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Adolescent Cybersurfing for Health Information
A New Resource That Crosses Barriers
Dina L. G. Borzekowski, EdD;
Vaughn I. Rickert, PsyD
Arch Pediatr Adolesc Med. 2001;155:813-817.
ABSTRACT
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Objective To examine adolescents' use of and attitudes toward accessing health
information through the Internet.
Design Cross-sectional, school-based survey.
Participants A socioeconomically and ethnically diverse sample of 412 suburban New
York 10th graders (mean [SD] age, 15.8 [0.68] years).
Main Outcome Measures Accessing the Internet for health information.
Results Half (49%) of the sampled adolescents had used the Internet to get health
information. Topics most often explored through the Internet included sexually
transmitted diseases; diet, fitness, and exercise; and sexual behaviors. Adolescents
found Internet information to be of high value (using a composite gauging
worth, trustworthiness, use, and relevance), with no significant differences
related to sex, ethnicity, or mother's education. When considering 11 separate
health topics, girls found it more valuable to have information on birth control,
diet and nutrition, exercise, physical abuse, sexual abuse, and dating violence.
Only for alternative medicine were there differences by ethnicity, and there
were no differences based on mother's education for the value of having specific
health information available through the Internet.
Conclusion For adolescents, the Internet is an accessed and valued information
source on a range of sensitive health issues.
INTRODUCTION
MOST HEALTH behavior change models stress the importance of individuals
gaining knowledge about specific health issues and incorporating this information
into their daily activities.1 For adolescents,
accessible, relevant, and accurate health information can clearly help guide
decision making,2 such as identifying alternative
options or possible consequences.3 Adolescents
readily accept information on topics from smoking cessation4
to reproductive health.5 Although conveying
information may or may not reduce adolescent risk behaviors, gains in knowledge
can occur1 and serve as an initial step in
health promotion.6
In 1998, more than 17 million US adults used the Internet to obtain
health information, and the expectation is that this number will grow substantially.7 A recent online survey of more than 3200 Internet
users found that 82% had used the Internet to obtain health information (5%
daily, 15% weekly, 23% monthly, and 39% less than once a month).8
Women and older individuals were more likely to report using the Internet
as a health source.8 Information on the following
topics was retrieved by those accessing health information through the Internet:
diseases, 52%; diet and nutrition, 36%; pharmaceuticals, 33%; online health
newsletters, 32%; women's health, 31%: fitness, 29%; children's health, 15%;
and illness support groups, 13%.7
Although there is little doubt that adolescents of different backgrounds,
ethnic groups, and socioeconomic status levels can and will use the Internet
to gather health information, hardly any data exist on whether adolescents
currently use this medium for health information.
For adolescents, the Internet can serve as an important tool in acquiring
health information for several reasons. First, adolescents can easily access
this medium9; a December 1999 survey of 625
respondents who were 10 to 17 years old found that three quarters had home
access and practically all had school access to the Internet.10
Second, the Internet offers adolescents a confidential and less threatening
way to get information that might otherwise be difficult or compromising to
obtain. Third, the interactive nature of the Internet can provide adolescents
"personalized" information. With this medium, an adolescent can enter data
on his or her specific concerns and receive individualized advice.
This study's purpose was to explore and provide current information,
drawn from a diverse sample of 10th graders, on adolescent use of the Internet
as a health information source. To begin, we offer comparative data on adolescent
use of health information sources for different content areas. Next, we describe
whether adolescents use the Internet for health information for personal use.
Then, we consider which adolescent characteristics relate to using the Internet
as a health information source. We also describe the value adolescents ascribe
to the Internet as a health information source, noting whether adolescents
find the conveyed information to be trustworthy, useful, and relevant. Lastly,
we present information on how worthwhile adolescents perceive it is to have
Internet information on 11 health issues.
