Search

Objective: To better understand cancer clinical trials (CCT) information-seeking, a necessary precursor to patient and provider engagement with CCT., Methods: Data from the National Cancer Institute's Cancer Information Service (CIS) were used to examine CCT information-seeking patterns over a 5-year period. Descriptive and logistic regression analyses were conducted to examine characteristics of CIS inquiries and their associations with having a CCT discussion., Results: Between September 2018 - August 2023, 117,016 CIS inquiries originated from cancer survivors, caregivers, health professionals, and the general public; 27.5 % of these inquiries included a CCT discussion (n = 32,160). Among CCT discussions, 35.5 % originated from survivors, 53.5 % from caregivers, 6.1 % from the public, and 4.9 % from health professionals. Inquiries in Spanish had lower odds of a CCT discussion (OR=.26, [.25-.28]), whereas inquiries emanating from the CIS instant messaging (OR=2.29, [2.22-2.37]) and email (OR=1.24, [1.18-1.30]) platforms were associated with higher odds of discussing CCT compared to the telephone. Individuals who were male, younger, insured, and had higher income and education had significantly higher odds of a CCT discussion while those who were non-Hispanic Black and living in rural locales had significantly lower odds., Conclusions: Disparities in CCT information-seeking may contribute to downstream CCT participation., Practice Implications: Quality, language-concordant health information is needed to enable equitable awareness of - and ultimately engagement in - CCT., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier B.V.)

