Abstract
Introduction
Access to the internet at home may be an important barrier to electronic health (eHealth) smoking cessation interventions. The current study explored possible sociodemographic disparities in access to the internet at home among veteran smokers.
Methods
Data from participants proactively recruited and enrolled in a randomized smoking cessation effectiveness trial (N = 408) that compared a web-based smoking cessation intervention to Veterans Affairs (VA) usual care were used to examine the demographic attributes of smokers with and without internet access at home. Multivariable logistic regression was used to examine associations between demographic factors and home internet access. Data from patients randomized to the internet arm of the study (N = 205) were used to ascertain correlates of utilization of the intervention website.
Results
While the majority of the sample (82 %) endorsed access to the internet at home, veterans who were African-American, older, and not married were significantly less likely to have home internet access. Veterans who were African-American, older, less educated, had longer travel times to the nearest VA facility, and increased nicotine dependence were less likely to access the internet on a daily basis. While several sociodemographic variables (e.g., age, race, education, employment) were related to utilization of a free membership to a commercial, web-based smoking cessation intervention in bivariate analyses, only access to the internet at home was related to use of the smoking cessation site in adjusted results.
Conclusion
These results highlight gaps in internet access and use among veterans and additionally underscore the importance of improving accessibility of eHealth interventions for low-income, minority, and socially disadvantaged veteran populations.
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References
Centers for Disease Control and Prevention. Tobacco use: targeting the nation's leading killer. Atlanta: Centers for Disease Control and Prevention; 2010.
Centers for Disease Control and Prevention. Smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000-2004. MMWR. 2008;57(45):1226–8.
Tsai J, Edens EL, Rosenheck RA. Nicotine dependence and its risk factors among users of veterans health services, 2008-2009. Prev Chron Dis. 2011;8:A127.
Acheson SK, Straits-Troster K, Calhoun PS, Beckham JC, Hamlett-Berry K. Characteristics and correlates of tobacco use among U.S. veterans returning from Iraq and Afghanistan. Mil. Psychology. 2011;23(2):297–314. doi:10.1080/08995605.2011.570589.
National Institute of Health. National Institutes of Health state-of-the-science conference statement: tobacco use: prevention, cessation, and control. Ann Intern Med. 2006;145:839–44.
King G, Polednak A, Bendel RB, Vilsaint MC, Nahata SB. Disparities in smoking cessation between African Americans and whites: 1990-2000. Am J Public Health. 2004;94(11):1965–71.
Trinidad DR, Perez-Stable EJ, White MM, Emery SL, Messer KA. Nationwide analysis of US racial/ethnic disparities in smoking behaviors, smoking cessation, and cessation-related factors. Am J Public Health. 2011;101(4):699–706. doi:10.2105/AJPH.2010.191668.
Lawrence D, Graber JE, Mills SL, Meissner HI, Warnecke R. Smoking cessation interventions in U.S. racial/ethnic minority populations: an assessment of the literature. Prev Med. 2003;36(2):204–16.
Cokkinides VE, Halpern MT, Barbeau EM, Ward E, Thun MJ. Racial and ethnic disparities in smoking-cessation interventions: analysis of the 2005 National Health Interview Survey. Am J Prev Med. 2008;34(5):404–12. doi:10.1016/j.amepre.2008.02.003.
Piper ME, Cook JW, Schlam TR, Jorenby DE, Smith SS, Bolt DM, et al. Gender, race, and education differences in abstinence rates among participants in two randomized smoking cessation trials. Nicotine Tob Res. 2010;12(6):647–57. doi:10.1093/ntr/ntq067.
Fu SS, Sherman SE, Yano EM, van Ryn M, Lanto AB, Joseph AM. Ethnic disparities in the use of nicotine replacement therapy for smoking cessation in an equal access health care system. Am J Health Promot. 2005;20(2):108–16.
Franks P, Fiscella K, Meldrum S. Racial disparities in the content of primary care office visits. J Gen Intern Med. 2005;20(7):599–603. doi:10.1111/j.1525-1497.2005.0109.x.
