JANUARY15,2013

Health Online 2013

35% of U.S. adults have gone online to figure out a medical condition; of
these, half followed up with a visit to a medical professional

SusannahFox
AssociateDirector,PewInternetProject
MaeveDuggan
ResearchAssistant,PewInternetProject

PewResearchCentersInternet&AmericanLifeProject
1615LSt.,NWSuite700
Washington,D.C.20036
Phone:2024194500

http://pewinternet.org/Reports/2013/Healthonline.aspx

Summary of Findings
One in three American adults have gone online to figure out a medical
condition
ThirtyfivepercentofU.S.adultssaythatatonetimeoranothertheyhavegoneonlinespecificallytotry
tofigureoutwhatmedicalconditiontheyorsomeoneelsemighthave.

ThesefindingscomefromanationalsurveybythePewResearchCentersInternet&AmericanLife
Project.Throughoutthisreport,wecallthosewhosearchedforanswersontheinternetonline
diagnosers.

Whenaskediftheinformationfoundonlineledthemtothinktheyneededtheattentionofamedical
professional,46%ofonlinediagnoserssaythatwasthecase.Thirtyeightpercentofonlinediagnosers
sayitwassomethingtheycouldtakecareofathomeand11%sayitwasbothorinbetween.

Whenweaskedrespondentsabouttheaccuracyoftheirinitialdiagnosis,theyreported:
- 41%ofonlinediagnoserssayamedicalprofessionalconfirmedtheirdiagnosis.Anadditional2%
sayamedicalprofessionalpartiallyconfirmedit.
- 35%saytheydidnotvisitacliniciantogetaprofessionalopinion.
- 18%saytheyconsultedamedicalprofessionalandtheclinicianeitherdidnotagreeoroffereda
differentopinionaboutthecondition.
- 1%saytheirconversationwithaclinicianwasinconclusive.
Womenaremorelikelythanmentogoonlinetofigureoutapossiblediagnosis.Othergroupsthathave
ahighlikelihoodofdoingsoincludeyoungerpeople,whiteadults,thosewholiveinhouseholdsearning
$75,000ormore,andthosewithacollegedegreeoradvanceddegrees.
Itisimportanttonotewhatthesefindingsmeanandwhattheydontmean.Historically,peoplehave
alwaystriedtoanswertheirhealthquestionsathomeandmadepersonalchoicesaboutwhetherand
whentoconsultaclinician.Manyhavenowaddedtheinternettotheirpersonalhealthtoolbox,helping
themselvesandtheirlovedonesbetterunderstandwhatmightbeailingthem.Thisstudywasnot
designedtodeterminewhethertheinternethashadagoodorbadinfluenceonhealthcare.Itmeasures
thescope,butnottheoutcome,ofthisactivity.
Clinicians are a central resource for information or support during serious
health episodes and the care and conversation take place mostly offline
Totrytocaptureafocusedpictureofpeopleshealthinformationsearchandinformationassessment
strategies,weaskedrespondentstothinkaboutthelasttimetheyhadaserioushealthissueandto
whomtheyturnedforhelp,eitheronlineoroffline:

- 70%ofU.S.adultsgotinformation,care,orsupportfromadoctororotherhealthcare
professional.
- 60%ofadultsgotinformationorsupportfromfriendsandfamily.
- 24%ofadultsgotinformationorsupportfromotherswhohavethesamehealthcondition.
Thevastmajorityofthiscareandconversationtookplaceoffline,butasmallgroupofpeopledid
communicatewitheachofthesesourcesonline.And,sinceamajorityofadultsconsulttheinternet
whentheyhavehealthquestions,thesecommunicationswithclinicians,family,andfellowpatients
joinedthestreamofinformationflowingin.
Eight in 10 online health inquiries start at a search engine
Lookingmorebroadlyattheonlinelandscape,72%ofinternetuserssaytheylookedonlineforhealth
informationofonekindoranotherwithinthepastyear.Thisincludessearchesrelatedtoserious
conditions,generalinformationsearches,andsearchesforminorhealthproblems.Forbrevityssake,
wewillrefertothisgroupasonlinehealthseekers.
Whenaskedtothinkaboutthelasttimetheyhuntedforhealthormedicalinformation,77%ofonline
healthseekerssaytheybeganatasearchenginesuchasGoogle,Bing,orYahoo.Another13%saythey
beganatasitethatspecializesinhealthinformation,likeWebMD.Just2%saytheystartedtheir
researchatamoregeneralsitelikeWikipediaandanadditional1%saytheystartedatasocialnetwork
sitelikeFacebook.
Half of health information searches are on behalf of someone else
Whenaskedtothinkaboutthelasttimetheywentonlineforhealthormedicalinformation,39%of
onlinehealthseekerssaytheylookedforinformationrelatedtotheirownsituation.Another39%say
theylookedforinformationrelatedtosomeoneelseshealthormedicalsituation.Anadditional15%of
theseinternetuserssaytheywerelookingbothontheirownandsomeoneelsesbehalf.

One in four people seeking health information online have hit a pay wall
Twentysixpercentofinternetuserswholookonlineforhealthinformationsaytheyhavebeenaskedto
payforaccesstosomethingtheywantedtoseeonline.Ofthosewhohavebeenaskedtopay,just2%
saytheydidso.Fully83%ofthosewhohitapaywallsaytheytriedtofindthesameinformation
somewhereelse.Thirteenpercentofthosewhohitapaywallsaytheyjustgaveup.
The social life of health information is a low-key but steady presence in
American life
Inpastsurveys,thePewInternetProjecthasnotdefinedatimeperiodforhealthactivitiesonline.This
time,thephraseinthepast12monthswasaddedtohelpfocusrespondentsonrecentepisodes.We

findonceagainthatthereisasociallifeofhealthinformation,aswellaspeertopeersupport,as
peopleexchangestoriesabouttheirownhealthissuestohelpeachotherunderstandwhatmightlie
ahead:
- 26%saytheyreadorwatchedsomeoneelsesexperienceabouthealthormedicalissuesinthe
last12months.
- 16%ofinternetuserssaytheywentonlineinthelastyeartofindotherswhomightsharethe
samehealthconcerns.
Healthrelatedreviewsandrankingscontinuetobeusedbyonlyamodestgroupofconsumers.About
oneinfiveinternetusershaveconsultedonlinereviewsofparticulardrugsormedicaltreatments,
doctorsorotherproviders,andhospitalsormedicalfacilities.Andjust34%ofinternetusershave
postedonlinereviewsofhealthcareservicesorproviders.

About this study

Theresultsreportedherecomefromanationwidesurveyof3,014adultslivingintheUnitedStates.
Telephoneinterviewswereconductedbylandline(1,808)andcellphone(1,206,including624withouta
landlinephone).ThesurveywasconductedbyPrincetonSurveyResearchAssociatesInternational.
InterviewsweredoneinEnglishandSpanishbyPrincetonDataSourcefromAugust7toSeptember6,
2012.Statisticalresultsareweightedtocorrectknowndemographicdiscrepancies.Themarginof
samplingerrorforthecompletesetofweighteddatais2.4percentagepoints.
ThePewInternet&AmericanLifeProjectisaninitiativeofthePewResearchCenter,anonprofitfact
tankthatprovidesinformationontheissues,attitudesandtrendsshapingAmericaandtheworld.The
Projectisnonpartisanandtakesnopositiononpolicyissues.SupportfortheProjectisprovidedbythe
PewCharitableTrusts.
SupportforthisstudywasprovidedbytheCaliforniaHealthCareFoundation,anindependent
philanthropycommittedtoimprovingthewayhealthcareisdeliveredandfinancedinCalifornia.

Part One: Information triage

For one-third of U.S. adults, the internet is a diagnostic tool
AsofSeptember2012,81%ofU.S.adultsusetheinternetand,ofthose,72%saytheyhavelooked
onlineforhealthinformationinthepastyear.
Sinceonlinepersonaldiagnosisisascenariothathasintriguedobserversforyearsandcausedsome
anxietyaboutpeoplesabilitytonavigatetheonlineinformationlandscapethePewResearchCenters
Internet&AmericanLifeProjectexploreditinsomedepthinitsmostrecenthealthsurvey.Ofthose
whohavelookedonlineforhealthinformation,59%saytheyhaveevergoneonlinespecificallytotryto
figureoutwhatmedicalconditiontheyorsomeoneelsemighthave.Thattranslatesto35%ofU.S.
adults.
Womenaremorelikelythanmentogoonlinetofigureoutapossiblediagnosis.Othergroupsthathave
ahighlikelihoodofdoingsoincludeyoungerpeople,whiteadults,thoseinthehighestincomebracket,
andthosewithmoreeducation(seethetablebelowfordetails).
Thefollowinganalysisisbasedonquestionsaskedonlyofthat35%ofthepopulationwhoanswered
thattheyhavegoneonlinetofigureoutwhattheyorsomeoneelsemighthave.Wewillrefertothemas
onlinediagnosers.
First,onlinediagnoserswereaskediftheinformationtheyfoundonlineledthemtothinkthatthiswasa
conditionthatneededtheattentionofadoctororothermedicalprofessional,orthatitwasperhaps
somethingtheycouldtakecareofathome:
- 46%ofonlinediagnoserssaythattheconditionneededtheattentionofadoctor;
- 38%sayitcouldbetakencareofathome;and
- 11%saiditwaseitherbothorinbetween.
Fiftythreepercentofonlinediagnoserssaytheytalkedwithamedicalprofessionalaboutwhatthey
foundonline,46%didnot(seetablebelowfordetails).
Separately,weaskedifamedicalprofessionalconfirmedwhattheythoughttheconditionwasand
foundthat:
- 41%ofonlinediagnoserssayyes,amedicalprofessionalconfirmedtheirsuspicions.An
additional2%sayamedicalprofessionalpartiallyconfirmedthem.
- 35%saytheydidnotvisitacliniciantogetaprofessionalopinion.
- 18%sayamedicalprofessionaleitherdidnotagreeorofferedadifferentopinionaboutthe
condition.
- 1%saytheirconversationwithaclinicianwasinconclusivetheprofessionalwasunableto
diagnosewhattheyhad.