PARTICIPANTS AND METHODS
PARTICIPANTS AND PROCEDURES
Participants were 10th-grade students from East Ramapo, NY, a community
located approximately 40 km (25 mi) northwest of New York City that is both
ethnically and economically diverse. All students, except for those not in
mainstream classes (eg, special education), were eligible to participate.
Passive parental and active student consent were obtained.
In May 2000, students completed media use surveys during a single class
period. Adolescents responded to 136 close-ended questions and this one-time-only,
18-page, anonymous survey took a half hour to complete. This study was approved
by The Mount Sinai School of Medicine Panel on Human Subjects in Medical Research.
MEASURES
We customized a self-report survey used in an earlier study of adolescent
Internet use (n = 319),11 and adolescent health
researchers reviewed this instrument to ensure its readability and ease of
understanding. The final instrument began with a demographic section and then
assessed adolescent media ownership and use.
Regarding health information sources, the instrument first assessed
a range of potential sources across 3 different health content areas: (1)
birth control and safer sex; (2) diet, nutrition, and exercise; and (3) dating
and family violence. Then, the questions focused on whether adolescents use
and how they perceive the Internet as a health information source. Students
chose from 17 health topics those that they had ever tried to get information
on from the Internet. Then, the students selected the one area that they had
"tried to get the most health information on from the Internet." Four questions
measured the Internet's value as a general health information source, assessing
its worth, trustworthiness, usefulness, and relevance ( = .81). Lastly,
we asked students to rank on a 5-point scale how worthwhile it was to have
health information available on the Internet for 11 different health areas.
STATISTICAL ANALYSES
Owing to this study's descriptive nature, we provide univariate statistics
for the sample's demographics and media use, focusing on Internet use. We
describe the most frequently cited health information sources and indicate
whether associations were observed between the source type and adolescent
characteristics. We report overall percentages for Internet use and perceptions
and use association tests to determine whether differences exist across adolescent
groups. We performed the statistical analyses using SAS statistical software,
version 8 (SAS Institute Inc, Cary, NC) and considered results significant
at = .05.
RESULTS
For this study, 412 students in the 10th grade, of whom 46% were male,
participated. The sample was 40% African American, 30% white, 10% Latin American,
10% Asian American, 5% multiethnic, and 5% "other" ethnic students, and the
average age was 15.8 years (SD, 0.68 years). For mother's education, 29% of
the students reported a high school education or less, 36% reported some college
or completed college, and 25% reported education beyond college. A little
more than half (55%) lived in households with 4 or 5 people, whereas 18% had
fewer than 4 people and 27% had more than 5 people. A third (33%) of these
students had a job. A total of 70% were born in the United States, and 87%
indicated that English was the main language spoken in their homes. More than
half (57%) of the students reported to be in "good" or "very good" health,
and 41% said they exercised rigorously 3 to 5 days a week.
This sample owned and frequently used all types of electronic media.
On average, there were 5.7 radios, 4.0 televisions, and 1.4 computers per
household. Most (88%) of these adolescents had a home computer, with 40% having
2 or more computers. The most common place to use the Internet was one's own
home, with 72% saying this was where they accessed the Internet most often.
The next most common place was one's school (17%), followed by a friend's
home (4%). Places of Internet access differed by ethnicity ( 225 = 92.8, P<.001), mother's education (210 = 22.9, P = .03), number of
household members (215 = 38.0, P<.001), and citizenship (25 = 12.6, P = .04). White and Asian American students, those whose
mothers had an education beyond college, those with fewer people in their
households, and those born in the United States usually accessed the Internet
from home. Close to a third (31%) had a computer in their bedroom, and no
differences were observed across demographic groups.
