RESEARCH AND PRACTICE
Health Information–Seeking Behaviors, Health Indicators,
and Health Risks
James B. Weaver III, PhD, MPH, Darren Mays, PhD, MPH, Stephanie Sargent Weaver, PhD, MPH, Gary L. Hopkins, MD, DrPH,
Doğan Eroğlu, PhD, and Jay M. Bernhardt, PhD, MPH
Internet access is a widely available technology
in the United States.1,2 Among the variety of
online activities, searching for and using health
information appear to be particularly prevalent,
undertaken by between 40% and 70% of US
adults.1,3–7 Hoping to take advantage of the
Internet’s potential,8 public health practitioners,
clinicians, and researchers have contributed to an
emerging literature detailing characteristics of
individuals engaging in health information–
seeking behaviors (HISBs), exploring motives
for engaging in HISBs, and documenting the
types of health and medical information being
sought.9–11
Previous HISB research has primarily ex-
amined how patients seek and use health
information across diverse health care contexts,
yielding the recurrent observation that indi-
viduals striving to deal with stressful health
challenges—such as a recent illness diagnosis or
chronic disease management—were strongly
motivated to engage in Internet HISBs.9,10,12–14
Several population-based studies,9,15–21 many of
which have also conceptualized HISB primarily
as ‘‘a key coping strategy in health-promotive
activities and psychosocial adjustment to ill-
ness,’’22(p1006) have yielded corresponding evi-
dence. It should be recognized, however, that
a cluster of these studies17–19,21 were informed by
a common evidentiary resource (i.e., 2000–
2002 Pew Internet and American Life Project
data), potentially exaggerating the apparent con-
sistency of the ‘‘disease and illness’’ motivation
for HISB.
Although informative, the predominant fo-
cus in previous research on a ‘‘disease and
illness’’ motive for HISB has left the hypothesis
that healthy individuals may pursue informa-
tion to maximize positive health outcomes
essentially unexplored.23 A small but growing
body of findings suggests, however, that many
individuals actively seek out wellness informa-
tion (e.g., information promoting a healthy life-
style). Specifically, emerging evidence reveals
1520 | Research and Practice | Peer Reviewed | Weaver et al.
Objectives. We examined how different types of health information–seeking
behaviors (HISBs)—no use, illness information only, wellness information only,
and illness and wellness information combined—are associated with health risk
factors and health indicators to determine possible motives for health informa-
tion seeking.
Methods. A sample of 559 Seattle–Tacoma area adults completed an Internet-
based survey in summer 2006. The survey assessed types of HISB, physical and
mental health indicators, health risks, and several covariates. Covariate-adjusted
linear and logistic regression models were computed.
Results. Almost half (49.4%) of the sample reported HISBs. Most HISBs (40.6%)
involved seeking a combination of illness and wellness information, but both
illness-only (28.6%) and wellness-only (30.8%) HISBs were also widespread.
Wellness-only information seekers reported the most positive health assess-
ments and the lowest occurrence of health risk factors. An opposite pattern
emerged for illness-only information seekers.
Conclusions. Our findings reveal a unique pattern of linkages between the
type of health information sought (wellness, illness, and so on) and health self-
assessment among adult Internet users in western Washington State. These
associations suggest that distinct health motives may underlie HISB, a phenom-
enon frequently overlooked in previous research. (Am J Public Health. 2010;100:
1520–1525. doi:10.2105/AJPH.2009.180521)
a positive association between a self-reported physical health indicators and health risk
‘‘health-conscious’’ or ‘‘health-active’’ orientation factors across 4 discrete categories of Internet
and engaging in wellness information–seeking HISBs—no use, illness content only, wellness
behavior.20,24–27 Indeed, since 2000, the pro- content only, and illness and wellness content
portion of American adults reporting that they combined—among a sample of adults in the
have looked online for diet, exercise, or fitness Seattle–Tacoma, Washington area to explore
information has increased substantially and motivations of HISB.