Online diagnosis and professional follow-up

%ofadultswholookedonlinetodiagnoseaconditionandthe%ofthoseonlinediagnoserswho
followedupwithamedicalprofessionalaboutwhattheyfound

Lookedonlinetodiagnose
acondition
(Nforalladults=3,014)
Followedupwithmedical
professionalafteronline
diagnosis
(Nforonlinediagnosers=1,003)
All 35% 53%
Men 30 50
Women 40* 55
Age
1829 47** 47
3049 43** 55
5064 29* 58
65+ 13 47
Race/ethnicity
White,NonHispanic 37** 52
Black,NonHispanic 30 59
Hispanic 25 58
Annualhouseholdincome
Lessthan$30,000/yr 25 44
$30,000$49,999 37* 60*
$50,000$74,999 44* 62*
$75,000+ 51** 53
Educationlevel
Lessthanhighschooldiploma 9
Highschoolgrad 26* 51
SomeCollege 41** 55
College+ 49*** 51
Source:PewInternetHealthSurvey,August7September6,2012.N=3,014adultsages18+.Interviews
wereconductedinEnglishandSpanishandonlandlineandcellphones.Marginoferroris+/2.4
percentagepointsforalladultsand+/3.6percentagepointsforonlinediagnosers.
*Statisticallysignificantdifferencecomparedwithothersinthesamegrouping.Additionalasterisks
indicateamoresignificantdifference.

Thereisnostatisticallysignificantdifferencebetweenthosewhohavehealthinsuranceandthosewho
donotwhenitcomestousingtheinternettofigureoutanillness.
Itisimportanttonotewhatthesefindingsmeanandwhattheydontmean.Historically,peoplehave
alwaystriedtoanswertheirhealthquestionsathomeandmadepersonalchoicesaboutwhetherand
whentoconsultaclinician.Manyhavenowaddedtheinternettotheirpersonalhealthtoolbox,helping
themselvesandtheirlovedonesbetterunderstandwhatmightbeailingthem.Thisstudywasnot
designedtodeterminewhethertheinternethashadagoodorbadinfluenceonhealthcare.Itmeasures
thescope,butnottheoutcome,ofthisactivity.
Eight in ten online health inquiries start at a search engine
Again,72%ofinternetuserssaytheylookedonlineforhealthinformationwithinthepastyear.For
brevityssake,wewillrefertothisgroupasonlinehealthseekers.
Whenaskedtothinkaboutthelasttimetheydidso,77%ofonlinehealthseekerssaytheybeganata
searchenginesuchasGoogle,Bing,orYahoo.Another13%saytheybeganatasitethatspecializesin
healthinformation,likeWebMD.Just2%saytheystartedtheirresearchatamoregeneralsitelike
Wikipediaandanadditional1%saytheystartedatasocialnetworksitelikeFacebook.
Usingasearchengineissomewhatassociatedwithbeingyounger.Forexample,82%ofonlinehealth
seekersage1829yearsoldsaytheyusedGoogle,Bing,Yahoo,oranothersearchengine,compared
with73%ofthoseages50andolder.
Overall,thispatternmatcheswhatwefoundinourveryfirsthealthsurvey,conductedin2000,when
justhalfofU.S.adultshadinternetaccess.Then,asnow,eightintenonlinehealthseekersstartedata
generalsearchenginewhenlookingonlineforhealthormedicalinformation.
Clinicians are a central resource for information or support during serious
health episodes and the care and conversation take place mostly offline
Totrytocaptureanaccuratepictureofpeopleshealthinformationseekingstrategies,weasked
respondentstothinkaboutthelasttimetheyhadaserioushealthissueandtowhomtheyturnedfor
help:
- 70%ofU.S.adultsgotinformation,care,orsupportfromadoctororotherhealthcare
professional.
- 60%ofadultsgotinformationorsupportfromfriendsandfamily.
- 24%ofadultsgotinformationorsupportfromotherswhohavethesamehealthcondition.
Thevastmajorityofthiscareandconversationtookplaceoffline(seetablebelow).

Thelasttimeyouhadahealthissue,did
yougetinformation,care,orsupport
from
Total
yes
Yes,
online
Yes,
offline
Yes,
both
Nota
source
Adoctororotherhealthcare
professional
70% 1% 61% 8% 28%
Friendsandfamily 60 1 39 20 39
Otherswhohavethesamehealth
condition
24 2 15 7 73
Source:PewResearchCentersInternet&AmericanLifeProject,August7September6,2012
Survey.N=3,014adults.Marginoferrorforinternetusers(N=2,392)is+/2.6percentage
points.

Certaingroupsaresignificantlymorelikelytoreportcallinguponaclinicianforhealthadvice:women,
adultsages50andolder,nonHispanicwhites,andadultswithatleastsomecollegeeducation.Fully
threequartersofpeoplewhohavehealthinsuranceconsultedadoctororotherhealthcare
professional,comparedwithhalf(49%)oftheuninsured.
Womenaremoreinclinedthanmentoseekinformation,care,orsupportfromfriendsandfamily:68%
vs.53%.NonHispanicwhites,adultswithhealthinsurance,andthosewithsomecollegeeducationare
alsomorelikelythanothergroupstoturntofriendsandfamily.Almosttwothirds(63%)ofthosewith
insuranceapproachedfriendsandfamily,whilehalf(48%)oftheuninsureddidso.
Differencesamongdemographicgroupsarelessapparentwhenlookingatpeerhealthsupport,buttwo
groupsstandout:womenandpeoplewithhealthinsurance.Twentyeightpercentofwomenhave
soughtadvicefromotherswhohavethesamehealthcondition,comparedwith21%ofmen.One
quarter(26%)oftheinsuredsoughtoutotherswiththesamehealthcondition,comparedto19%of
thosewithoutinsurance.
Thesefindingsreflectdifferenceswefirstobservedin2010,withlittlechangeoverthepasttwoyears.
Half of online health inquiries are on behalf of someone else
Whenaskedtothinkaboutthelasttimetheywentonlineforhealthormedicalinformation,39%of
internetuserswhohavedonethistypeofresearchsaytheylookedforinformationrelatedtotheirown
situation.Another39%saytheylookedforinformationrelatedtosomeoneelseshealthormedical
situation.And15%oftheseinternetuserssaytheywerelookingbothontheirownandsomeoneelses
behalf.
Onlinehealthseekersage65andolderaremorelikelythanthoseinthemiddleagegroupstosaytheir
lastsearchwasontheirownbehalf:48%,comparedwith39%of5064yearolds,forexample.Parents
aremorelikelythannonparentstolookonbehalfofsomeoneelse:44%,comparedwith36%.

10

Thistrendhasnotchangedsignificantlysincewefirstbegantrackingitin2000:morethanhalfofhealth
searchesareconductedonbehalfofsomeonenottouchingthekeyboard.
Specific diseases and treatments continue to dominate peoples online
queries
Inpastsurveys,thePewInternetProjecthasnotdefinedatimeperiodforhealthsearchesonline.This
time,thephraseinthepast12monthswasaddedtohelpfocusrespondentsonrecentsearches.
Asonewouldexpect,thepercentagesdippedforeachofthetopicsweincludeinthelist.Forexample,
55%ofinternetuserssaytheylookedonlineforinformationaboutaspecificdiseaseormedicalproblem
inthepastyear,comparedwith66%ofinternetuserswho,in2010,saidtheyhadeverdonesucha
search.
The%ofadultinternetuserswhohavelookedonlineinthelast12
monthsforinformationabout
55% Specificdiseaseormedicalproblem
43 Certainmedicaltreatmentorprocedure
27 Howtoloseweightorhowtocontrolyourweight
25 Healthinsurance,includingprivateinsurance,MedicareorMedicaid
19 Foodsafetyorrecalls
16 Drugsafetyorrecalls
16 Adrugyousawadvertised
15 Medicaltestresults
14 Caringforanagingrelativeorfriend
12 Pregnancyandchildbirth
11 Howtoreduceyourhealthcarecosts
20 Anyotherhealthissue
72 atleastoneoftheabovetopics
Source:PewResearchCentersInternet&AmericanLifeProject,August7September6,
2012Survey.N=3,014adults.Marginoferrorforinternetusers(N=2,392)is+/2.6
percentagepoints.

11

Womenaremorelikelythanmentoseekhealthinformationonline,asareinternetuserswithhigher
levelsofeducation:

Sex Educationlevel
Healthtopic
All
internet
users
Men Women
Some
high
school
High
school
grad
Some
college
College
grad
N=2,392 N=1,084 N=1,308 N=107 N=574 N=656 N=1,046
Specificdiseaseormedical
problem
55% 48% 62%* 34% 43% 58%** 67%***
Certainmedicaltreatment
orprocedure
43 37 49* 22 36* 45** 52***
Howtoloseweightorhow
tocontrolyourweight
27 19 34* 23 20 29* 32*
Healthinsurance,including
privateinsurance,Medicare
orMedicaid
25 25 25 17 17 26* 32**
Foodsafetyorrecalls 19 19 19 16 16 19 23*
Drugsafetyorrecalls 16 14 18* 10 13 17 20**
Adrugyousawadvertised 16 15 16 9 13 18* 17*
Medicaltestresults 15 13 16 3 8 15** 23***
Caringforanagingrelative
orfriend
14 15 13 8 12 15 16**
Pregnancyandchildbirth 12 11 13 17 9 14* 12
Howtoreduceyourhealth
carecosts
11 11 11 11 8 11 13*
Anyotherhealthissue 20 16 25* 12 15 22** 25**
Atleastoneoftheabove
topics
72 65 79* 57 63 74** 81***
Source:PewResearchCentersInternet&AmericanLifeProject,August7September6,2012Survey.
N=3,014adultsandthemarginoferroris+/2.6percentagepointsforinternetusers.Marginsoferrorfor
subpopulationsarehigher.
*Statisticallysignificantdifferencecomparedwithothersinthesamegroup.Additionalasterisksindicatea
moresignificantdifference.

12

Thereareonlyfoursignificantdifferencesamongwhite,AfricanAmerican,andLatinointernetusers
whenitcomestohealthtopics:specificdiseases,weightcontrol,adrugseeninadvertising,and
pregnancy.Differencesamongagegroupsareamuchmoremixedbagoftopics.