Practically all (96%) of these 10th graders used the Internet: 26% used
the Internet less than 1 day a week, 39% 2 to 5 days a week, and 35% 6 to
7 days a week. More boys (44%) than girls (28%) said they used the Internet
6 to 7 days a week (25 = 12.4, P = .048), and higher percentages of Asian American (43%) and white
(46%) students compared with African American (26%) and Latin American (30%)
used the Internet 6 to 7 days a week (225 = 46.0, P = .003). Among these students, 74% said they were "pretty"
or "extremely" comfortable and 75% "pretty" or "very much" liked using this
medium. Boys were more comfortable (24 = 14.9, P = .007) and liked the Internet more than did girls (24 = 19.7, P<.001) but no other
significant differences appeared among student groups.
Adolescents use a range of health information sources (Table 1, Table 2, and
Table 3). For different health content
areas, the media sources most often accessed were magazines and the Internet.
In addition to reporting the sources they use, adolescents selected the sources
they thought were most valuable. For birth control and safer sex, the top
4 most valuable sources were friends, parents, siblings or cousins, and then
health care providers or clinics. For diet, nutrition, and exercise, the most
valuable sources were parents, health care providers or clinics, friends,
and magazines, and for dating and family violence, the most valuable sources
were parents, friends, teachers or coaches, and siblings or cousins. Of the
15 different sources, the Internet ranked as the sixth or seventh most valuable
for these health areas.
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Table 1. Adolescents' Use of Different Sources for Birth Control and
Safer Sex Information
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Table 2. Adolescents' Use of Different Sources for Diet, Nutrition,
and Exercise Information
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Table 3. Adolescents' Use of Different Sources for Dating and Family
Violence Information
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We observed numerous associations by sex regarding health information
sources. When getting information on birth control and safer sex, girls were
more likely than boys to use as a source friends, siblings or cousins, books,
magazines, public health campaigns, and health care providers or clinics.
Boys more frequently than girls said that they used clergy as a source of
birth control and safer sex information. On diet, nutrition, and exercise
information, girls more frequently than boys used friends, books, magazines,
parents, and health care providers or clinics. For dating and family violence,
girls were more likely than boys to get information from friends, siblings
or cousins, books, and magazines. Boys more frequently than girls indicated
that they used health classes as an information source on these violence issues.
We did not observe significant differences for any health topic by sex for
using boyfriends/girlfriends, television, the Internet, other adults, teachers
or coaches, or "other" as information sources.
Across ethnicity, we found significant differences for those getting
information on birth control and safer sex from the Internet and health classes.
For diet, nutrition, and exercise information, ethnic group differences were
seen for using the Internet, parents, and clergy. On dating and family violence
information, we found significant differences for the percentage of adolescents
who used the Internet. We found no differences by ethnicity for the percentages
of adolescents using friends, siblings or cousins, boyfriends/girlfriends,
books, magazines, television, public health campaigns, other adults, teachers
or coaches, health care providers or clinics, or "other" as information sources.
When considering groupings based on an adolescent's mother's education,
we observed significant associations for those obtaining birth control and
safer sex information from another adult; diet, nutrition, and exercise information
from health classes; and dating and family violence information from television.
Across education level groups for the 3 different health areas, we found similar
percentages of adolescents using friends, siblings or cousins, boyfriends/girlfriends,
books, magazines, public health campaigns, the Internet, parents, teachers
or coaches, health care providers or clinics, clergy, and "other" sources.
Half (49%) had tried to get some type of health information from the
Internet. Notably, seeking Internet health information was not significantly
associated with sex, ethnicity, or mother's education. Table 4 presents the percentages of students who tried to get information
on a range of different topics. Students indicated that they most frequently
used the Internet for sexual information (eg, sexual activities, contraception,
and pregnancy) followed by fitness and exercise and then sexually transmitted
diseases.
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Table 4. Health Topics Accessed Through the Internet
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Using a composite assessing perceptions of worth, trustworthiness, use,
and relevance of general health information on the Internet, we found that
adolescents value this medium with no significant differences related to sex,
ethnicity, or mother's education. We observed, however, that those who had
tried to get health information through the Internet had significantly higher
scores for this composite than those who had not tried to get health information
through the Internet (t = 4.5, P<.001).