Objective: This mixed-method study assessed 1) survivors' and parents' information needs; and 2) associations between unmet information needs and clinical and socio-demographic characteristics., Methods: Stage 1: CCS and parents of CCS, >5years post-diagnosis completed a questionnaire on information needs, overall health and perceived risk. Predictors for unmet information needs were assessed by multivariable regression. Stage 2: participants were interviewed in-depth on these topics., Results: Questionnaires were completed by 485 participants comprising 322 survivors (mean age: 26.7years, SD=7.9; time since diagnosis: 19.7years, SD=8.8) and 163 parents (child age: 12.9years, SD=2.4; time since diagnosis: 9.7years, SD=2.3), and complemented by 70 interviews. Survivors reported unmet information needs about late effects (57.5%) and parents for fertility issues (62.5%). Survivors had more unmet needs for medical information whereas parents had significantly more regarding sexual issues and lifestyle. Being a parent (p=0.001), dissatisfaction with follow-up care (p=0.003), lower overall health (p=0.014), higher perceived risk of late effects (p<0.001), and greater anxiety/depression (p<0.001) were significantly associated with more unmet needs., Conclusion: Unmet information needs were common for survivors and parents of CCS., Practice Implications: Future efforts towards tailoring information on potential late effects, healthy lifestyles and follow-up care may help to address unmet information needs., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objectives: Patients and consumers make many choices that affect their health and their health care. Some of these decisions are informed by evidence, but many are not. A growing body of research indicates that those who are more activated or engaged in their health are more likely to seek out and use information to inform their health decisions. In this paper we review the evidence about patient activation and information seeking, health behaviors, and health outcomes. We also review what is known about how to increase patient activation, and how best to support patients who are at different levels of activation to use information to support their choices., Discussion: Strategies can be tailored to support and information for patients at different levels of activation. These strategies might be implemented in different clinical settings and situations, tailored and targeted approaches for care transitions, health coaching, and in the use of shared-decision-making., Conclusions: Efforts to support informed consumer choices have largely been a 'one size fits all' approach. Understanding consumers, and trying to meet them where they are, is likely to be the focus of the 'next generation' of interventions to support informed consumer choices., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: The determinants of adult congenital heart disease (ACHD) research output are only partially understood. The heterogeneity of ACHD naturally calls for collaborative work; however, limited information exists on the impact of collaboration on academic performance. We aimed to examine the global topology of ACHD research, distribution of research collaboration and its association with cumulative research output., Methods and Results: Based on publications presenting original research between 2005 and 2011, a network analysis was performed quantifying centrality measures and key players in the field of ACHD. In addition, network maps were produced to illustrate the global distribution and interconnected nature of ACHD research. The proportion of collaborative research was 35.6 % overall, with a wide variation between countries (7.1 to 62.8%). The degree of research collaboration, as well as measures of network centrality (betweenness and degree centrality), were statistically associated with cumulative research output independently of national wealth and available workforce. The global ACHD research network was found to be scale-free with a small number of central hubs and a relatively large number of peripheral nodes. In addition, we could identify potentially influential hubs based on cluster analysis and measures of centrality/key player analysis., Conclusions: Using network analysis methods the current study illustrates the complex and global structures of ACHD research. It suggests that collaboration between research institutions is associated with higher academic output. As a consequence national and international collaboration in ACHD research should be encouraged and the creation of an adequate supporting infrastructure should be further promoted., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objectives: To determine whether librarian and information specialist authorship was associated with better reported systematic review (SR) search quality., Study Design and Setting: SRs from high-impact general internal medicine journals were reviewed for search quality characteristics and reporting quality by independent reviewers using three instruments, including a checklist of Institute of Medicine Recommended Standards for the Search Process and a scored modification of the Peer Review of Electronic Search Strategies instrument., Results: The level of librarian and information specialist participation was significantly associated with search reproducibility from reported search strategies (Χ(2) = 23.5; P < 0.0001). Librarian co-authored SRs had significantly higher odds of meeting 8 of 13 analyzed search standards than those with no librarian participation and six more than those with mentioned librarian participation. One-way ANOVA showed that differences in total search quality scores between all three groups were statistically significant (F2,267 = 10.1233; P < 0.0001)., Conclusion: Problems remain with SR search quality and reporting. SRs with librarian or information specialist co-authors are correlated with significantly higher quality reported search strategies. To minimize bias in SRs, authors and editors could encourage librarian engagement in SRs including authorship as a potential way to help improve documentation of the search strategy., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: This study explores cancer survivors' engagement with information about dieting to control weight from doctors, interpersonal, and media sources and examines whether engagement from these sources impacts subsequent dieting behavior., Methods: A total of 1128 respondents diagnosed with colorectal, breast, or prostate cancers were surveyed over three years following their cancer diagnoses. Using weighted logistic regression analyses, the authors predicted the odds of dieting based on earlier information engagement with sources, controlling for dieting in the previous year and confounders., Results: Participants reported talking with doctors more frequently (37%) than seeking or scanning from interpersonal and media sources about dieting (15-22%). Seeking from interpersonal and media sources, and discussion with physicians, significantly predicted dieting behavior. In addition, discussions with physicians increased the odds of subsequent dieting behavior by 2.32 times (95% CI: 1.50-3.61; p=.002), over and above the effects of other information engagement., Conclusion: Cancer survivors reported engaging with a variety of information sources about dieting. Engagement with doctors and information-seeking from interpersonal or media sources predicted cancer survivors' dieting behavior a year later., Practice Implications: The results may inform strategies to encourage and empower cancer survivors to engage with information about healthy lifestyle changes for promoting long-term health., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Objective: Health information helplines have an important function in health education, prevention and counseling. Information and help services are increasingly provided online. This study focuses on the differences and similarities between online help services and telephone services., Methods: The telephone service of the Dutch AIDS STI helpline was compared to its e-mail equivalent. After consulting the helpline service, both callers and e-mailers (N(tot) = 455) were asked to participate in a survey that evaluated their background characteristics, contacting reasons, and satisfaction