Use of the internet for health information: United States, 2009

Abstract

Research has shown that 74% of all U.S. adults use the Internet, and 61% have looked for health or medical information on the Internet. Additionally, 49% have accessed a website that provides information about a specific medical condition or problem. In 2009, the National Health Interview Survey (NHIS) became the first nationally representative household survey to collect data on the use of health information technology when the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation sponsored 10 questions that asked about use of the Internet to look up health information, refill a prescription, schedule a medical appointment, learn about health topics in online chat groups, and e-mail a health care provider. This report provides estimates, using 2009 NHIS data, about adult use of the Internet for health information in the past 12 months, by selected sociodemographic characteristics.

Full text

NCHS Data Brief ■ No. 66 ■ July 2011
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
Use of the Internet for Health Information: United States, 2009
Robin A. Cohen, Ph.D.; and Patricia F. Adams
Key ndings
Data from the National
Health Interview Survey,
2009
• Amongadultsaged18and
over,womenweremorelikely
thanmentohaveusedthe
Internetforhealthinformation.
• Amongadultsaged18–64,
non-Hispanicwhitepersons
werealmosttwiceaslikely
asHispanicpersonstohave
usedtheInternetforhealth
information.
• Adultsaged18–64with
higherincomesweremore
likelytohaveusedtheInternet
forhealthinformationthan
adultswithlowerincomes.
• Employedadultsaged18–64
weremorelikelythanadults
whowereunemployedornotin
theworkforcetohaveusedthe
Internetforhealthinformation.
Researchhasshownthat74%ofallU.S.adultsusetheInternet,and61%have
lookedforhealthormedicalinformationontheInternet(1).Additionally,49%
haveaccessedawebsitethatprovidesinformationaboutaspecicmedical
conditionorproblem.In2009,theNationalHealthInterviewSurvey(NHIS)
becametherstnationallyrepresentativehouseholdsurveytocollectdataon
theuseofhealthinformationtechnologywhentheU.S.DepartmentofHealth
andHumanServices,OfceoftheAssistantSecretaryforPlanningand
Evaluationsponsored10questionsthataskedaboutuseoftheInternettolook
uphealthinformation,rellaprescription,scheduleamedicalappointment,
learnabouthealthtopicsinonlinechatgroups,ande-mailahealthcare
provider.Thisreportprovidesestimates,using2009NHISdata,aboutadult
useoftheInternetforhealthinformationinthepast12months,byselected
sociodemographiccharacteristics.
Keywords: health information technology, Internet, National Health Interview
Survey
Among adults aged 18 and over, women were more likely
than men to have used the Internet for health information.
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NCHS Data Brief ■ No. 66 ■ July 2011
■ 2 ■
WomenweremorelikelythanmentohaveusedtheInternetforhealthinformationinthepast12
monthsforeachagegroupexcept65andover(Figure1).
ThepercentageofadultswhousedtheInternetforhealthinformationwashighestamongwomen
aged25–34(65.8%)andlowestamongadultsaged65andover(under25%).
Among adults aged 18–64, non-Hispanic white persons were almost
twice as likely as Hispanic persons to have used the Internet for health
information.
UseoftheInternetbyadultsaged18–64forhealthinformationinthepast12monthswashighest
foradultswhowerenon-Hispanicwhite(57.3%),followedbynon-HispanicAsian(47.8%),non-
Hispanicblack(38.3%),andHispanic(28.8%)(Figure2).
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NCHS Data Brief ■ No. 66 ■ July 2011
■ 3 ■
Among adults aged 25–64, higher education was associated with increased
use of the Internet for health information.
Amongadultsaged25–64,73.8%ofpersonswithatleastacollegedegreeusedtheInternetfor
healthinformationinthepast12months,whileonly13.8%ofthosewithlessthanahighschool
educationdidso(Figure3).
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Adults aged 18–64 with higher incomes were more likely to have used the
Internet for health information than adults with lower incomes.
Adultsaged18–64withincomesatorabove300%ofthefederalpovertylevel(FPL)weremore
thantwiceaslikely(63.4%)tohaveusedtheInternetforhealthinformationinthepast12months
comparedwithadultswithincomeslessthan100%oftheFPL(28.9%)(Figure4).
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NCHS Data Brief ■ No. 66 ■ July 2011
■ 4 ■
Employed adults aged 18–64 were more likely than adults who were
unemployed or not in the workforce to have used the Internet for health
information.
Morethanone-half(53.4%)ofemployedadultsaged18–64usedtheInternetforhealth
informationinthepast12monthscomparedwith40.9%ofunemployedadultsand42.5%of
adultsnotintheworkforce(Figure5).
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Using the Internet for health information was related to health insurance
status.
Amongadultsaged18–64,58.7%ofthosewithprivatehealthinsurancecoverageusedthe
Internetforhealthinformationinthepast12monthscomparedwith31.3%ofthoseonMedicaid
and33.3%ofthosewithnoinsurancecoverage(Figure6).
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NCHS Data Brief ■ No. 66 ■ July 2011
■ 5 ■
Summary
Sociodemographicandsocioeconomicfactorswereassociatedwithadultswhohadusedthe
Internettolookuphealthinformation.GreateruseoftheInternetforhealthinformationin
thepast12monthsamongadultswasassociatedwithbeingages25–44,non-Hispanicwhite,
employed,collegeeducated,withincomeatorabove300%oftheFPL,andhavingprivatehealth
insurance.
Theactiveinvolvementofconsumersinmanagingtheirhealthcareincludesactivitiessuchas
useofcomputerstoaccess,retrieve,store,orsharehealthcareinformation.Forconsumersthis
mayincludeusingtheInternettolookuphealthinformation,usinge-mailortextmessagingto
communicatewithhealthcareprovidersorpharmacies,andhavinganelectronichealthrecord.
AsthepercentageofadultsintheUnitedStatesusingtheInternetcontinuestogrow,theInternet
asasourceofhealthinformationforconsumersmaybecomeincreasinglyimportant.Although
useoftheInternethasthepotentialtoimproveconsumerhealthbyfacilitatingcommunication
betweenprovidersandpatientsandamongproviders,previousresearchhasfoundthatmany
consumersareconcernedaboutsecurityandcondentialityissuesrelatedtoschedulingmedical
appointmentsoraccessingpersonalhealthrecordsonline(2).
Denitions
LookeduphealthinformationontheInternetinthepast12months:Basedonapositiveresponse
tobothofthefollowingquestions:“Haveyoueverusedcomputersforanyofthefollowing?…
LookeduphealthinformationontheInternet”and“Didyoulookuphealthinformationonthe
Internetinthepast12months?”Adultswhoanswered“Refused”or“Don’tknow”foreitherof
thesequestionswereexcludedfromthedenominatorforthisanalysis.
Povertystatusandpercentageofpovertylevel:Basedonfamilyincome,familysize,andthe
numberofchildreninthefamily,and,forfamilieswithtwoorfeweradults,ontheageofthe
adultsinthefamily.ThepovertylevelisbasedondenitionsoriginallydevelopedbytheSocial
SecurityAdministration.TheseincludeasetofincomethresholdsdeningtheFPLthatvary
byfamilysizeandcomposition.Familiesorindividualswithincomesbelowtheirappropriate
thresholdsareclassiedasbelowthepovertylevel.Thesethresholdsareupdatedannuallybythe
U.S.CensusBureautoreectchangesintheConsumerPriceIndexforallurbanconsumers.For
furtherinformation,visithttp://www.census.gov/hhes/www/poverty/poverty.html.Estimatesby
povertystatusarebasedonbothreportedandimputedfamilyincome.Familyincomeinformation
wascompletelymissingfor5%ofpersons,andwasonlyreportedinbroadcategoriesforan
additional19%ofpersonsin2009.Therefore,familyincomewasimputedfor24%ofpersonsin
2009usingNHISimputedincomeles(3).NotethatNHISasksrespondentsabouttheirpersonal
earningsandfamilyincomeforthepreviouscalendaryear;therefore,U.S.CensusBureau
povertythresholdsforthepreviouscalendaryearshouldbeusedwhencalculatingpovertyratios
forthecurrentNHISsurveyyear.Forexample,thepovertyratiosinthe2009NHISdatales
werecalculatedusingtheU.S.CensusBureau’s2008povertythresholds(4).
Healthinsurancecoverage:Denedbroadlytoincludebothpublicandprivatepayerswhocover
medicalexpendituresincurredbyadenedpopulationinavarietyofsettings.Thisincludes
personscoveredbyprivatehealthinsurance,whetherofferedthroughemploymentorpurchased
individually,andpersonscoveredbypublicprogramssuchasMedicare,Medicaid,Children’s