On 11 separate health topics (smoking, alcohol use, drug use, birth
control, diet and nutrition, exercise, physical abuse, sexual abuse, dating
violence, alternative medicine, and antiviolence), students rated from 1 to
5 how worthwhile it would be to have information available through the Internet.
Girls gave significantly higher scores for having available Internet information
on birth control, diet and nutrition, exercise, physical abuse, sexual abuse,
and dating violence. Only for alternative medicine were there significant
differences among ethnic groups (F = 2.4, P = .04),
with white students rating it the highest. No significant differences were
observed across mother's education groups for how worthwhile it would be to
have Internet information for these health topic areas.
COMMENT
Whereas interpersonal health sources involve considerable time and cost
outlays, mass media can and have been used to reach adolescents with health
information without such requirements. In the past decade, studies have documented
that television,12, 13, 14
videogames,15 and computer technology16, 17 can offer solutions to constraints
inherent in the health care system. A persistent concern, however, with these
media and now the Internet, has been access.
Our data, along with those of other studies18, 19
on media use among youth, show that adolescents own and use all types of electronic
technology. Among this diverse sample of 10th graders, we found Internet use
to be prevalent, with reportedly high levels of access, use, and comfort.
Although other studies have found discrepancies among demographic groups,
this sample found frequent use for most of the surveyed adolescents. The "digital
divide" that appears in other research9 does
not appear for adolescents11 and was not observed
in this study.
Besides turning to interpersonal sources, such as friends, relatives,
or health care providers, adolescents access the Internet for health information.
Along with magazines, this medium is used frequently and valued. Although
we found associations related to sex for various health information sources,
such was not the case with the Internet. In contrast to our expectation that
there would be differences in how adolescents of various groups used and perceived
Internet health information, we observed strikingly few differences in adolescents
using this source. Our data reveal that most adolescents not only use the
Internet for health information but also consider this medium to be valuable.
Interestingly, although both sexes report high levels of use, girls thought
it was more worthwhile than boys for there to be Internet information on a
range of health topics.
The Internet can serve as a useful supplement to existing health care
services and systems. It allows consumers to educate themselves on a variety
of health-related topics from diseases to prescription drugs. The Internet
also offers patients suggestions of questions that they can ask their physicians,
additional opinions and options regarding treatments, and links to online
support groups and individuals.20, 21
Especially for adolescents, who can feel marginalized by restricted access
to available health care resources22, 23
or anxious asking about sensitive health issues, this medium can provide suggestions
for approaching a medical practitioner with frequently asked questions.
Measurement limitations, including reliance on self-report, memory errors,
and perceived bias for and against the Internet, potentially influence the
strength and validity of these results. The media use survey, which occurred
in a school setting, asked adolescents to provide information on Internet
use; however, we did not monitor actual Internet use and behaviors. We would
recommend a naturalistic, observational study to provide actual descriptions
of whether and how adolescents use the Internet for health information; however,
such research seems implausible, since it would require deceiving subjects
and concealing the study's true objectives. Such barriers, though, should
not thwart researchers in their continued efforts to better understand how
adolescents use the Internet for health information. Examining other samples
that differ by geography, age, and experience with different risk behaviors
may also advance our knowledge of how people use the Internet. Lastly, more
research on how adolescents use the Internet, for both general and specific
health information, can provide scholars with data to rethink and provide
insights on how adolescents get health information and the ways that educators
might present Internet health information.
AUTHOR INFORMATION
Accepted for publication March 2, 2001.
From The Mount Sinai Hospital Adolescent Health Center, Mount Sinai
School of Medicine, New York, NY.
Corresponding author and reprints (after August 1): Dina L. G. Borzekowski,
EdD, The Johns Hopkins University, Department of Population and Family Health
Sciences, School of Hygiene and Public Health, 615 N Wolfe St, Baltimore,
MD 21205 (e-mail: dborzeko{at}jhsph.edu).
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