with the specific service and information received. The survey also included questions regarding the advice received from the helpline. A follow-up measure 4 weeks after the baseline survey evaluated to what extent clients acted upon the advice., Results: The study shows that both services are positively evaluated and are equally persuasive in their counseling. Differences between callers and e-mailers were found regarding background characteristics, content of the consultation, satisfaction, and the advice received., Conclusion: It can be concluded that online health information services are an important addition to, but not a replacement for, the traditional telephone helplines., Practice Implications: In order to provide an optimal health service to a wide public, both online and telephone counseling should be offered., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Objective: This study aims to review systematically the available literature on health outcomes of online cancer support and resources., Methods: We searched major databases with the following selection criteria: (1) empirical study on use of online support or resources by cancer survivors, (2) reporting effects or outcomes of online support or resources, (3) focusing on adult cancer survivors, and (4) peer-reviewed articles published by 2010., Results: A total of 24 studies (37 articles) were included in the review. Most studies were focused on breast cancer survivors and had small sample sizes. Fifteen studies employed a cross-sectional design including eight qualitative studies. Only five studies used pre-post design, and four employed RCT design. The outcome measures have focused on psychosocial effects; most studies reported positive effects, although none of the RCT studies reported significant outcomes., Conclusion: Existing studies of online cancer support and resources have demonstrated preliminary but inconclusive evidence for positive outcomes. We call for additional studies with rigorous study designs and the inclusion of more diverse participants and cancer conditions., Practice Implications: Connecting diverse cancer survivors to culturally appropriate, evidence-based online support and resources is a strategy to enhance health outcomes., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Objective: To examine the prevalence and predictors of patients' post-appointment online health information-seeking and the reasons behind their information searches., Methods: Survey of 274 Internet support community members who had been seen by a physician within 30 days. The questionnaire included measures of trust in the physician, health worries, changes in amount of worrying following the visit, online health information-seeking, and standard demographic and visit characteristics., Results: A majority of respondents (68%) went online in search of information after their visits. In a logistic regression analysis, going online was associated with lower trust (P=.002), greater worrying (P=.049), and becoming more (P=.024) or less worried (P=.05) by the visit. Among those who went online, the most common reasons for doing so were sheer curiosity (71%) and disappointment with some aspect of the physician's behavior (32%)., Conclusion: Patients in this online forum routinely turned to the Internet after their medical visits, but were especially likely to do so when trust in the physician was low, anxieties were high, and the visit altered (for better or worse) their anxiety levels., Practice Implications: Since many patients seek online information after their appointments, physicians should suggest credible websites suited to the circumstances of each patient., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Objective: Health information-seeking behaviors (HISBs) are associated with active participation in cancer care decisions which, in turn, may positively impact health outcomes. The goal of this study was to develop a taxonomy of topics for which post-treatment cancer patients sought information, and to explore HISB patterns by sociodemographic factors and cancer type., Methods: We examined how health information seeking is associated with social determinants in a survey of 521 post-treatment cancer patients., Results: Four major topics of interest were found: disease/treatment, self-care management, health services, and work/finance. Assessment of the relationship between social determinants and these four topics showed associations for (1) HISBs on disease/treatment topics decreased with age and increased with education; (2) HISBs on self-care management increased with education and varied by cancer type; (3) HISBs on health services increased with education; and (4) HISBs on work/finance decreased with age and wealth, but increased with debt., Conclusion: These results demonstrate one pathway through which social determinants may drive communication inequalities, which may result in increased disparities in health outcomes., Practice Implications: Further exploration of the relationship between social determinants and information-seeking among post-treatment cancer patients may contribute to the development of strategies to reduce health disparities., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Objective: Compare the characteristics of rural and urban callers to NCI's Cancer Information Service (CIS), and explore the association of geographic location and discussion of cancer clinical trials., Methods: Using CIS call data from 2006 to 2008, we assigned a rural or urban designation to caller ZIP codes using Rural-Urban Commuting Area Codes. Calls which discussed clinical trials were analyzed using univariate and multivariate analyses., Results: The CIS received 227,579 calls from 2006 to 2008 where geographic location could be determined. Overall, 10.3% of calls included a discussion of clinical trials; there were significantly more discussions among urban dwellers than rural individuals (10.5% versus 9.4%, respectively). Multivariate regression analyses supported the univariate findings. In addition, compared to other callers, patients (OR 5.58 [95% CI: 4.88, 6.39]) and family and friends (6.26 [5.48, 71.5]) were significantly more likely to discuss clinical trials., Conclusion: Urban callers were more likely than their rural counterparts to discuss cancer treatment trials, placing individuals living in rural areas at a disadvantage in learning about and communicating with their providers about possible participation in clinical trials., Practice Implications: Through its multiple access points, the CIS can serve as an important source of clinical trials information for rural cancer patients, family members, and providers., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Objective: To examine community pharmacists' use of language-access services (LASs) in the United States., Design: Cross-sectional study., Setting: United States from January to February 2009., Participants: 1,000 pharmacists (500 community chain and 500 community independent pharmacists)., Intervention: Mailed survey., Main Outcomes Measure: Use, availability, and characterization of written translation and verbal interpretation LASs, along with perceived barriers for LASs., Results: 296 surveys were completed, yielding an adjusted response rate of 30.0%. Computer software was used more often for translation LASs (57.4%) compared with pharmacists using on-site personnel (38.4%). Almost one-half of all pharmacies (49.8%) that possessed LAS capacity failed to notify patients of their availability. Many respondents indicated that they never used translation (40.9%) or interpretation (39.8%) in their pharmacies. The most commonly cited barrier for use of LASs by community pharmacists was potential inaccuracies in translation/interpretation (52.1%). Lack of time (25.1%) was frequently cited for failing to use LASs., Conclusion: Community pharmacists are not consistently or optimally using LASs in daily practice. Failure to use LASs can result in poorer outcomes for patients with limited English proficiency. Developing means to navigate work station-related barriers to LASs may yield improved patient care. Incorporation of professional continuing educational programs, automated LAS kiosks, natural language processing, and social media solutions merit exploration in addressing these challenges.