Burgess D, van Ryn M, Noorbaloochi S, Clothier B, Taylor B, Sherman S, et al. Smoking cessation among African American and white smokers in the veterans affairs health care system. Am J Public Health. 2014;104(S4):S580–S7. doi:10.2105/AJPH.2014.302023.
Sherman SE, Joseph AM, Yano EM, Simon BR, Arikian NJ, Rubenstein LV, et al. Assessing the institutional approach to implementing smoking cessation practice guidelines in veterans health administration facilities. Mil Med. 2006;171:80–7.
Bock B, Graham A, Sciamanna C, Krishnamoorthy J, Whiteley J, Carmona-Barros R, et al. Smoking cessation treatment on the internet: content, quality, and usability. Nicotine Tob Res. 2004;6(2):207–19. doi:10.1080/14622200410001676332.
Cho AH, Arar NH, Edelman DE, Hartwell PH, Oddone EZ, Yancy Jr WS. Do diabetic veterans use the internet? Self-reported usage, skills, and interest in using my HealtheVet web portal. Telemedicine and e-Health. 2010;16(5):595–602. doi:10.1089/tmj.2009.0164.
Tsai J, Rosenheck RA. Use of the internet and an online personal health record system by US veterans: comparison of veterans affairs mental health service users and other veterans nationally. J Am Med Inform Assoc. 2012;19(6):1089–94. doi:10.1136/amiajnl-2012-000971.
Chumbler NR, Haggstrom D, Saleem JJ. Implementation of health information technology in veterans health administration to support transformational change: telehealth and personal health records. Med Care. 2011;49:S36–42. doi:10.1097/MLR.0b013e3181d558f9.
McInnes K, Gifford A, Kazis L, Wagner T. Disparities in health-related internet use by US veterans: results from a national survey. Journal of Innovation in Health Informatics. 2010;18(1):59–68.
Schneiderman AI, Lincoln AE, Curbow B, Kang HK. Variations in health communication needs among combat veterans. Am J Public Health. 2004;94(12):2074–6.
Sayer NA, Noorbaloochi S, Frazier P, Carlson K, Gravely A, Murdoch M. Reintegration problems and treatment interests among Iraq and Afghanistan combat veterans receiving VA medical care. Psychiatr Serv. 2010;61(6):589–97.
Calhoun PS, Datta S, Olsen MK, Smith VA, Moore SD, Hair LP, et al. Comparative effectiveness of an internet-based smoking cessation intervention versus clinic-based specialty care for veterans. J Subst Abuse Treat in press.
McGinnis KA, Brandt CA, Skanderson M, Justice AC, Shahrir S, Butt AA, et al. Validating smoking data from the Veteran's affairs health factors dataset, an electronic data source. Nicotine Tob Res. 2011;13(12):1233–9. doi:10.1093/ntr/ntr206.
Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. The Fagerström test for nicotine dependence: a revision of the Fagerström tolerance questionnaire. Br J Addict. 1991;86:1119–27. doi:10.1111/j.1360-0443.1991.tb01879.x.
Anderson EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale. Am J Prev Med. 1994;10:77–84.
Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale. Am J Prev Med. 1994;10(2):77–84.
Bjorgvinsson T, Kertz SJ, Bigda-Peyton JS, McCoy KL, Aderka IM. Psychometric properties of the CES-D-10 in a psychiatric sample. Assessment. 2013;20(4):429–36. doi:10.1177/1073191113481998.
Prins A, Ouimette PC, Kimerling R, Cameron RP, Hugelshofer DS, Shaw-Hegwer J, et al. The primary care PTSD screen (PC-PTSD): development and operating characteristics. Int J Psychiat Clin Prac. 2004;9:9–14. doi:10.1185/135525703125002360.
Calhoun PS, McDonald SD, Guerra VS, Eggleston AM, Beckham JC, Straits-Troster K. Clinical utility of the primary care-PTSD screen among U.S. veterans who served since September 11, 2001. Psychiatry Res. 2010;178(2):330–5. doi:10.1016/j.psychres.2009.11.009.