Race/ethnicity Age
Healthtopic
All
internet
users
White Black Latino 1829 3049 5064 65+
N=2,392 N=1,531 N=348 N=314 N=454 N=759 N=668 N=463
Specificdiseaseor
medicalproblem
55% 58%** 47% 48% 53%* 59%* 59%* 43%
Certainmedical
treatmentorprocedure
43 45 42 39 39 48** 44* 36
Howtoloseweightor
howtocontrolyour
weight
27 23 34* 35* 32** 32** 21* 11
Healthinsurance,
includingprivate
insurance,Medicareor
Medicaid
25 24 23 26 26 28* 23 19
Foodsafetyorrecalls 19 18 18 20 18 24*** 17 12
Drugsafetyorrecalls 16 16 20 16 14* 20* 17* 8
Adrugyousaw
advertised
16 15 22* 15 16 15 18* 11
Medicaltestresults 15 16 12 15 13 15 19** 10
Caringforanaging
relativeorfriend
14 14 15 15 13 16* 15* 8
Pregnancyandchildbirth 12 10 11 17* 25*** 13** 2
Howtoreduceyour
healthcarecosts
11 10 13 12 10* 13* 11* 5
Anyotherhealthissue 20 21 16 17 17 24** 22* 14
Atleastoneoftheabove
topics
72 73 69 66 76* 75* 71* 58
Source:PewResearchCentersInternet&AmericanLifeProject,August7September6,2012Survey.
N=3,014adultsandthemarginoferroris+/2.6percentagepointsforinternetusers.Marginsoferrorfor
subpopulationsarehigher.
*Statisticallysignificantdifferencecomparedwithothersinthesamegroup.Additionalasterisksindicatea
moresignificantdifference.

Internetuserswithhealthinsurancearesignificantlymorelikelythanthosewithouthealthinsuranceto
researchcertaintopics,suchasaspecificdiseaseortreatment.Othertopics,suchasfoodanddrug
safety,aremoderatelymorepopularamonginternetuserswithhealthinsurance,comparedwiththose
whodonotreporthavinginsurancecoverage.

13

Seeking health information online

%ofinsuredvs.uninsuredinternetuserswhohavelookedforinformationonlineabout

Insured
(n=2,066)
Uninsured
(n=326)
Specificdiseaseormedicalproblem 60%* 35%
Certainmedicaltreatmentorprocedure 48* 24
Howtoloseorcontrolweight 27 24
Healthinsurance 25 25
Foodsafetyorrecalls 20* 15
Drugsafetyorrecalls 17* 12
Medicaltestresults 17* 6
Advertiseddrug 16 12
Caringforanaginglovedone 15 11
Pregnancyandchildbirth 11 15
Reducepersonalhealthcarecosts 11 11
Otherhealthissue 22* 13
Anyoftheabove 75* 59
Source:PewResearchCentersInternet&AmericanLifeProject,August7September6,
2012Survey.N=3,014adults.Marginoferrorforinternetusers(N=2,392)is+/2.6
percentagepoints.
*Statisticallysignificantdifferencecomparedwithothersinthesamegroup.
Internet access drives information access
SinceoneinfiveU.S.adultsdonotgoonline,thepercentageofonlinehealthinformationseekersis
lowerwhencalculatedasapercentageofthetotalpopulation:59%ofalladultsintheU.S.saythey
lookedonlineforhealthinformationwithinthepastyear.
Therearetwoforcesatplay:accesstotheinternetandinterestinhealthinformation.Forexample,
womenandmenareequallylikelytohaveaccesstotheinternet,butwomenaremorelikelythanmen
toreportgatheringhealthinformationonline,whichexplainsthegendergapinthechartbelow.Forthe
othergroups,theiroveralllowerrateofinternetadoptioncombinedwithlowerlevelsofhealth
informationseekingonlinedrivestheirnumbersdownsignificantlywhencomparedwithotheradults.

14

Looking online for health information:

demographics

%of
adults
whogo
online
%ofinternetusers
wholookonlinefor
healthinformation
%ofalladults
wholookonline
forhealth
information
Total 81% 72% 59%
Gender
Male 81 65 53
Female 81 79* 64*
Race
White 83** 73 60**
African
American
74 69 51
Latino 73 66 48
Age
1829 95*** 76* 72**
3049 89** 75* 67**
5064 77* 71* 54*
65+ 52 58 30
Education
Somehigh
school
47 57 27
Highschool 72* 63 45*
Some
college
90** 74** 67**
College
graduate
96*** 81*** 78***
Householdincome
<$30,000 68 65 45
$30,000
$49,999
86* 71 61*
$50,000
$74,999
95** 81** 77**
$75,000+ 97** 80** 78**
Source:PewResearchCentersInternet&AmericanLifeProject,August7
September6,2012Survey.N=3,014adultsandthemarginoferroris+/
2.4percentagepointsforthefullsample.Marginsoferrorforsub
populationsarehigher.
*Statisticallysignificantdifferencecomparedwithothersinthesame
group.Additionalasterisksindicateamoresignificantdifference.

(SeetheAppendixformoredetailedinformationonspecifichealthtopics.)

15

Younger adults and minorities lead the way with mobile health information
search
Some85%ofU.S.adultsownacellphoneand,ofthose,31%saytheyhaveusedtheirphonetolookfor
healthormedicalinformationonline.Somegroupsaremorelikelythanotherstolookforhealth
informationontheirphones:Latinos,AfricanAmericans,thosebetweentheagesof18and49,and
thosewhohaveattendedatleastsomecollegeeducation.
Mobile health information: demographics
%ofcellphoneownerswithineachgroupwhousetheirphonestolook
forhealthormedicalinformationonline
Allcellphoneowners(n=2,581) 31%
Men(n=1,163) 29
Women(n=1,418) 33
Age
1829(n=451) 42**
3049(n=770) 39**
5064(n=710) 19*
65+(n=599) 9
Race/ethnicity
White,NonHispanic(n=1,586) 27
Black,NonHispanic(n=434) 35*
Hispanic(n=351) 38*
Annualhouseholdincome
Lessthan$30,000/yr(n=690) 28
$30,000$49,999(n=456) 30
$50,000$74,999(n=345) 37*
$75,000+(n=646) 37*
Educationlevel
Nohighschooldiploma(n=187) 17
Highschoolgrad(n=681) 26*
SomeCollege(n=679) 33**
College+(n=1020) 38**
Source:PewInternet/CHCFHealthSurvey,August7September6,2012.
N=3,014adultsages18+.InterviewswereconductedinEnglishand
Spanish,onlandlineandcellphones.Marginoferroris+/2.6
percentagepointsforresultsbasedoncellphoneowners.
*Statisticallysignificantdifferencecomparedwithothersinthesame
grouping.Additionalasterisksindicateamoresignificantdifference.

16

Half of smartphone owners have used their phone to look up health

information
HalfofcellphoneownersintheU.S.(53%)saythattheyownasmartphone.Thistranslatesto45%ofall
Americanadults.Youngerpeoplearemorelikelythanolderadultstoownasmartphone,asarepeople
withhigherincomeandeducationlevels.
Who Owns Smartphones
%ofU.S.adultswithineachgroupwhohaveasmartphone
Alladults(n=3,014) 45%
Men(n=1,337) 46
Women(n=1,677) 45
Age
1829(n=478) 66***
3049(n=833) 59**
5064(n=814) 34*
65+(n=830) 11
Race/ethnicity
White,NonHispanic(n=1,864) 42
Black,NonHispanic(n=497) 47
Hispanic(n=427) 49*
Annualhouseholdincome
Lessthan$30,000/yr(n=876) 35
$30,000$49,999(n=523) 42*
$50,000$74,999(n=371) 56**
$75,000+(n=680) 68***
Educationlevel
Nohighschooldiploma(n=269) 21
Highschoolgrad(n=830) 36*
SomeCollege(n=778) 50**
College+(n=1,115) 61***
Geographiclocation
Urban(n=1,095) 48*
Suburban(n=1,406) 49*
Rural(n=396) 29

17

Source:PewInternet/CHCFHealthSurvey,August7September6,2012.
N=3,014adultsages18+.InterviewswereconductedinEnglishand
Spanish,onlandlineandcellphones.Marginoferroris+/2.4percentage
pointsforresultsbasedonalladults.
*Statisticallysignificantdifferencecomparedwithothersinthesame
grouping.Additionalasterisksindicateamoresignificantdifference.

Fiftytwopercentofsmartphoneownershavelookeduphealthinformationontheirphone,compared
withjust6%ofothercellphoneowners.
Apersonslikelihoodtousehisorhercellphonetolookforhealthinformationisamplifiedbyeachof
thecharacteristicsidentifiedinthetablesabove:relativeyouthfulness,havingahigherlevelof
education,livinginahigherincomehousehold,beingLatino,beingAfricanAmericanandowninga
smartphone.Eachoftheseobservationsholdstrueunderstatisticalanalysisisolatingeachfactor.In
otherwords,itisnotjustthatsmartphoneownersarelikelytobeyoungerthanotherAmericanadults
andbothgroupsarelikelytousetheirphonestolookuphealthinformation.Eachcharacteristichasan
independenteffectonmobilehealthinformationconsumption.
One in four people seeking health information online have hit a pay wall
Twentysixpercentofinternetuserswholookonlineforhealthinformationsaytheyhavebeenaskedto
payforaccesstosomethingtheywantedtoseeonline.Seventythreepercentsaytheyhavenotfaced
thischoicewhileseekinghealthormedicalinformationonline.
Ofthosewhohavebeenaskedtopay,just2%saytheydidso.Fully83%ofthosewhohitapaywallsay
theytriedtofindthesameinformationsomewhereelse.Thirteenpercentofthosewhohitapaywall
saytheyjustgaveup.
Men,women,peopleofallagesandeducationlevelswereequallylikelytoreporthittingapaywall
whenlookingforhealthinformation.Respondentslivinginlowerincomehouseholdsweresignificantly
morelikelythantheirwealthiercounterpartstosaytheygaveupatthatpoint.Wealthierrespondents
werethelikeliestgrouptosaytheytriedtofindthesameinformationelsewhere.Noincomegroupwas
morelikelytosaytheypaidthefee.

18

Part Two: Peer-to-peer Healthcare

Some seek counsel from fellow patients and caregivers
Wehavebeeninterestedinthesocialaspectofonlinehealthresourcessincetheverybeginningofour
project.In2000,weaskedpeopleiftheyhademailedadoctorandiftheyparticipatedinanonline
supportgroupforpeoplewhosharedthesamehealthissues.Associaltoolsproliferated,weadapted
oursurveyquestionstofitthecurrentreality.