Objective: There is much research describing cancer patients' information needs and their use of the Internet, print media, and other sources to fulfill these needs. Yet little is known about whether patients with different types of cancer vary in their information needs and seeking behaviors. This study used population-based data to address this question., Methods: A sample was randomly drawn from the list of patients with breast, prostate, or colorectal cancer reported to the Pennsylvania Cancer Registry in 2005. Patients completed a mail survey (N=2010); respective response rates were 68%, 64%, and 61%., Results: Colorectal cancer patients reported consistently less information seeking than breast and prostate cancer patients. Multivariate analyses revealed that differences by cancer type were not explained by sex or other demographics, disease stage, or treatment received. These differences were most pronounced among patients with early stage cancer., Conclusion: Cancer patients have myriad information needs and use a range of sources to satisfy these needs, but there appear to be important differences in information engagement by cancer type., Practice Implications: Understanding differences in information seeking among disease-specific populations may help guide future patient education and decision making across the care continuum., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Background: Racial and ethnic disparities exist in the prevalence of certain eye diseases. Minority primary care physicians are in a unique position to help prevent vision loss and blindness, especially among minority populations., Methods: To measure physicians' knowledge and attitudes regarding eye health and to better understand the facts regarding patient information and counseling concerning eye health and disease, the National Eye Institute included key eye health knowledge, attitude, and practice questions in the 2007 DocStyles Survey, a Web-based survey of primary care physicians about physician perceptions and attitudes concerning communication with patients., Results: A total of 428 minority primary care physicians responded to the survey. Results indicate that minority primary care physicians have favorable attitudes regarding eye health and the role they should play in talking with patients about eye health. Approximately 60% indicated that they could identify patients at higher risk for eye disease; however, only 52% of physicians indicated that they have adequate knowledge to advise their patients on vision health. Regarding information sources, most minority physicians prefer to obtain information about vision and eye health from professional journals, medical Web sites, and continuing medical education., Conclusions: Findings from this research reveal both a need and an opportunity with regard to increasing physician confidence in identifying patients at higher risk for eye disease and advising their patients on eye health.