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■ 6 ■
HealthInsuranceProgram(CHIP),andotherstate-sponsoredprograms.PersonswithonlyIndian
HealthService(IHS)coverageorhavingonlyaprivateplanthatpaidforonetypeofservicesuch
asaccidentsordentalcarewerenotconsideredtobecoveredbyhealthinsurance.Inthisreport,
coverageismeasuredonlyonthedayoftheNHISinterview.
Privateinsurance:Indicatedwhenrespondentsreportthattheywerecoveredbyprivatehealth
insurancethroughanemployer,union,orindividualpurchase.Privatehealthinsuranceincludes
managedcaresuchashealthmaintenanceorganizationsanddoesnotincludemilitaryhealth
plans.
Medicaid:IndicatedwhenrespondentsreportthattheywerecoveredbyMedicaid.Individuals
werealsoconsideredcoveredbyMedicaidiftheyreportedcoveragebyCHIPorotherstate-
sponsoredplans.Inthisanalysis,healthinsurancecategoriesarehierarchical,andadultscovered
bybothprivateinsuranceandMedicaidwereconsideredtohaveprivateinsurance.
Othercoverage:IncludespersonswhodonothaveprivatecoverageorMedicaid(orotherpublic
coverage),butwhohaveanytypeofmilitaryhealthplan(includesVA,TRICARE,andCHAMP–
VA)orMedicare.Thiscategoryalsoincludespersonswhoarecoveredbyothergovernment
programs.
Uninsured:Indicatedwhenrespondentsreportthattheydidnothavecoverageunderprivate
healthinsurance,Medicare,Medicaid,CHIP,anotherstate-sponsoredhealthplan,other
government-sponsoredprograms,oramilitaryhealthplan(TRICARE,VA,orCHAMP–VA).
ApersonwasalsodenedasuninsuredifheorshehadonlyIHScoverageoraprivateplanthat
paidforonetypeofservicesuchasaccidentsordentalcare.
Data source and methods
Datafromthe2009NHISwereusedforthisanalysis.NHISisconductedcontinuously
throughouttheyearbyinterviewersoftheU.S.CensusBureaufortheCentersforDisease
ControlandPrevention’s(CDC)NationalCenterforHealthStatistics(NCHS).NHIScollects
informationaboutthehealthandhealthcareoftheciviliannoninstitutionalizedU.S.population.
Interviewsareconductedinrespondents’homes,butfollowupstocompleteinterviewsmay
beconductedoverthetelephone.IntheFamilycomponentofthesurvey,familyrespondents
areaskedquestionsabouteveryoneinthefamily,includingquestionsabouthealthinsurance
coverage.QuestionsonuseoftheInternetarefromtheSampleAdultcomponent.In2009,
informationwascollectedonatotalof27,731personsaged18andoverfromtheSampleAdult
componentofthesurvey.ForfurtherinformationaboutNHIS,includingthequestionnaire,visit
http://www.cdc.gov/nchs/nhis.htm.
NHISisdesignedtoyieldasamplerepresentativeoftheciviliannoninstitutionalizedpopulation
oftheUnitedStates,andthisanalysisusesweightstoproducenationalestimates.Data-
weightingproceduresaredescribedinmoredetailelsewhere(5).Pointestimatesandestimates
ofcorrespondingvariancesforthisanalysiswerecalculatedusingSUDAANsoftware(6)to
accountforthecomplexsampledesignofNHIS.TheTaylorserieslinearizationmethodwas
chosenforvarianceestimation.Differencesbetweenpercentageswereevaluatedusingtwo-
sidedsignicancetestsatthe0.05level.Termssuchas“higherthan”and“lessthan”indicate
statisticallysignicantdifferences.Termssuchas“similar”and“nodifference”indicatethat