Now,insteadofnamingcertainwebsitesorservices,wedescribeanactivityandtrackpeoplesuseof
theseresourcesovertime.Forexample,inthecurrentsurvey,wedidnotaskspecificallyabout
Facebook,insteadfocusingonmoregeneralsocialinteractionwhichmaytakeplaceonavarietyofsites.
Wetrustthatpeopleknowwhatwemeanwhenweaskiftheyhave,forexample,postedahealth
relatedquestiononlineandwedonotparticularlyneedtoknowhoworwheretheypostedit.

ThesociallifeofhealthinformationisasteadypresenceinAmericanlife.Aswenotedabove,onein
fouradults(24%)saysthattheyturnedtootherswhohavethesamehealthconditionduringtheirlast
boutwithillness,essentiallythesamefindingasinour2010survey.Oneinfourinternetusers(26%)
havereadorwatchedsomeoneelsesexperienceabouthealthormedicalissuesinthelast12months.
And16%ofinternetusershavegoneonlinetofindotherswhomightsharethesamehealthconcernsin
thelastyear.Weexploredthisphenomenoningreaterdepthinthe2011report,Peertopeer
Healthcare.
1

Elevenpercentofinternetuserssaytheyhavesigneduptoreceiveemailupdatesoralertsabouthealth
ormedicalissuesinthepastyear.Twelvepercentofinternetusershavedownloadedformsonlineor
appliedforhealthinsuranceonlineinthepastyear,includingprivateinsurance,Medicare,orMedicaid.
Someofthemoststrikingdifferenceswerebetweenthosewhohavehealthinsuranceandthosewhodo
not(seetablebelow).

1
ht t p: / / www.pewint ernet .org/ Report s/ 2011/ P2PHealt hcare.aspx

19

Online health activities, by insurance status
%ofinsuredvs.uninsuredinternetuserswhohavegoneonlineinthepastyearto.

Insured
(n=2,601)
Uninsured
(n=413)
Read/watchsomeoneelseshealthormedicalexperienceonline 22%* 17%
Findotherswhomighthavesimilarhealthconcerns 13 11
Downloadformsonlineorappliedforhealthinsuranceonline 10* 6
Receiveanyemailupdatesoralertsabouthealthormedicalissues 9* 6
Anyoftheabove 33* 26
Source:PewResearchCentersInternet&AmericanLifeProject,August7September6,2012Survey.N=3,014
adultsandthemarginoferroris+/2.6percentagepointsforinternetusers.
*Statisticallysignificantdifferencebetweengroups.

Eightpercentofinternetuserssaytheyhave,inthepast12months,postedahealthrelatedquestion
onlineorsharedtheirownpersonalhealthexperienceonlineinanyway.Ofthose:
- 40%saytheypostedcommentsorstoriesaboutpersonalhealthexperiences
- 19%saytheypostedspecifichealthquestions
- 38%saytheypostedboth
Inaddition,78%ofthosewhopostedacomment,story,orquestionabouttheirhealthsaythattheydid
sotoreachageneralaudienceoffriendsorotherinternetusers.Elevenpercentsaytheyposted
somewherespecificallytogetfeedbackfromahealthprofessional.Fourpercentrepliedthatthey
postedforbothageneralandaprofessionalaudienceand5%saidneitherofthosechoicesfit.
Health care reviews have not caught on among general consumers
ThePewInternetProjecthastrackedtheuseofonlineconsumerreviewssince2000andithasalways
rankedamongthemostpopularactivitiesinthecommercialrealm:8in10internetuserssaytheyhave
researchedaproductorserviceonline.Bycontrast,onlyaboutoneinfiveinternetusershaveconsulted
onlinereviewsandrankingsofhealthcareserviceprovidersandtreatments.
Whenitcomestowritingreviewsofgeneralinterestitems,37%ofinternetuserssaytheyhaverateda
product,service,orpersononlineand32%havepostedacommentorreviewonlineaboutproductthey
boughtorservicetheyreceived.Peoplearemuchlesslikelytopostareviewofatreatment,hospital,or
clinicianbetween34%ofinternetusershavedoneso.
Theresultsforhealthrelatedreviewsarecomparabletothosewerecordedin2010.Consultingonline
reviewsofparticulardrugsormedicaltreatments,however,tookanoticeabledipinthelasttwoyears.
Some18%ofinternetusersdosotoday,comparedto24%in2010.

20

Reviews and rankings online, 2010-2012

%ofinternetuserswhoconsultedorpostedonlinereviewsorrankingsforthefollowinghealthrelatedsubjects

2010
(n=2,065)
2012
(n=2,392)
Consultedonlinereviewsofparticulardrugsormedicaltreatments 24%* 18%
Consultedonlinerankingorreviewsofdoctorsorotherproviders 16 17
Consultedonlinerankingsorreviewsofhospitalsormedicalfacilities 15 14
Postedareviewonlineofadoctor 4 4
Postedareviewonlineofahospital 3 3
Postedyourexperienceswithaparticulardrugormedicaltreatmentonline 4 3
Source:PewResearchCentersInternet&AmericanLifeProject.Marginsoferrorare+/2.6percentagepoints
forinternetusers.
*Statisticallysignificantdifferencebetweenyears.

Internetusersbetweentheagesof3064yearsoldarethemostlikelygrouptosaytheyhaveconsulted
onlinereviewsandrankingsofhealthtreatmentsandservices.Suburbaninternetusersaremorelikely
thanruralinternetuserstoconsultonlinehealthcarereviews.
Consulting reviews and rankings online, by age
%ofinternetuserswithineachagegroupwhoconsultedonlinereviewsorrankingsforthe
followinghealthrelatedsubjects

Source:PewResearchCentersInternet&AmericanLifeProject,August7September6,2012
Survey.N=3,014adultsandthemarginoferroris+/2.6percentagepointsforinternetusers.

17
14
13
19
21
16
21
17
14
11
10
8
0
5
10
15
20
25
drugsormedical
treatments
doctorsorother
healthcareproviders
hospitalsorother
medicalfacilities
1829
3049
5064
65+

21

Consulting reviews and rankings online, by urbanity

%ofinternetuserswithineachgroupwhoconsultedonlinereviewsorrankingsforthe
followinghealthrelatedsubjects

Source:PewResearchCentersInternet&AmericanLifeProject,August7September6,2012
Survey.N=3,014adultsandthemarginoferroris+/2.6percentagepointsforinternetusers.

Internetuserswithhigherlevelsofeducationweremorelikelytoconsultonlinereviewsandrankings
thantheirlesseducatedcounterparts.Thosewithanannualhouseholdincomebelow$30,000wereless
likelythanallotherincomebracketstoconsultorposthealthrelatedreviewsandrankingsonline.
18
17
14
20 20
15
13
11
10
0
5
10
15
20
25
drugsormedical
treatments
doctorsorother
healthcareproviders
hospitalsorother
medicalfacilities
Urban
Suburban
Rural

22

Consulting reviews and rankings online, by education

%ofinternetuserswithineachgroupwhoconsultedonlinereviewsorrankingsforthefollowing
healthrelatedsubjects
Source:PewResearchCentersInternet&AmericanLifeProject,August7September6,2012
Survey.N=3,014adultsandthemarginoferroris+/2.6percentagepointsforinternetusers.

6
3
5
11
9 9
19
16
14
24
27
20
0
5
10
15
20
25
30
drugsormedical
treatments
doctorsorother
healthcareproviders
hospitalsorother
medicalfacilities
Nodiploma
Highschoolgrad
somecollege
collegegrad

23

Consulting reviews and rankings online, by annual household income

%ofinternetuserswithineachgroupwhoconsultedonlinereviewsorrankingsforthefollowinghealth
relatedsubjects

Source:PewResearchCentersInternet&AmericanLifeProject,August7September6,2012Survey.
N=3,014adultsandthemarginoferroris+/2.6percentagepointsforinternetusers.

Postingonlinehealthreviewsandrankingsiscomparativelyinfrequent.Just7%ofinternetusershave
everpostedreviewsorrankingsonanyofthethethreehealthtopicswesurveyed:drugsandmedical
treatments,doctors,andhospitals.Thistranslatesinto6%ofAmericanadults.

13
10
8
20
14
15
20
21
18
22
25
18
0
5
10
15
20
25
30
drugsormedical
treatments
doctorsorother
healthcareproviders
hospitalsorother
medicalfacilities
<$30,000
$30,000$49,999
$50,000$74,999
$75,000+

24

Consulting vs. posting online health reviews and rankings

%ofinternetuserswhoconsultedvs.postedonlinereviewsorrankingsforthefollowinghealth
relatedsubjects

Source:PewResearchCentersInternet&AmericanLifeProject,August7September6,2012
Survey.N=3,014adultsandthemarginoferroris+/2.6percentagepointsforinternetusers.

Unlikeconsultingonlinehealthrankingsandreviews,therearenocleardemographictrendswhenit
comestoposting.(SeeAppendixfordetails.)
18
17
14
3
4
3
0
2
4
6
8
10
12
14
16
18
20
drugsormedical
treatments
doctors hospitals
Consultedonline
reviews/rankings
Postedonline
reviews/rankings

25

Appendix
Additionaldetailsaboutwhohassearchedforspecifichealthtopics.
Health Topics, by Age
%ofalladultswhohaveeverlookedonlineforinformationaboutvarioushealthtopics,byage

AllAdults
N=3,014
Age
1829
N=478
3049
N=833
5064
N=814
65+
N=830
Specificdiseaseormedicalproblem 45 50* 52** 45 23
Certainmedicaltreatmentorprocedure 35 38* 43** 34* 19
Healthinsurance,includingprivateinsurance,
MedicareorMedicaid
20 24** 25** 18* 10
Pregnancyandchildbirth 10 24*** 12** 1 0
Foodsafetyorrecalls 16 17* 22** 14* 7
Drugsafetyorrecalls 13 14* 17* 13* 4
Medicaltestresults 12 12* 14* 14* 5
Howtoloseweightorcontrolyourweight 22 31** 28** 16* 6
Howtoreducehealthcarecosts 9 10* 12* 9* 3
Caringforanagingrelativeorfriend 12 12* 15* 11* 4
Drugyousawadvertised 13 15* 14* 14* 6
Anyotherhealthissue 17 17* 21* 17* 8
Source:PewInternetHealthSurvey,August7September6,2012.N=3,014adultsages18+.Interviewswere
conductedinEnglishandSpanishandonlandlineandcellphones.Marginoferroris+/2.4percentagepointsfor
alladults.
*Statisticallysignificantdifferencecomparedwithothersinthesamegrouping.Additionalasterisksindicatea
moresignificantdifference.