Ethical considerations with respect to experimental animal use and regulatory testing are worldwide under heavy discussion and are, in certain cases, taken up in legislative measures. The most explicit example is the European cosmetic legislation, establishing a testing ban on finished cosmetic products since 11 September 2004 and enforcing that the safety of a cosmetic product is assessed by taking into consideration "the general toxicological profile of the ingredients, their chemical structure and their level of exposure" (OJ L151, 32-37, 23 June 1993; OJ L066, 26-35, 11 March 2003). Therefore the availability of referenced and reliable information on cosmetic ingredients becomes a dire necessity. Given the high-speed progress of the World Wide Web services and the concurrent drastic increase in free access to information, identification of relevant data sources and evaluation of the scientific value and quality of the retrieved data, are crucial. Based upon own practical experience, a survey is put together of freely and commercially available data sources with their individual description, field of application, benefits and drawbacks. It should be mentioned that the search strategies described are equally useful as a starting point for any quest for safety data on chemicals or chemical-related substances in general.

Objective: Patients increasingly use the Internet for medical information. For doctor-patient communication it is important to gain insight into the use and impact of medical Internet searches of patients. This study aims to evaluate patients' use of the Internet for information about their pain problem., Methods: A self-administered survey on pain-related Internet use was sent to 200 new patients attending a university pain center. The response rate was 61%., Results: Half of all respondents used the Internet for medical information and a smaller percentage (39%) searched for specific information about pain. Patients found information on the Internet to be of good quality and quite easy to find and understand. In general, Respondents did not learn anything new. The on-line medical information confirmed what they already knew. Less than half of the respondents discussed information from the Internet with their physician., Conclusion: Half of all patients used the Internet for medical information. Patients are reasonably certain that the information is accurate and reliable, while this may not always be the case., Practice Implications: Physicians should inquire about patients' use of various sources of information (such as the Internet) and offer to clarify any questions or concerns that arise from that use.

Objective: To examine the cancer information seeking behaviors and preferences of cancer survivors., Methods: This cross-sectional study used the National Cancer Institute's 2003 Health Information National Trends Survey data to evaluate 619 cancer survivors., Results: Two-thirds (67.5%, n = 418) of the survivors sought cancer information (InfoSeek) and 32.5% (n = 201) did not (NoInfoSeek). Significant predictors of cancer information seeking included age (less than 65), gender (female), income (>US$ 25,000/year), and having a regular health care provider (HCP)., Conclusion: Not all survivors actively look for cancer information. Although most survivors prefer receiving cancer information from their HCP, many turn to a variety of other sources, primarily the Internet., Practice Implications: HCPs should periodically assess information seeking behaviors and preferences of cancer survivors and actively refer patients to the Internet as an extension of and enhancement to their patient interactions. Credible and useful websites could be identified and recommended by the HCP as a means to address some of the barriers identified by survivors.

Objective: Health information is one of the most frequently sought topics on the Internet. A review of the literature was carried out to determine the use of the Internet for health information by the patient and how this could affect the patient-health professional relationship., Methods: This study is a literature review, summarizing multiple empirical studies on a single subject and is not intended to be a meta-analysis., Results: The review showed that the majority of health related Internet searches by patients are for specific medical conditions. They are carried out by the patient: (1) before the clinical encounter to seek information to manage their own healthcare independently and/or to decide whether they need professional help; (2) after the clinical encounter for reassurance or because of dissatisfaction with the amount of detailed information provided by the health professional during the encounter., Conclusion: There has been a shift in the role of the patient from passive recipient to active consumer of health information. Health professionals are responding to the more 'Internet informed' patient in one or more of three ways: (1) the health professional feels threatened by the information the patient brings and responds defensively by asserting their 'expert opinion' (health professional-centred relationship). (2) The health professional and patient collaborate in obtaining and analysing the information (patient-centred relationship). (3) The health professional will guide patients to reliable health information websites (Internet prescription)., Practice Implications: It is important that health professionals acknowledge patients' search for knowledge, that they discuss the information offered by patients and guide them to reliable and accurate health websites. It is recommended that courses, such as 'patient informatics' are integrated in health professionals' education.

Objective: This study analyzes the use patterns of , an English-, Spanish-, Arabic- and French-language web site dedicated to three methods of early pregnancy termination: mifepristone/misoprostol, methotrexate/misoprostol and misoprostol alone., Methods: This study examines both the overall and language-specific use patterns of the web site from October 1, 2004, through September 30, 2005. Data were recorded using Wusage 8.0, a web site statistics program., Results: Over the 12-month study period, received more than 78,000 visits and nearly 240,000 page requests. The English version is the most popular version of the web site (accessed in 46.1% of all visits), followed by the Spanish (35.0%), Arabic (10.4%) and French (8.8%) versions. Spanish-language visits are nearly three times as likely to access the misoprostol-only section of the web site when compared with the other language versions (p<.001)., Conclusion: This study confirms that multilingual, medically accurate online resources have the potential to expand information about medication abortion to both providers and women considering the option of abortion in diverse communities. Analysis of the language-specific use patterns highlights the different priorities of various types of web site visitors and suggests future priorities for educational outreach, collaboration and research.

