to identify distinct classes of participants; latent class regression was performed to identify factors predicting latent class membership. Three classes emerged through LCA. The Health-Improving Group (50.40%) reported high probabilities of reasons relevant to improving their or someone else’s health but low probabilities of reasons relevant to patient–provider interaction. The Active Group (32.98%) showed high probabilities of almost all of the reasons for seeking health information. The Passive Group (16.62%) showed low probabilities across all of the reasons. Compared to the Health-Improving Group, the Active Group was significantly more likely to have higher education and perceive higher information-seeking self-efficacy. The individuals in the Passive Group were significantly more likely to be male, be younger, have lower health literacy, and have fewer years of education than those in the Health-Improving Group. This LCA approach can provide important information on how communication strategies should be applied to different population subgroups.     

Does Context Matter? Examining PRISM as a Guiding Framework for Context-Specific Health Risk Information Seeking Among Young Adults

Research indicates that when people seek health information, they typically look for information about a specific symptom, preventive measure, disease, or treatment. It is unclear, however, whether general or disease-specific theoretical models best predict how people search for health information. We surveyed undergraduates (N = 963) at a large public southeastern university to examine health information seeking in two incongruent health contexts (sexual health and cancer) to test whether a general model would hold for specific topics that differed in their immediate personal relevance for the target population. We found that the planned risk information seeking model was statistically a good fit for the data. Yet multiple predicted paths were not supported in either data set. Certain variables, such as attitudes, norms, and affect, appear to be strong predictors of intentions to seek information across health contexts. Implications for theory building, research methodology, and applied work in health-related risk information seeking are discussed.     

Patient–Provider Discussion of Online Health Information: Results From the 2007 Health Information National Trends Survey (HINTS)

Increasing numbers of people have turned to the Internet for health information. Little has been done beyond speculation to empirically investigate patients' discussion of online health information with health care professionals (HCPs) and patients' perception of HCPs' reactions to such discussion. The author analyzed data from the 2007 Health Information National Trends Survey (HINTS) to identify the characteristics of patients (a) who search for health information on the Internet, (b) who discuss the information found on the Internet with HCPs, and (c) who positively assess HCPs' reaction to the online information. Findings show that men were more likely than were women to have a conversation on online information with HCPs. It is unfortunate that patients who had trouble understanding or trusting online health information were no more likely to ask questions to or seek guidance from HCPs. Reactions of HCPs to online information were perceived as particularly negative by certain groups of patients, such as those who experienced poor health and those who had more concerns about the quality of their searched information. Results are discussed for their implications for patient empowerment and patient–HCP relationships.     

The Causal Effect of Education on Health: What is the Role of Health Behaviors?

We investigate the causal effect of education on health and the part of it that is attributable to health behaviors by distinguishing between short‐run and long‐run mediating effects: whereas, in the former, only behaviors in the immediate past are taken into account, in the latter, we consider the entire history of behaviors. We use two identification strategies: instrumental variables based on compulsory schooling reforms and a combined aggregation, differencing, and selection on an observables technique to address the endogeneity of both education and behaviors in the health production function. Using panel data for European countries, we find that education has a protective effect for European men and women aged 50+. We find that the mediating effects of health behaviors—measured by smoking, drinking, exercising, and the body mass index—account in the short run for around a quarter and in the long run for around a third of the entire effect of education on health. Copyright © 2015 John Wiley & Sons, Ltd.     

Navigating the Cancer Information Environment: The Reciprocal Relationship Between Patient–Clinician Information Engagement and Information Seeking from Nonmedical Sources

Prior theory has argued and empirical studies have shown that cancer patients rely on information from their health care providers as well as lay sources to understand and make decisions about their disease. However, research on the dynamic and interdependent nature of cancer patients’ engagement with different information sources is lacking. This study tested the hypotheses that patient–clinician information engagement and information seeking from nonmedical sources influence one another longitudinally among a representative cohort of 1,293 cancer survivors in Pennsylvania. The study hypotheses were supported in a series of lagged multiple regression analyses. Baseline seeking information from nonmedical sources positively predicted subsequent patient–clinician information engagement at 1-year follow-up. The reverse relationship was also statistically significant; baseline patient–clinician information engagement positively predicted information seeking from nonmedical sources at follow-up. These findings suggest that cancer survivors move between nonmedical and clinician sources in a dynamic way to learn about their disease.     