Bradley KA, Bush KR, Epler AJ, Dobie DJ, Davis TM, Sporleder JL, et al. Two brief alcohol-screening tests from the alcohol use disorders identification test (AUDIT): validation in a female veterans affairs patient population. Arch Intern Med. 2003;163(7):821–9. doi:10.1001/archinte.163.7.821.
Crawford EF, Fulton JJ, Swinkels CM, Beckham JC, Mid-Atlantic VA, OEF MIRECC. OIF registry workgroup, Calhoun PS. Diagnostic efficiency of the AUDIT-C in U.S. veterans with military service since September 11, 2001. Drug Alcohol Depend. 2013;132(1):101–6. doi:10.1016/j.drugalcdep.2013.01.012.
Perrin A, Duggan M. American's Internet Access: 2000-2015. Pew Research Center. 2015. Retrieved from URL:www.pewinternet.org/2015/06/26/americans-internet-access-2000-2015/.
Delva J, Tellez M, Finlayson TL, Gretebeck KA, Siefert K, Williams DR, et al. Cigarette smoking among low-income African Americans: a serious public health problem. Am J Prev Med. 2005;29(3):218–20.
Fagan P, King G, Lawrence D, Petrucci SA, Robinson RG, Banks D, et al. Eliminating tobacco-related health disparities: directions for future research. Am J Public Health. 2004;94(2):211–7.
Hertzberg JS, Carpenter VL, Kirby AC, Calhoun PS, Moore SD, Dennis MF, et al. Mobile contingency management as an adjunctive smoking cessation treatment for smokers with posttraumatic stress disorder. Nicotine Tob Res. 2013;15(11):1934–8. doi:10.1093/ntr/ntt060.
Carpenter VL, Hertzberg JS, Kirby AC, Calhoun PS, Moore SD, Dennis MF, et al. Multicomponent smoking cessation treatment including mobile contingency management in homeless veterans. J Clin Psychiatry. 2015;76:959–64. doi:10.4088/JCP.14m09053.
Newby JM, Twomey C, Li SSY, Andrews G. Transdiagnostic computerised cognitive behavioral therapy for depression and anxiety: a systematic review and meta-analysis. J Affect Disord. 2016;199:30–41. doi:10.1016/j.jad.2016.03.018.
Dedert EA, McDuffie JR, Swinkels CM, Shaw R, Fulton JJ, Allen KD et al. Computerized cognitive behavioral therapy for adults with depressive or anxiety disorders. Washington (DC): Department of Veterans Affairs (US); 2013.
Gustafson DH, McTavish FM, Chih MY, Atwood AK, Johnson RA, Boyle MG, et al. A smartphone application to support recovery from alcoholism: a randomized clinical trial. JAMA psychiatry. 2014;71(5):566–72. doi:10.1001/jamapsychiatry.2013.4642.
Acknowledgments
This work was supported in part by the Department of Veterans Affairs (VA) Office of Research and Development (ORD) Health Services Research and Development Service (HSR&D; I01HX000132) and the National Institutes of Health (R01CA196304). Dr. Dedert was supported by a Career Development Award (IK2CX000718) from the Clinical Science Research and Development Service (CSR&D) of the VA ORD. Dr. Beckham was supported by a VA Research Career Scientist Award (11S-RCS-009) from the CSR&D of the VA ORD. Funding sources had no role in the design, execution, analysis, interpretation of the data, or the decision to submit results for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the VA or US government or any of the institutions with which the authors are affiliated. The authors have no competing financial interests to report.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Durham VA Medical Center Institutional Review Board.
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Informed consent was obtained from all individual participants included in the study.
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Calhoun, P.S., Wilson, S.M., Hicks, T.A. et al. Racial and Sociodemographic Disparities in Internet Access and eHealth Intervention Utilization Among Veteran Smokers. J. Racial and Ethnic Health Disparities 4, 846–853 (2017). https://doi.org/10.1007/s40615-016-0287-z
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DOI: https://doi.org/10.1007/s40615-016-0287-z