26

Health Topics, by Education

%ofalladultswhohaveeverlookedonlineforinformationaboutvarioushealthtopics,byeducationlevel

AllAdults
N=3,014
Education
LTHS
N=269
HS
N=830
Some
Coll.
N=778
Coll+
N=1,115
Specificdiseaseormedicalproblem 45 16 31* 52** 64***
Certainmedicaltreatmentorprocedure 35 10 26* 40** 50***
Healthinsurance,includingprivateinsurance,
MedicareorMedicaid
20 8 12 24** 30***
Pregnancyandchildbirth 10 8 6 12** 11*
Foodsafetyorrecalls 16 8 11 18** 22**
Drugsafetyorrecalls 13 5 9* 15** 19**
Medicaltestresults 12 2 6* 13** 22***
Howtoloseweightorcontrolyourweight 22 11 14 26** 30**
Howtoreducehealthcarecosts 9 5 6 10** 13**
Caringforanagingrelativeorfriend 12 4 8* 13** 16**
Drugyousawadvertised 13 4 9* 16** 17**
Anyotherhealthissue 17 6 11* 20** 24**
Source:PewInternetHealthSurvey,August7September6,2012.N=3,014adultsages18+.Interviewswere
conductedinEnglishandSpanishandonlandlineandcellphones.Marginoferroris+/2.4percentagepointsfor
alladults.
*Statisticallysignificantdifferencecomparedwithothersinthesamegrouping.Additionalasterisksindicatea
moresignificantdifference.

AdditionaldetailsaboutthehealthinsurancelandscapeintheU.S.
Health Insurance Coverage, by Type of Insurance
%ofAmericanswhoreporthavingthefollowingtypesofhealthinsurance

Alladults
(n=3,014)
Privatehealthinsuranceofferedthroughan
employerorunion
51%
Medicare 21
Medicaidorsomeothertypeofstatemedical
assistanceforlowincomepeople
14
Privatehealthinsurancepaidbytheindividual 17
Healthinsurancethroughanyothersource,
includingmilitaryorveteranscoverage
12
Totalinsured 82
Notinsured 18
Source:PewResearchCentersInternet&AmericanLifeProject,August7
September6,2012Survey.N=3,014adultsandthemarginoferroris+/2.4
percentagepointsforthefullsample.

27

Womenaremorelikelytohavehealthinsurancethanmen,alongwithwhitesandAfricanAmericans
comparedtoHispanics.Thosewithahigherincomeandlevelofeducationarealsomorelikelytohave
healthinsurance.Verynearlyalladultsover65havehealthinsurance(99%),mostlyduetoMedicare.

Health insurance coverage, by demographic group
%ofadultswithineachgroupwhohavehealthinsurance
Alladults(n=3,014) 82%
Men(n=1,337) 79
Women(n=1,677) 86*
Age
1829(n=478) 64
3049(n=833) 83*
5064(n=814) 86*
65+(n=830) 99***
Race/ethnicity
White,NonHispanic(n=1,864) 87**
Black,NonHispanic(n=497) 81*
Hispanic(n=427) 63
Annualhouseholdincome
Lessthan$30,000/yr(n=876) 67
$30,000$49,999(n=523) 84*
$50,000$74,999(n=371) 95**
$75,000+(n=680) 96**
Educationlevel
Nohighschooldiploma(n=269) 67
Highschoolgrad(n=830) 78*
SomeCollege(n=778) 82*
College+(n=1,115) 94***
Source:PewResearchCentersInternet&AmericanLifeProject,August7
September6,2012Survey.N=3,014adultsandthemarginoferroris+/2.4
percentagepointsforthefullsample.Marginsoferrorforsubpopulationsare
higher.
*Statisticallysignificantdifferencecomparedwithothersinthesamegroup.
Additionalasterisksindicateamoresignificantdifference.

28

Additionaldetailsaboutthosewhopostreviewsonline.

29

Survey questions
Heal t h Tracki ng Sur vey 2012
Revised Topline 11/ 27/ 2012
DataforAugust7September6,2012
Princet on Survey Research Associat es I nt ernat ional for
t he Pew Research Cent ers I nt ernet & American Life Proj ect


Sample: n= 3,014 nat ional adult s, age 18 and older, including 1,206 cell phone int erviews
I nt erviewing dat es: 08.07.2012 09.06.2012

Margin of error is plus or minus 2.4 percent age point s for result s based on t ot al [ n= 3,014]
Margin of error is plus or minus 2.6 percent age point s for result s based on int ernet users [ n= 2,392]
Margin of error is plus or minus 2.6 percent age point s for result s based on cell phone owners [ n= 2,581]
Margin of error is plus or minus 3.1 percent age point s for result s based on online healt h seekers [ n= 1,741]
Margin of error is plus or minus 3.8 percent age point s for result s based on caregivers [ n= 1,171]

Q1 Overall,howwouldyouratethequalityoflifeforyouandyourfamilytoday?Wouldyousayitis
excellent,verygood,good,fairorpoor?

EXCELLENT VERY GOOD GOOD FAI R POOR DON' T KNOW

2
REFUSED
Current
17 26 32 19 5 * *

2
For t his quest ion and many ot hers t hroughout t he t opline, result s for Dont know oft en reflect combined Dont know
and Refused percent ages. DK and REF are report ed separat ely where available.

30

I NTUSE Do you use t he int ernet , at least occasionally?

EMLOCC Do you send or receive email, at least occasionally?
I NTMOB Do you access t he int ernet on a cell phone, t ablet or ot her mobile handheld device, at
least occasionally?
3

USES I NTERNET
DOES NOT USE
I NTERNET
Current 81 19

QL1 Do you have a cell phone... or a Blackberry or iPhone or ot her device t hat is also a cell
phone?
4

YES NO DON T KNOW REFUSED

Current
85 15 * 0

SMPH Some cell phones are called smart phones because of cert ain feat ures t hey have. I s
your cell phone a smart phone, such as an iPhone, Android, Blackberry or Windows
phone, or are you not sure?
5

Based on cell phone owners
CURRENT

%
53 Yes, smart phone

40 No, not a smart phone

6 Not sure/ Dont know

* Refused
[ n= 2,581]

3
The definit ion of an int ernet user varies from survey t o survey. From January 2005 t hru February 2012, an int ernet user is
someone who uses t he int ernet at least occasionally or sends/ receives email at least occasionally (t wo-part definit ion wit h
quest ion wording Do you use t he int ernet , at least occasionally? OR Do you send or receive email, at least
occasionally? ). Prior t o January 2005, an int ernet user is someone who goes online t o access t he int ernet or t o send and
receive email (quest ion wording Do you ever go online t o access t he I nt ernet or World Wide Web or t o send and receive
email? ).
4
Quest ion was asked of landline sample only. Result s shown here have been recalculat ed t o include cell phone sample in
t he "Yes" percent age. I n past polls, quest ion was somet imes asked as an independent quest ion and somet imes as an it em
in a series. I n January 2010, quest ion wording was Do you have...a cell phone or a Blackberry or iPhone or ot her handheld
device t hat is also a cell phone. I n Dec 2008, Nov 2008, May 2008, January 2005 and Nov 23-30 2004, quest ion wording
was "Do you happen t o have a cell phone?" I n August 2008, July 2008 and January 2008, quest ion wording was "Do you
have a cell phone, or a Blackberry or ot her device t hat is also a cell phone?" I n April 2008, Dec 2007, Sept 2007 and April
2006, quest ion wording was Do you have a cell phone? Beginning December 2007, quest ion/ it em was not asked of t he
cell phone sample, but result s shown here reflect Tot al combined Landline and cell phone sample.
5
Prior t o t he current survey, quest ion wording was slight ly different : Some cell phones are called smart phones because of
cert ain feat ures t hey have. I s your cell phone a smart phone or not , or are you not sure?

31

CELL1 Please t ell me if you ever use your cell phone t o do any of t he following t hings. Do you
ever use your cell phone t o [ I NSERT I TEMS; ALWAYS ASK a-b FI RST in order;
RANDOMI ZE c-f] ?
6

Based on cell phone owners

YES NO DON T KNOW REFUSED

a. Sendorreceiveemail

Current[N=2,581]
50 50 * 0
b. Sendorreceivetextmessages

Current
80 20 * 0
c. Takeapicture

Current
82 18 * *
d. Accesstheinternet
7

Current
56 44 0 0
e. Lookforhealthormedical
informationonline
8

Current
31 69 * *
f. Checkyourbankaccountbalanceor
doanyonlinebanking
9

Current
29 70 * *

6
I n May 2011, t he quest ion was asked of all Form B cell phone owners and Form A cell phone owners who said in CELL7
t hat t hey do more t han make calls on t heir phone. The percent ages shown here are based on all cell phone users, count ing
as no Form A cell phone owners who said in CELL7 t hey use t heir phones only for making calls. Prior t o May 2011,
quest ion was asked of all cell phone owners. Prior t o January 2010, quest ion wording was Please t ell me if you ever use
your cell phone or Blackberry or ot her device t o do any of t he following t hings. Do you ever use it t o [ I NSERT I TEM] ? I n
January 2010, quest ion wording was Please t ell me if you ever use your cell phone or Blackberry or ot her handheld device
t o do any of t he following t hings. Do you ever use it t o [ I NSERT I TEMS] ? For January 2010, December 2009, and
Sept ember 2009, an answer cat egory Cell phone cant do t his was available as a volunt eered opt ion; No percent ages for
t hose t rends reflect combined No and Cell phone cant do t his result s.
7
I n December 2007, it em wording was Access t he int ernet for news, weat her, sport s, or ot her informat ion
8
I n April 2012, quest ion was asked of cell phone owners who use t he int ernet or email on t heir cell phone or download
apps t o t heir cell phone [ N= 953] ; result s are re-percent aged on all cell phone owners. I n Sept ember 2010, quest ion was a
st andalone quest ion wit h t he following quest ion wording: Do you ever use your cell phone t o look up healt h or medical
informat ion?
9
I n April 2012, quest ion was asked of Form A cell phone owners who use t he int ernet or email on t heir cell phone or
download apps t o t heir cell phone [ N= 953] ; result s are re-percent aged on all Form A cell phone owners.