Background: Standard case criteria are proposed for combined use of the Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule to diagnose autism and to define the broader category of autism spectrum disorders., Method: Single and combined Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule algorithms were compared to best estimate diagnoses in four samples: U.S. (n = 960) and Canadian (n = 232) participants 3 years and older, U.S. participants younger than 36 months (n = 270), and U.S. participants older than 36 months with profound mental retardation (n = 67)., Results: Sensitivities and specificities of 80% and higher were obtained when strict criteria for an autism diagnosis using both instruments were applied in the U.S. samples, and 75% or greater in the Canadian sample. Single-instrument criteria resulted in significant loss of specificity. Specificity was poor in the sample with profound mental retardation. Lower sensitivity and specificity were also obtained when proposed criteria for broader spectrum disorders were applied., Conclusions: The Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule make independent, additive contributions to the judgment of clinicians that result in a more consistent and rigorous application of diagnostic criteria.

The purpose of this study was to present preliminary data on sources of and exposure to pro- and anti-tobacco messages. A questionnaire was administered to 1130 Kenyan primary schoolchildren. Forty-seven percent had received risk information from broadcast media and 88% was exposed to tobacco advertisements. Nonsmokers held more favorable attitudes toward control policies and were less frequently exposed to pro-and anti-tobacco messages. Adolescents receive risk information mainly from the broadcast media. Advertising is an important risk factor of smoking status in this developing country.

Purpose: The aim of the survey 'Parcours de Femmes 2001' was to evaluate the overall management and care of women with female cancers and to determine their needs., Methods: Women with breast or gynecological cancer who had either received at least 3 months of treatment or had completed treatment <1 year before the study were enrolled in this cross-sectional, observational study., Results: From February to November 2001, 2839 questionnaires were distributed; 1870 were returned (66% response rate), mainly by breast cancer patients (87%). While 92% of women reported having received information at diagnosis, 34% of relapsed patients complained of lack of information concerning their disease and treatment. Only 18% of patients were included in the treatment decision process and 66% of women obtained complementary information from the media, patients and care professionals. Fatigue was the most severe problem quoted (78% of cases) and was poorly managed by caregivers due to diagnostic and treatment difficulties. Problems relating to family and to affective and socio-professional life were poorly identified and remained largely unmanaged., Conclusions: Information given to female cancer patients must be improved in relapsed patients, particularly regarding the adverse effects of treatment. Psychosocial management requires a more holistic approach through new channels, together with the coordination of existing structures.

Ciao is a website specifically designed for young people and focuses mainly on health issues. This report presents the process of setting up the site and a first evaluation undertaken by using two self-administered questionnaires administered via the website itself. It suggests that it is possible to provide young people with authoritative health information and to facilitate their access to counseling and health care facilities by having young people use such a website.

Objective: Consumer health information, once the domain of books and booklets, has become increasingly digitized and available on the Internet. This study assessed the effect of using computerized health information on consumers' demand for medical care., Methods: The dependent variable was self-reported number of visits to the doctor in the past year. The key independent variable was the use of computerized health information, which was treated as endogenous. We tested the effect of using computerized health information on physician visits using ordinary least squares, instrumental variables, fixed effects, and fixed-effects instrumental variables models. The instrumental variables included exposure to the Healthwise Communities Project, a community-wide health information intervention; computer ownership; and Internet access. Random households in three cities were mailed questionnaires before and after the Healthwise Communities Project. In total, 5909 surveys were collected for a response rate of 54%., Results: In both the bivariate and the multivariate analyses, the use of computerized health information was not associated with self-reported entry into care or number of visits. The instrumental variables models also found no differences, with the exception that the probability of entering care was significantly greater with the two-stage conditional logit model (P <.05)., Conclusions: Although providing people with health information is intuitively appealing, we found little evidence of an association between using a computer for health information and self-reported medical visits in the past year. This study used overall self-reported utilizations as the dependent variable, and more research is needed to determine whether health information affects the health production function in other important ways, such as the location of care, the timing of getting care, or the intensity of treatment.

Objective: To determine the proportion of South Australians accessing online health care information, predictive characteristics of online health seekers, nature of the information sought and consumer behaviour., Methods: A probability-based survey of 3,027 South Australians, aged 15 years and older, as part of the Spring 2000 South Australian Health Omnibus., Results: Internet access decreases with age, while the prevalence of online health seekers is constant (26% to 28%) among people aged between 15 and 54 years. Predictive characteristics of online health seekers include gender, age, education and income. Most commonly sought information is the cause or description of disease (60%). Consumers use online health information as a second opinion (19%), discuss it with their doctor or pharmacist (16%), or change their health care management (11%)., Conclusions: The Australian prevalence of online health seekers is likely to be slightly higher than 21%., Implications: The Intemet can deliver preventative and clinical health information to a critical mass of Australians, but poorer and older Australians may be unable to access it.