Oregon Parents’ Perceptions of the Supportiveness of the School Environment for Their Children's Health Behaviors

ObjectiveTo describe Oregon parents’ perceptions of their children's school regarding health behaviors; examine how perceptions vary by parent, child, and community characteristics; and identify recommendations for improving school environments.MethodsOregon parents with an elementary school–aged child completed an electronic survey.ResultsOver 90% of parents (n = 814) described their child's school as supportive of healthy eating and physical activity. Parents who ate ≥5 fruits/vegetables per day more often perceived their children's school as unsupportive of healthy eating (P < 0.001) and physical activity (P < 0.05) relative to others. Parents of children eligible for free/reduced-price lunch more often perceived the school as unsupportive of physical activity (P < 0.05) relative to others. Parental recommendations included improving school meals and providing short physical activity breaks.Conclusions and ImplicationsParents’ suggested school improvements can inform school wellness committees’ and administrators’ quality-improvement efforts and, in turn, better support children's healthy behaviors.     

Does Social Support Predict Pregnant Mothers’ Information Seeking Behaviors on an Educational Website?

We examine how social support (perceived support and support from a spouse, or committed partner) may influence pregnant women’s information seeking behaviors on a pregnancy website. We assess information seeking behavior among participants in a trial testing the effectiveness of a web-based intervention for appropriate gestational weight gain. Participants were pregnant women (N = 1,329) recruited from clinics and private practices in one county in the Northeast United States. We used logistic regression models to estimate the likelihood of viewing articles, blogs, frequently asked questions (FAQs), and resources on the website as a function of perceived social support, and support from a spouse or relationship partner. All models included socio-demographic controls (income, education, number of adults and children living at home, home Internet use, and race/ethnicity). Compared to single women, women who were married or in a committed relationship were more likely to information seek online by viewing articles (OR 1.95, 95 % CI [1.26–3.03]), FAQs (OR 1.64 [1.00–2.67]), and blogs (OR 1.88 [1.24–2.85]). Women who felt loved and valued (affective support) were more likely to seek information by viewing articles on the website (OR 1.19 [1.00–1.42]). While the Internet provides a space for people who have less social support to access health information, findings from this study suggest that for pregnant women, women who already had social support were most likely to seek information online. This finding has important implications for designing online systems and content to encourage pregnant women with fewer support resources to engage with content.     

Where Do U.S. Adults Who Do Not Use the Internet Get Health Information? Examining Digital Health Information Disparities From 2008 to 2013

With more people turning to the Internet for health information, a few questions remain: Which populations represent the remaining few who have never used the Internet, and where do they go for health information? The purpose of this study is to describe population characteristics and sources of health information among U.S. adults who do not use the Internet. Data from 3 iterations of the Health Information National Trends Survey (n = 1,722) are used to examine trends in health information sources. Weighted predicted probabilities demonstrate changes in information source over time. Older adults, minority populations, and individuals with low educational attainment represent a growing percentage of respondents who have looked for health information but have never used the Internet, highlighting trends in digital information disparities. However, 1 in 10 respondents who have never used the Internet also indicate that the Internet was their first source of health information, presumably through surrogates. Findings highlight digital disparities in information seeking and the complex nature of online information seeking. Future research should examine how individuals conceptualize information sources, measure skills related to evaluating information and sources, and investigate the social nature of information seeking. Health care organizations and public health agencies can leverage the multifaceted nature of information seeking to better develop information resources to increase information access by vulnerable populations.     

Americans’ Health Priorities During the COVID-19 Pandemic

ObjectivesThis study aimed to examine how Americans’ opinions of the seriousness of various health-related problems have changed over time and to quantify the public’s preferences for research prioritization.MethodsWe conducted a survey that asked respondents to rate the seriousness of 80 health-related problems on a 4-point Likert scale (“very serious problem,” “somewhat serious problem,” “not too serious of a problem,” or “not a problem at all”). Results were compared with past surveys from 2001 and 2013 that examined the same set of health-related problems (with the exception of COVID-19). The survey also included best-worst scaling questions that asked respondents to select, from 20 health problems, those they considered most and least important for research funding. Respondents were recruited from the KnowledgePanel, a nationally representative sample of American households.ResultsA total of 768 adults completed the survey between September 3, 2020, and September 14, 2020. The health-related problems that Americans consider to be “very serious” generally align with the leading causes of death and noncommunicable diseases such as heart disease, diabetes, and mental health; nevertheless, several social determinants of health are also identified. COVID-19 was an unsurprising top priority, whereas cancer remains the highest and a persistent priority for research funding.ConclusionsAmericans consider a diverse set of health-related problems to be “very serious,” with recognition of social determinants of health rising. Our findings offer guidance as to the disease areas for which the public would value further public and private investment in treatment innovations.     