32

Q2 Swit ching t opics... I n general, how would you rat e your own healt h excellent , good,
only fair, or poor?

CURRENT

% 28 Excellent
52 Good
16 Only fair
4 Poor
* Dont know
* Refused

33

Q3 Are you now living wit h any of t he following healt h problems or condit ions? First ,
[ I NSERT I TEM; RANDOMI ZE a-e; I TEM f ALWAYS LAST] ? And what about ... [ I NSERT
I TEM] ? [ I F NECESSARY: Are you now living wit h [ I NSERT I TEM] ?]

YES NO DON T KNOW REFUSED

a. Diabetesorsugardiabetes

Current
11 88 * *
b. Highbloodpressure

Current
25 74 1 *
c. Asthma,bronchitis,emphysema,orother
lungconditions

Current
13 86 * *
d. Heartdisease,heartfailureorheartattack

Current
7 92 * *
e. Cancer

Current
3 96 * *
f. Anyotherchronichealthproblemor
conditionIhaventalreadymentioned

Current
16 83 * *

Q4 I n t he last 12 mont hs, have you personally...[ I NSERT I TEMS I N ORDER] ?

YES NO DON T KNOW REFUSED

a. Facedaseriousmedicalemergencyor
crisis
10

Current
11 89 * *
b. Gonetotheemergencyroomorbeen
hospitalizedunexpectedly

Current
17 83 * *

10
I n Sept ember 2010, quest ion was asked as a st andalone quest ion. For December 2008 and earlier, t rend quest ion
wording was: And in t he last 12 mont hs, have you or has someone close t o you faced a serious medical emergency or
crisis?

34

c. Experiencedanysignificantchangeinyour
physicalhealth,suchasgainingorlosinga
lotofweight,becomingpregnant,or
quittingsmoking
11

Current
18 81 * *

Q5 Thinking about t he LAST t ime you had a serious healt h issue or experienced any
significant change in your physical healt h... Did you get informat ion, care or support
from... [ I NSERT I TEM; RANDOMI ZE] ? [ I F YES AND I NTERNET USER: Did you int eract
wit h t hem ONLI NE t hrough t he int ernet or email, OFFLI NE by visit ing t hem in person or
t alking on t he phone, or BOTH online and offline?]
12

YES,
ONLI NE
YES,
OFFLI NE YES, BOTH
NO, NOT A
SOURCE
DON T
KNOW REFUSED
a. Adoctororotherhealthcare
professional

Current
1 61 8 28 1 1
b. Friendsandfamily

Current
1 39 20 39 * 1
c. Otherswhohavethesamehealth
condition

Current
2 15 7 73 1 1

11
I n Sept ember 2010, quest ion was asked as a st andalone quest ion wit h t he following quest ion wording: And in t he last 12
mont hs, have you experienced any ot her significant change in your physical healt h, such as gaining or losing a lot of weight ,
becoming pregnant , or quit t ing smoking?
12
Sept ember 2010 quest ion wording was slight ly different : Thinking about t he LAST t ime you had a healt h issue, did you
get informat ion, care or support from [ I NSERT; RANDOMI ZE] ? [ I F YES AND I NTERNET USER: Did you int eract wit h t hem
ONLI NE t hrough t he int ernet or email, OFFLI NE by visit ing t hem in person or t alking on t he phone, or BOTH online and
offline?]

35

[ READ TO ALL: ] On anot her t opic...

CARE2 I n t he past 12 mont hs, have you provided UNPAI D care t o an adult relat ive or friend 18
years or older t o help t hem t ake care of t hemselves? Unpaid care may include help wit h
personal needs or household chores. I t might be managing a persons finances,
arranging for out side services, or visit ing regularly t o see how t hey are doing. This
person need not live wit h you.
[ I F R ASKS I F GI VI NG MONEY COUNTS, ASK: ] Aside from giving money, do you provide
any ot her t ype of unpaid care t o help t hem t ake care of t hemselves, such as help wit h
personal needs, household chores, arranging for out side services, or ot her t hings?
CURRENT

% 36 Yes
64 No
* Dont know
* Refused

CARE3 Do you provide t his t ype of care t o j ust one adult , or do you care for more t han one
adult ?
Based on t hose who provide unpaid care t o adult s
CURRENT

% 66 One adult only

34 Provide care t o mult iple adult s
* Dont know
* Refused
[ n= 1,085]

36

CARE4 [ ASK I F PROVI DE UNPAI D CARE TO ONE ADULT: ] I s t his person your parent or your
mot her-in-law or fat her-in-law, or not ?
13

CARE5 [ ASK I F PROVI DE UNPAI D CARE TO MULTI PLE ADULTS, DONT KNOW OR REFUSED: ]
Are any of t he adult s you care for your parent or your mot her-in-law or fat her-in-law, or
not ?
14

Based on t hose who provide unpaid care t o adult s
CURRENT

% 47 Yes, parent or mot her-in-law/ fat her-in-law

53 No, not a parent or mot her-in-law/ fat her-in-law
* Dont know
* Refused
[ n= 1,085]

CARE6 I n t he past 12 mont hs, have you provided UNPAI D care t o any CHI LD under t he age of
18 because of a medical, behavioral, or ot her condit ion or disabilit y? This could include
care for ongoing medical condit ions or serious short -t erm condit ions, emot ional or
behavioral problems, or development al problems, including ment al ret ardat ion.
CURRENT

% 8 Yes
92 No
* Dont know
* Refused

13
Sept ember 2010 quest ion wording was slight ly different : I s t his person a parent of yours, or not ?
14
Sept ember 2010 quest ion wording was slight ly different : Are any of t he adult s you care for a parent of yours, or not ?

37

Q6 Now, wed like t o know if youve looked for informat ion ONLI NE about cert ain healt h or
medical issues, eit her for yourself or someone else. Specifically, in t he last 12 mont hs,
have you looked online for informat ion about ... [ I NSERT FI RST I TEM; ASK a-b FI RST I N
ORDER THEN RANDOMI ZE c-k; I TEM L ALWAYS LAST] ? I n t he last 12 mont hs, have you
looked online for informat ion about ... [ I NSERT NEXT I TEM] ?
15

Based on all int ernet users [ N= 2,392]

YES, HAVE
DONE THI S
NO, HAVE NOT
DONE THI S DON T KNOW REFUSED
a. Aspecificdiseaseormedicalproblem

Current
55 44 * *
b. Acertainmedicaltreatmentorprocedure

Current
43 56 * *
c. Healthinsurance,includingprivate
insurance,MedicareorMedicaid

Current
25 75 * *
d. Pregnancyandchildbirth

Current
12 88 0 *
e. Foodsafetyorrecalls

Current
19 80 * *
f. Drugsafetyorrecalls

Current
16 84 * *
g. Medicaltestresults

Current
15 85 * *
h. Howtoloseweightorhowtocontrolyour
weight

Current
27 73 * *
i. Howtoreduceyourhealthcarecosts

Current
11 89 * *

15
Prior t o t he current survey, quest ion wording was: Now, wed like t o ask if youve looked for informat ion ONLI NE about
cert ain healt h or medical issues. Specifically, have you ever looked online for [ I NSERT I TEM] ? List of it ems may vary
from survey t o survey. The phrase in t he last 12 mont hs was added in t he 2012 survey.

38

YES, HAVE
DONE THI S
NO, HAVE NOT
DONE THI S DON T KNOW REFUSED
j. Caringforanagingrelativeorfriend

Current
14 86 * *
k. Adrugyousawadvertised

Current
16 84 * *
l. Anyotherhealthissue

Current
20 79 * *

Totalyestoanyitemabove
72
Totalnotoallitems
28

Q7 Thinking about t he LAST t ime you went online for healt h or medical informat ion... Did
you go online t o look for informat ion relat ed t o YOUR OWN healt h or medical sit uat ion
or SOMEONE ELSES healt h or medical sit uat ion?
Based on online healt h seekers

CURRENT

% 39 Own
39 Someone elses
15 Bot h (VOL.)
3 Dont know
3 Refused
[ n= 1,741]

39

Q8 St ill t hinking about t he LAST t ime you went online t o look for healt h informat ion... How
did you begin looking? Did you st art ... [ READ 1-4 I N ORDER]
Based on online healt h seekers [ N= 1,741]

CURRENT

% 77 At a search engine such as Google, Bing or Yahoo

13 At a sit e t hat specializes in healt h informat ion, like WebMD
2 At a more general sit e like Wikipedia, t hat cont ains informat ion on all kinds of
t opics, OR
1 At a social net work sit e like Facebook?
3 (VOL.) Ot her (SPECI FY)
2 (VOL.) Dont know
2 (VOL.) Refused

There is no Quest ion Q9.

40

Q10 When looking for healt h informat ion online, have you ever been asked t o PAY for access
t o somet hing you want ed t o see on t he int ernet ?
Based on online healt h seekers [ N= 1,741]
CURRENT

% 26 Yes
73 No
1 Dont know
* Refused

Q11 The last t ime you were asked t o PAY t o access healt h cont ent online, what did you do?
Did you... [ READ 1-3; READ CATEGORI ES I N REVERSE ORDER FOR HALF THE SAMPLE]
Based on online healt h seekers who have been asked t o pay for healt h cont ent online [ N= 456]

CURRENT

% 2 Pay for access

83 Try t o find t he same informat ion somewhere else
13 Give up
1 (VOL.) Ot her
* (VOL.) Dont know
* (VOL.) Refused

Q12 Have you ever gone online specifically t o t ry t o figure out what medical condit ion you or
someone else might have?
Based on online healt h seekers [ N= 1,741]
CURRENT

% 59 Yes
40 No
* Dont know
* Refused

41

Q13 Did t he informat ion you found online lead you t o t hink t hat t his was a condit ion t hat
needed t he at t ent ion of a doct or or ot her medical professional, or t hat it was somet hing
you could t ake care of at home?
Based on online healt h seekers who have gone online t o figure out what medical condit ion t hey or someone
else might have [ N= 1,003]

CURRENT

% 46 Needed at t ent ion of doct or

38 Could t ake care of at home
11 Bot h/ in-bet ween (VOL.)
4 Dont know
1 Refused
Q14 Did you happen t o t alk wit h a medical professional about what you found online?
Based on online healt h seekers who have gone online t o figure out what medical condit ion t hey or someone
else might have [ N= 1,003]
CURRENT

% 53 Yes
46 No
1 Dont know
1 Refused
Q15 Did a medical professional confirm what you t hought t he condit ion was wit h a medical
diagnosis, did t hey offer a different medical opinion or diagnosis, or did you not visit a
doct or or ot her medical professional for a diagnosis?
Based on online healt h seekers who have gone online t o figure out what medical condit ion t hey or someone
else might have [ N= 1,003]

CURRENT

% 41 Yes, confirmed
18 No, did not confirm/ offered different diagnosis
35 Did not visit a doct or or medical professional for a diagnosis
2 Confirmed part but not all of Rs diagnosis (VOL.)
1 Medical professional was unable t o diagnose (VOL.)
1 Dont know
1 Refused

42

Q16 Apart from looking for informat ion online, t here are many different act ivit ies relat ed t o
healt h and medical issues a person might do on t he int ernet . I m going t o read a list of
online healt h-relat ed act ivit ies you may or may not have done in t he last 12 mont hs.
Just t ell me if you happened t o do each one, or not . ( First ,) in t he last 12 mont hs, have
you... [ I NSERT I TEM; RANDOMI ZE] ? I n t he last 12 mont hs, have you...[ I NSERT I TEM] ?