NCHS Data Brief ■ No. 66 ■ July 2011
■ 7 ■
thestatisticsbeingcomparedwerenotsignicantlydifferent.Lackofcommentregardingthe
differencebetweenanytwostatisticsdoesnotnecessarilysuggestthatthedifferencewastested
andfoundtobenotsignicant.
About the authors
RobinA.CohenandPatriciaF.AdamsarewithCDC’sNCHS,DivisionofHealthInterview
Statistics.
References
1. FoxS,JonesS.ThesociallifeofInternetusers.Washington,DC:PewInternet&American
LifeProject.2009.
2. ThestateofhealthinformationtechnologyinCalifornia.Oakland,CA:CaliforniaHealthCare
Foundation.2008.
3. SchenkerN,RaghunathanTE,ChiuPL,etal.Multipleimputationoffamilyincomeand
personalearningsintheNationalHealthInterviewSurvey:Methodsandexamples.Available
from:http://www.cdc.gov/nchs/data/nhis/tecdoc.pdf.
4. DeNavas-WaltC,ProctorBD,SmithJC.Income,poverty,andhealthinsurancecoveragein
theUnitedStates:2008.U.S.CensusBureau.Currentpopulationreports,P60–236.Washington,
DC:U.S.GovernmentPrintingOfce.2009.Availablefrom:http://www.census.gov/
prod/2009pubs/p60-236.pdf.
5. BotmanSL,MooreTF,MoriarityCL,ParsonsVL.DesignandestimationfortheNational
HealthInterviewSurvey,1995–2004.NationalCenterforHealthStatistics.VitalHealthStat
2(130).2000.
6. ResearchTriangleInstitute.SUDAAN(Release10.0).ResearchTrianglePark,NC:Research
TriangleInstitute.2008.

NCHS Data Brief ■ No. 66 ■ July 2011
Suggested citation
CohenRA,AdamsPF.UseoftheInternet
forhealthinformation:UnitedStates,2009.
NCHSdatabrief,no66.Hyattsville,MD:
NationalCenterforHealthStatistics.2011.
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