Environmental and Occupational Health Information Resources from the National Library of Medicine

Fornearlyfortyyears ,theNationalLibraryofMedicine’s(NLM )ToxicologyandEnvironmentalHealthInformationProgram(TEHIP)hasbeenasignifcantleaderinorganizingandprovidingpublicaccesstoanextensivestorehouseofenvironmental,occupationalmedicine ,andtoxi cologicalinformationthroughitsonlinedatabases .WiththeadventoftheInternet ,TEHIPhasexpandeditsroletoalsoserveasapre eminentportaltotoxicologicalinformationworldwide .ITsprimarydatabasesre sidewithintheWeb basedTOXNETsystem ,andincludethescien…     

Patterns of Older Americans’ Health Care Utilization Over Time

Objectives. We analyzed correlates of older Americans’ continuous and transitional health care utilization over 4 years.Methods. We analyzed data for civilian, noninstitutionalized US individuals older than 50 years from the 2006 and 2008 waves of the Health and Retirement Study. We estimated multinomial logistic models of persistent and intermittent use of physician, inpatient hospital, home health, and outpatient surgery over the 2004–2008 survey periods.Results. Individuals with worse or worsening health were more likely to persistently use medical care and transition into care and not transition out of care over time. Financial variables were less often significant and, when significant, were often in an unexpected direction.Conclusions. Older individuals’ health and changes in health are more strongly correlated with persistence of and changes in care-seeking behavior over time than are financial status and changes in financial status. The more pronounced sensitivity to health status and changes in health are important considerations in insurance and retirement policy reforms.In choosing to seek medical care, individuals weigh the financial cost of treatment against its perceived benefit to their health. Clearly physician input, in combination with the presence and generosity of health insurance coverage, weighs heavily in this decision. As individuals age they begin to experience the onset of new health conditions at the same time that their households often begin to deplete their savings to finance retirement.1–4 Because of these new experiences and potentially limited financial resources, older individuals may become more selective in which types of care they receive, perhaps focusing first on their most pressing medical needs or delaying or skipping procedures prescribed by their physician that they deem relatively costly or not immediately necessary.Studies have investigated the differences in health care expenses for the elderly by health status and changes in health status,5 the changes in health related to persistence or changes in health insurance coverage for the near elderly,6 correlation between health and health insurance coverage,7,8 and the relationship between functional change and hospital use and cost.9 None of these studies, however, has focused on the relative importance of financial versus health factors in determining an elderly population’s persistent or intermittent health care use over time.The motivation for our study comes from a related recent analysis we conducted showing that dental use was surprisingly resistant to changes in household net wealth and household income.1 We found that only when household net wealth falls by 50% or more were older adults less likely to seek dental care.1 This finding inspired our interest in pursuing related findings for medical care.In this study, we determined correlates of continuous and intermittent health care use for a population of civilian, noninstitutionalized Americans older than 50 years. This population is of particular concern because they consume an increasingly disproportionate share of health care as the baby boomer generation advances to the top of the national age distribution. We investigated the relative strengths of financial factors and health factors at 1 point in time and over time as correlates of this older population’s altering or continuing medical care use.Our analysis is particularly relevant at a time when the financial status of many US households has been affected adversely by economic conditions.10 We used longitudinal data from the 2006 and 2008 waves of the Health and Retirement Study (HRS) to explore health and financial factors associated with older adults’ changes in and persistence of health care use between these periods, including (1) physician visits, (2) overnight hospital stays, (3) outpatient surgery, and (4) home health care. We hypothesized for this population that health factors would outweigh financial factors in explaining continuous and intermittent health care use over this period.     