YES NO DON T KNOW REFUSED

a. Signeduptoreceiveemailupdatesoralerts
abouthealthormedicalissues

Currentinternetusers[N=2,392]
11 89 * *
b. Readorwatchedsomeoneelse'scommentary
orpersonalexperienceabouthealthormedical
issuesonline

Currentinternetusers
26 74 * *
c. Goneonlinetofindotherswhomighthave
healthconcernssimilartoyours

Currentinternetusers
16 84 * *
d. Downloadedformsonlineorappliedforhealth
insuranceonline,includingprivateinsurance,
Medicare,orMedicaid

Currentinternetusers
12 88 * 0

Q17 St ill t hinking j ust about t he last 12 mont hs, have you post ed a healt h-relat ed quest ion
online or shared your own personal healt h experience online in any way?
Based on all int ernet users [ N= 2,392]
CURRENT

% 8 Yes
92 No
* Dont know
0 Refused

43

Q18 And what was it t hat you post ed or shared online? Was it a specific QUESTI ON about
your healt h, a COMMENT or STORY about your personal healt h experience, or BOTH a
quest ion and a comment ?
Based on int ernet users who have post ed about a healt h t opic or shared a healt h experience online [ N= 173]
CURRENT

% 19 Specific healt h quest ion

40 Comment s/ St ories about personal healt h experiences
38 Bot h
2 Neit her/ Somet hing else (VOL.)
1 Dont know
0 Refused

Q19 And t he LAST t ime you post ed or shared healt h mat erial online, did you post it
somewhere specifically t o get feedback from a healt h professional, or did you post it
somewhere it would be read by a more general audience of friends or ot her int ernet
users?
Based on int ernet users who have post ed about a healt h t opic or shared a healt h experience online [ N= 173]
CURRENT

% 11 Healt h professional
78 More general audience
4 Bot h (VOL.)
5 Neit her/ Somet hing else (VOL.)
1 Dont know
0 Refused

44

Q20 Thinking again about healt h-relat ed act ivit ies you may or may not do online, have you...
[ I NSERT I TEM; RANDOMI ZE] ?

(Next ,) have you...[ I NSERT I TEM] ?
16

YES NO DON T KNOW REFUSED

a. Consultedonlinerankingsorreviewsofdoctors
orotherproviders
17

Currentinternetusers[N=2,392]
17 83 * *
b. Consultedonlinerankingsorreviewsof
hospitalsorothermedicalfacilities
18

Currentinternetusers
14 86 * 0
c. Consultedonlinereviewsofparticulardrugsor
medicaltreatments

Currentinternetusers
18 82 1 *
d. Postedareviewonlineofadoctor

Currentinternetusers
4 96 0 0
e. Postedareviewonlineofahospital

Currentinternetusers
3 97 * *
f. Postedyourexperienceswithaparticulardrug
ormedicaltreatmentonline

Currentinternetusers
3 97 * 0

16
Current quest ion was asked of all int ernet users. Sept ember 2010 t rend quest ion was also asked of all int ernet users,
wit h it ems asked in rot at ed order. December 2008 t rend quest ion was asked of online healt h seekers, wit h t he
following quest ion wording: There are many different act ivit ies relat ed t o healt h and medical issues a person might do
on t he int ernet . I m going t o read a list of t hings you may or may not have ever done online relat ed t o healt h and
medical issues. Just t ell me if you happened t o do each one, or not . Have you [ I NSERT I TEM; ROTATE] ?
17
December 2008 t rend it em wording was Consult ed rankings or reviews online of doct ors or ot her providers
18
December 2008 t rend it em wording was Consult ed rankings or reviews online of hospit als or ot her medical facilit ies

45

[ READ TO CELL PHONE OWNERS: ] Now t hinking about how you might use your cell phone t o
help manage your healt h...

Q21 Do you receive any TEXT updat es or alert s about healt h or medical issues, such as from
your doct ors or pharmacist s?
Based on cell phone owners who t ext message [ N= 1,896]
CURRENT

% 9 Yes
91 No
* Dont know
* Refused

Q22 On your cell phone, do you happen t o have any soft ware applicat ions or apps t hat
help you t rack or manage your healt h, or not ?
Based on cell phone owners
CURRENT

% 11 Yes
88 No
1 Dont know
* Refused
[ n= 2,581]

46

Q23 What kind of healt h apps do you current ly have on your phone? [ I F NECESSARY,
CLARI FY: What healt h issue or t opic do your apps deal wit h?] [ DO NOT READ;
PRECODED OPEN-END]
Based on t hose who have healt h apps on t heir cell phone [ N= 254]

CURRENT

%
38 Exercise, fit ness, pedomet er or heart rat e monit oring (includes specific t ypes of
exercise like running, ab workout s, yoga, et c.)

31 Diet , food, calorie count er

12 Weight

7 Period or menst rual cycle

5 Blood pressure

4 WebMD

3 Pregnancy

2 Blood sugar or diabet es

2 Medicat ion management (t racking, alert s, et c.)

* Mood

* Sleep

14 Ot her (SPECI FY)

6 Dont know

* Refused
Not e: Tot al may exceed 100% due t o mult iple responses.

47

[ READ TO ALL: ] A few last quest ions for st at ist ical purposes only...

I NS1 Now I would like t o ask you about any healt h insurance you CURRENTLY have t hat helps
pay for t he cost of healt h care. I m going t o read a list of a few t ypes of healt h
insurance, and I d like you t o t ell me which of t hese you have, if any. ( First ,) are you
now PERSONALLY covered by [ I NSERT I TEMS I N ORDER] ?
[ I F RESPONDENT NOT SURE WHI CH I NSURANCE I S I NCLUDED: Please t hink about
insurance plans t hat cover t he cost s of doct or and hospit al bills I N GENERAL, and NOT
t hose t hat cover ONLY dent al or eye care or t he cost s of caring for specific diseases.]
[ I F RESPONDENTS TRY TO TELL TYPE THEY HAVE I NSTEAD OF GOI NG THROUGH THE
LI ST: I m sorry but I have t o ask about each t ype of insurance for t he survey. Just t ell
me no if you dont have t his t ype.]

YES NO DON T KNOW REFUSED

a. Privatehealthinsuranceofferedthroughan
employerorunion[IFNO:Thiscouldbe
insurancethroughacurrentjob,aformerjob,
yourjoborsomeoneelsesjob.]
51 47 1 1
b. Aprivatehealthinsuranceplanthatyoubought
yourself
17 82 1 1
c. Medicaid,[IFSTATECALIFORNIA:MediCal],or
someothertypeofstatemedicalassistancefor
lowincomepeople
14 85 1 *
d. Medicare,thegovernmentprogramthatpays
healthcarebillsforpeopleoverage65andfor
somedisabledpeople
21 78 1 *
ItemE:Basedonthosewhoarenotinsuredthrough
privatehealthinsurance,Medicaid,orMedicare
[N=526]

e. HealthinsurancethroughANYothersource,
includingmilitaryorveteranscoverage
12 87 * 1
I NS2 Medicare is healt h insurance coverage most people receive when t hey t urn 65 and are
eligible for Social Securit y. This includes different kinds of healt h plans offered
THROUGH t he Medicare program like t he plans called H-M-Os. Are you now covered
by Medicare or by ANY Medicare plan?
Based on t hose age 65 and older who are not covered by Medicare [ N= 82]
CURRENT

% 38 Yes, covered
56 No, not covered
3 Dont know
3 Refused

48

I NS3 Does t his mean you personally have NO healt h insurance now t hat would cover your
doct or or hospit al bills?
Based on t hose who are not covered by any healt h insurance or are undesignat ed [ N= 450]
CURRENT

% 91 I do NOT have healt h insurance

7 I HAVE some kind of healt h insurance
1 Dont know
2 Refused

SUMMARY OF I NSURANCE STATUS ( BASED ON I NS1, I NS2, I NS3)

CURRENT

% 82 I nsured
18 Not insured

The remaining demographic quest ions are not report ed in t his t opline.

49

Methodology
Summary
The2012HealthSurvey,sponsoredbythePewResearchCentersInternet&AmericanLifeProjectand
theCaliforniaHealthCareFoundation,obtainedtelephoneinterviewswithanationallyrepresentative
sampleof3,014adultslivingintheUnitedStates.Telephoneinterviewswereconductedbylandline
(1,808)andcellphone(1,206,including624withoutalandlinephone).Thesurveywasconductedby
PrincetonSurveyResearchAssociatesInternational.InterviewsweredoneinEnglishandSpanishby
PrincetonDataSourcefromAugust7toSeptember6,2012.Statisticalresultsareweightedtocorrect
knowndemographicdiscrepancies.Themarginofsamplingerrorforthecompletesetofweighteddata
is2.4percentagepoints.
DESIGNANDDATACOLLECTIONPROCEDURES

SampleDesign

Acombinationoflandlineandcellrandomdigitdial(RDD)sampleswasusedtoreacharepresentative
sampleofalladultstheUnitedStateswhohaveaccesstoeitheralandlineorcellulartelephone.Both
samplesweredisproportionatelystratifiedtoincreasetheincidenceofAfricanAmericanandHispanic
respondents.Withinstrata,phonenumbersweredrawnwithequalprobabilities.Thelandlinesamples
werelistassistedanddrawnfromactiveblockscontainingthreeormoreresidentiallistingwhilethecell
sampleswerenotlistassisted,butweredrawnthroughasystematicsamplingfromdedicatedwireless
100blocksandsharedservice100blockswithnodirectorylistedlandlinenumbers.