Purpose: To determine the common sources of information regarding the effects of smoking on health and their relationship to knowledge, attitudes, and preventative efforts regarding exposure to environmental tobacco smoke (ETS) among urban African-American children and adolescents., Methods: All students who were enrolled in Grades 5-12 in an urban public school district located in the greater metropolitan area of Detroit, Michigan were surveyed using a structured, written questionnaire that assessed sources of information on the health effects of smoking, as well as knowledge, attitudes, and preventive efforts with respect to exposure to ETS. The primary analytic procedures utilized in the study were correlation analysis and analysis of variance., Results: The African-American students surveyed in this study received information regarding the health effects of smoking from many sources, most notably television, family, and teachers. Second, students who received information on the effects of smoking on health from family and external sources (teacher, parent's friend, and religious leader) had higher overall knowledge, attitude, and preventive efforts scores than students who received information from other sources (friends, electronic media, and printed media). Finally, family influence was greater when parents were not smokers, and influenced elementary students more than middle school or high school students., Conclusions: The active involvement of teachers, religious leaders, parents, and other influential adults should be elicited in tobacco education and prevention efforts to maximize their effectiveness.

An increasing number of breast cancer patients are accessing the Internet for medical information. A survey was administered to breast cancer patients and their families attending follow-up outpatient clinics in a comprehensive cancer care center to explore their frequency of Internet use, their motivation for online activity, the type of information they sought, and the perceived impact of the information they found on the Internet on their medical care. The survey was conducted over a 4-month period. A total of 107 surveys were returned. Seventy-nine of these (74%) were from patients while 28 (26%) were from family members and friends. Thirty-four of the patient responses (43%) indicated that the patient had used the Internet to look for cancer-related information. Patients who had used the Internet to access cancer-related information were significantly younger (P = 0.007), better educated (P = 0.027), and less satisfied with the amount of treatment-related information given by caregivers than those patients who had not used the Internet to access cancer-related information (P = 0.032). The majority of patient Internet users desired more information on their cancer and its treatment (91%), looked up information that was presented to them by their clinicians (66%), researched other treatment options (63%), and obtained more information on "alternative treatments" (63%). Patient Internet users generally found the cancer-related information on the Internet to be useful, and the majority discussed Internet-derived information with their health care providers and perceived that clinicians listened to such information. However, 53% were undecided about the trustworthiness of the medical information obtained via the Internet. Internet nonusers commonly lacked Internet access (53%) or were unfamiliar with the Internet (33%), but few (13%) distrusted Internet-derived information. This exploratory study underscores the need for more research in this area, specifically with the aims of identifying and verifying factors that lead patients to use the Internet and the impact of their online activities on their medical care.

We studied the nutrition information seeking behavior of primary care physicians (PCPs) and also PCPs' implementation of different strategies of nutrition guidance of patients. This was done by means of a questionnaire mailed to a nationwide random sample of 1000 PCPs in the Netherlands. The net response rate was 64%. The two most important nutrition information sources for PCPs were a dietitian (72% of respondents) and the literature (34% of respondents). Eighty-five percent of PCPs reported that they were actively involved in seeking nutrition information. For nutrition education of patients, PCPs gave personal information to patients, referred patients to a dietitian, and made publications available in the surgery. As preferred methods of obtaining nutrition information themselves, PCPs listed scientific journals, postgraduate nutrition education, congresses and study days, and publications. Determinants of nutrition information seeking behavior of PCPs as well as their implementation of different strategies of patient nutrition education were identified and discussed. PCPs were familiar with the body mass index, which is encouraging because treatment of overweight and obesity starts with a valid assessment. The findings in this study lead to a prudent positive conclusion about PCPs and nutrition information in practice. From this study and others it can be concluded that there are growing opportunities, challenges, and tools for PCPs to become more actively involved in nutrition guidance of patients.