Association between blood lead and mercury levels and periodontitis in the Korean general population: analysis of the 2008–2009 Korean National Health and Nutrition Examination Survey data

Objectives

We present data from the Korean National Health and Nutrition Examination Survey 2008–2009 regarding the association between blood lead and mercury levels and periodontitis in a representative sample of the adult South Korean population.

Methods

The analysis was restricted to participants ≥20 years of age who completed the health examination survey, including blood lead, cadmium, and mercury measurements (n = 3,966). Odds ratios (ORs) for periodontitis were calculated for log-transformed blood metal levels and quartiles thereof after covariate adjustment.

Results

In a logistic regression analysis using log-transformed blood lead and mercury levels as independent variables after covariate adjustment, including blood lead, mercury, and cadmium, the ORs and 95 % CI values in men for having periodontitis with doubling of blood lead and mercury were 1.699 (1.154–2.503) and 1.394 (1.057–1.838), respectively. Furthermore, in a logistic regression analysis using tertiles of blood lead and mercury as independent variables after covariate adjustment, the ORs and 95 % CIs of men for having periodontitis in the highest tertile were 1.756 (1.184–2.604) and 1.575 (1.507–2.347), respectively. ORs in the logistic regression analysis for men using log-transformed blood cadmium or the tertile of blood cadmium as independent variables after covariate adjustments were not statistically significant in either model. Unlike men, ORs in the logistic regression analyses for women using the same independent variables after covariate adjustment were not statistically significant in any blood metal analysis.

Conclusions

The association between blood lead and mercury levels and periodontitis was significant regardless of the type of variable (continuous or categorical) in the Korean male population.     

The Role of Patient–Clinician Information Engagement and Information Seeking from Nonmedical Channels in Fruit and Vegetable Intake Among Cancer Patients

Previous research suggests positive effects of health information seeking on prevention behaviors such as diet, exercise, and fruit and vegetable consumption. The present study builds upon this research and strengthens causal claims from it by examining the lagged effect of patient–clinician information engagement on fruit and vegetable consumption as well as the indirect effect on the outcome through seeking information from nonmedical channels. The results are based on data collected from a randomly drawn sample of breast, prostate, and colorectal cancer patients from the Pennsylvania Cancer Registry who completed mail surveys in the Fall of 2006 and 2007. There was a 65% response rate for baseline subjects (resulting n = 2,013); of those, 1,293 were interviewed 1 year later, and 1,257 were available for our analyses. Results show a positive lagged main effect of patient–clinician information engagement at baseline on fruit and vegetable consumption at follow-up (B = 0.26, SE = 0.10, p = .01). The mediation analysis shows that patient–clinician information engagement leads to increased fruit and vegetable consumption among cancer patients, in part through patients' information seeking from nonmedical channels. Implications of these findings for the cancer patient population and for physicians are discussed.     

Prevalence and Associated Factors of Tinnitus: Data From the Korean National Health and Nutrition Examination Survey 2009–2011

Background

Tinnitus is a common condition and frequently can be annoying to affected individuals. We investigated the prevalence and associated factors for tinnitus in South Korea using the data from the Korea National Health and Nutrition Examination Surveys (KNHANES) during 2009–2011.

Methods

KNHANES is a cross-sectional survey of the civilian, non-institutionalized population of South Korea (n = 21 893). A field survey team that included an otolaryngologist moved with a mobile examination unit and performed interviews and physical examinations.

Results

Among the population over 12 years of age, the prevalence of any tinnitus was 19.7% (95% CI 18.8%–20.6%). Tinnitus was more prevalent in women, and the prevalence rate increased with age (P < 0.001). Among those with any tinnitus, 29.3% (95% CI 27.3%–31.3%) experienced annoying tinnitus that affected daily life. Annoying tinnitus also increased with age (P < 0.001), but no sex difference was demonstrated (P = 0.25). In participants aged 40 years or older, age, quality of life, depressive mood, hearing loss, feeling of dizziness, and rhinitis were associated with any tinnitus (P < 0.05). Age, hearing loss, history of cardiovascular disease, and stress were associated with annoying tinnitus (P < 0.05).

Conclusions

Tinnitus is a common condition, and a large population suffers from annoying tinnitus in South Korea. Public understanding of associated factors might contribute to better management of tinnitus.Key words: tinnitus, epidemiology, associated factor, South Korea