ContactProcedures

InterviewswereconductedfromAugust7toSeptember6,2012.Asmanyas7attemptsweremadeto
contacteverysampledtelephonenumber.Samplewasreleasedforinterviewinginreplicates,whichare
representativesubsamplesofthelargersample.Usingreplicatestocontrolthereleaseofsample
ensuresthatcompletecallproceduresarefollowedfortheentiresample.Callswerestaggeredover
timesofdayanddaysoftheweektomaximizethechanceofmakingcontactwithpotential
respondents.Eachphonenumberreceivedatleastonedaytimecall.

Forthelandlinesample,interviewersaskedtospeakwitheithertheyoungestmaleoryoungestfemale
currentlyathomebasedonarandomrotation.Ifnomale/femalewasavailableatthetimeofthecall,
interviewersaskedtospeakwiththeyoungestadultoftheoppositesex.Thissystematicrespondent
selectiontechniquehasbeenshowntoproducesamplesthatcloselymirrorthepopulationintermsof
ageandgenderwhencombinedwithcellsample.

Forthecellsample,interviewswereattemptedwiththepersonwhoansweredthephone.Interviewers
firstverifiedthatthepersonwasandadultandinasafeplacebeforecontinuingwiththeinterview.

WEIGHTINGANDANALYSIS

Weightingisgenerallyusedinsurveyanalysistoadjustforeffectsofthesampledesignandto
compensateforpatternsofnonresponsethatmightbiasresults.Theweightingwasaccomplishedin

50

multiplestagestoaccountforthedisproportionatelystratifiedsample,theoverlappinglandlineandcell
sampleframesanddifferentialnonresponseassociatedwithsampledemographics.

Thefirststageofweightingcompensatedforthedisproportionatesampledesign.Thisadjustment
(calledSAMPWTinthedataset)wascomputedbydividingtheproportionofthepopulationfromeach
stratumbytheproportionofsampledrawnfromthestratum.Thelandlineandcellsamplesweredrawn
usingthesamerelativesamplingfractionswithinstratasothe.Table1showstheSAMPWTvaluesby
strata.

Table1.SAMPWTbyStratum
Strata
Population
Dist'n
Sample
Dist'n SAMPWT
1 10.8% 4.1% 2.63
2 9.0% 3.4% 2.63
3 9.8% 3.7% 2.63
4 9.5% 3.6% 2.63
5 10.6% 8.1% 1.31
6 9.0% 10.2% 0.88
7 9.7% 11.1% 0.88
8 11.4% 17.4% 0.66
9 9.3% 17.8% 0.53
10 10.7% 20.5% 0.53

Thesecondstageofweightingcorrectedfordifferentprobabilitiesofselectionbasedonthe
numberofadultsineachhouseholdandeachrespondentstelephoneuse(i.e.,whethertherespondent
hasaccesstoalandline,toacellphoneortobothtypesofphone).
Thesecondstageweightcanbeexpressedas:

1
IIi [
S
LL
S
CP

1
A

+ (CP

R)



LL
i
=1ifrespondenthasalandlinephoneand=0ifrespondenthasnolandlinephone
CP

=1ifrespondenthasacellphoneand=0ifrespondenthasnocellphone
S
LL
thesizeofthelandlinesample
S
CP
thesizeofthecellsample
R theestimatedratioofthesizeofthelandlinesampleframetothesizeofthecell

51

sampleframe.ForthissurveyR=0.55.

Bothadjustmentswereincorporatedintoafirststageweightthatwasusedasaninputweightforpost
stratification.Thedatawasrakedtomatchsampledistributionstopopulationparameters.TheAfrican
AmericanandWhite/Othersampleswererakedtomatchparametersforsexbyage,sexbyeducation,
agebyeducationandregion.Hispanicswererakedtomatchpopulationparametersforsexbyage,sex
byeducation,agebyeducationandregion.Inaddition,theHispanicgroupwasrakedtoanativity
parameter.

Thecombineddatawasthenrakedtomatchpopulationparametersforsexbyage,sexbyeducation,
agebyeducation,region,householdphoneuseandpopulationdensity.Thewhite,nonHispanic
subgroupwasalsobalancedbyage,educationandregion.Thetelephoneusageparameterwasderived
fromananalysisofrecentlyavailableNationalHealthInterviewSurveydata
19
.Thepopulationdensity
parameteriscountybasedandwasderivedfromCensus2000data.Allotherweightingparameters
werederivedfromtheCensusBureaus2011AnnualSocialandEconomicSupplement(ASEC).

Thisstageofweighting,whichincorporatedeachrespondent'sfirststageweight,wasaccomplished
usingSampleBalancing,aspecialiterativesampleweightingprogramthatsimultaneouslybalancesthe
distributionsofallvariablesusingastatisticaltechniquecalledtheDemingAlgorithm.Theraking
correctsfordifferentialnonresponsethatisrelatedtoparticulardemographiccharacteristicsofthe
sample.Thisweightensuresthatthedemographiccharacteristicsofthesamplecloselyapproximatethe
demographiccharacteristicsofthepopulation.Table2comparesfullsampleweightedandunweighted
sampledemographicstopopulationparameters.

19
Blumberg SJ, Luke JV. Wireless subst it ut ion: Early release of est imat es from t he Nat ional Healt h I nt erview Survey,
July-December, 2011. Nat ional Cent er for Healt h St at ist ics. June 2012.

52

Table2.SampleDemographics
Parameter Unweighted Weighted
Gender
Male 48.6 44.4 48.9
Female 51.4 55.6 51.1
Age
18-24 12.8 10.0 12.8
25-34 18.0 12.4 17.5
35-44 17.2 13.2 17.3
45-54 19.0 17.8 19.2
55-64 16.0 18.5 16.0
65+ 17.0 28.1 17.3
Education (changed)
Less than HS Graduate 13.3 9.0 11.7
HS Graduate 30.4 27.7 30.6
Some College/Assoc
Degree 28.5 26.0 28.8
College Graduate 27.8 37.3 28.9
Race/Ethnicity
White/not Hispanic 67.8 63.0 68.1
Black/not Hispanic 11.5 16.8 11.8
Hisp - US born 6.6 7.6 6.6
Hisp - born outside 7.4 6.8 7.0
Other/not Hispanic 6.7 5.7 6.5
Region
Northeast 18.3 16.4 19.2
Midwest 21.7 19.0 22.1
South 36.8 41.5 36.1
West 23.2 23.0 22.6
(continued)

Table2.SampleDemographics(continued)
County Pop. Density
1 - Lowest 20.1 18.8 20.4
2 20.0 18.0 20.1
3 20.1 18.9 20.2
4 20.2 20.0 19.9
5 - Highest 19.6 24.4 19.3

53

Household Phone Use

LLO 7.0 7.9 7.2
Dual - few,some cell 39.0 54.4 40.3
Dual - most cell 18.8 16.9 18.9
CPO 35.2 20.8 33.6

EffectsofSampleDesignonStatisticalInference

Postdatacollectionstatisticaladjustmentsrequireanalysisproceduresthatreflectdeparturesfrom
simplerandomsampling.PSRAIcalculatestheeffectsofthesedesignfeaturessothatanappropriate
adjustmentcanbeincorporatedintotestsofstatisticalsignificancewhenusingthesedata.Thesocalled
"designeffect"ordeffrepresentsthelossinstatisticalefficiencythatresultsfromadisproportionate
sampledesignandsystematicnonresponse.Thetotalsampledesigneffectforthissurveyis1.75.

PSRAIcalculatesthecompositedesigneffectforasampleofsizen,witheachcasehavingaweight,w
i

as:







2
1
1
2
|
.
|

\
|
=

=
=
n
i
i
n
i
i
w
w n
deff formula1

54

Inawiderangeofsituations,theadjustedstandarderrorofastatisticshouldbecalculatedby
multiplyingtheusualformulabythesquarerootofthedesigneffect(deff).Thus,theformulafor
computingthe95%confidenceintervalaroundapercentageis:





where p isthesampleestimateandnistheunweightednumberofsamplecasesinthegroupbeing
considered.

Thesurveysmarginoferroristhelargest95%confidenceintervalforanyestimatedproportionbased
onthetotalsampletheonearound50%.Forexample,themarginoferrorfortheentiresampleis
2.4percentagepoints.Thismeansthatin95outofevery100samplesdrawnusingthesame
methodology,estimatedproportionsbasedontheentiresamplewillbenomorethan2.4percentage
pointsawayfromtheirtruevaluesinthepopulation.Itisimportanttorememberthatsampling
fluctuationsareonlyonepossiblesourceoferrorinasurveyestimate.Othersources,suchas
respondentselectionbias,questionwordingandreportinginaccuracymaycontributeadditionalerrorof
greaterorlessermagnitude.Table3showsdesigneffectsandmarginsoferrorforkeysubgroups.

Table3.DesignEffectsandMarginsofSamplingError

Sample
Size
Design
Effect MarginofError
TotalSample 3,014 1.75 2.4percentagepoints

White,notHispanic 1,864 1.75 3.0percentagepoints
AfricanAmerican,notHispanic 497 1.62 5.6percentagepoints
Hispanic 427 1.56 5.9percentagepoints

|
|
.
|

\
|


n
p p
deff p

) 1 (
96 . 1
formula2

55

RESPONSERATE

Table4reportsthedispositionofallsampledtelephonenumberseverdialedfromtheoriginal
telephonenumbersamples.Theresponserateestimatesthefractionofalleligiblesamplethatwas
ultimatelyinterviewed.
20

Table 4. Sample Disposition
Landline Cell
1807 1205 I=Completes
8660 10980 R=Refusal and breakoff
3941 5570 NC=Non contact
164 87 O=Other
40051 13668 OF=Business/computer/not working/child's cell phone
4225 619 UH/UO=Unknown household/Unknown other

0.27 0.57 AAPOR's e=(I+R+NC+O)/(I+R+NC+O+OF)

11.5% 6.6% AAPOR RR3=I/[I+R+NC+O+(e*UH/UO)]

20
The sample disposit ion codes and report ing are consist ent wit h t he American Associat ion for Public Opinion
Research st andards.