generally exceeds the proportion seeking online
information about disease and illness topics METHODS
(e.g., cancer, arthritis, diabetes).28,29
Pandey et al. have asked, ‘‘Is it a disease or Adults living in the Seattle–Tacoma Desig-
an affliction that motivates the use of the nated Market Area (DMA) were administered
internet, or is it that the well and the healthy an Internet-based survey in the summer 2006.
use the internet in a proactive manner?’’23(p180) The Seattle–Tacoma DMA includes 18
As this question highlights, the nearly exclusive counties encompassing most of the western half
focus in previous research on Internet HISB as of Washington State. Approximately 72% of
a response to health-threatening situations has the total Washington State population (4.6
left questions regarding the potential positive million people) lives within the Seattle–
health outcomes motivating HISB unan- Tacoma DMA.
swered.22 We aimed to fill this knowledge gap The Seattle–Tacoma DMA was selected for
and further expand understanding of linkages its size (13th largest US media market) and the
between HISB and health perceptions and be- prevalence of Internet use (ranked first in
haviors. Specifically, we compared mental and the nation).30 The sample was drawn from
American Journal of Public Health | August 2010, Vol 100, No. 8

a panel of more than 60000 participants main-
tained by e-Rewards Marketing Research
(www.erewardsresearch.com).31 This panel was
chosen, in part, because it was constructed and is
maintained with a ‘‘by-invitation-only’’ recruit-
ment methodology designed to facilitate effective
demographic normalization while reducing the
potential for self-selection bias.32
A sample of panel members (n = 3140) were
solicited via e-mail by e-Rewards to complete
a consented survey, linked via a separate secure
server, about their self-perceptions and media
use. e-Rewards managed a stratified, multiwave
invitation procedure with oversampling of less
responsive demographic groups designed to
maximize sample representativeness. This pro-
cess yielded an American Association for Public
Opinion Research adjusted response rate33 of
23.69%, which is comparable to those of other
single-invitation online surveys,34,35 and met the
survey quota in approximately 48 hours.
Responses were analyzed from 559 adults,
most of whom were between 35 and 54 years
old (48.5%), female (51.9%), White (82.2%),
married (62.9%), college graduates (63.7%),
and reporting a household income of $75 000
or more (56.5%). These characteristics
(Table 1) were consistent with those samples
derived via random-digit-dialing sampling in
the Seattle–Tacoma DMA,30 with 2 exceptions:
respondents reported both higher household
income and educational achievement. These
differences were anticipated, however, on the
basis of the demographic characteristics of
Internet users.36
Health Information–Seeking Behaviors
HISBs were assessed by asking respondents
‘‘about how much time’’ they spent ‘‘during
a typical week’’ obtaining information online
related to 6 content domains: diet, exercise,
illness or disease, medications, parenting, and
treatments. The 6 items assessing information
content domains were selected from a pool of
several potential items following factor analysis
of formative pilot-test data drawn from mem-
bers of the sampling frame. For each item,
responses were computed to reflect usage per
week in minutes and transformed with a base-
10 logarithm to improve normality.
Principal component factor analysis,
employed to isolate the primary HISB content
dimensions, yielded a 2-factor solution that
August 2010, Vol 100, No. 8 | American Journal of Public Health
RESEARCH AND PRACTICE
accounted for 62% of the variance. Varimax
rotation to simple structures revealed that the
first factor, labeled illness information–seeking
behavior (eigenvalue = 2.50), was defined by
high factor loadings (correlation coefficients
between the variables and the direct factor
indices) on the illness or disease (0.79), medi-
cations (0.86), and treatments (0.78) items.
Factor 2, labeled wellness information–seeking
behavior (eigenvalue =1.22), was defined by
high factor loadings on the exercise (0.88),
diet (0.82), and parenting (0.40) items.
Dichotomous factor indices were created by
summing the variables defining each factor and
then coding all sums greater than zero as in-
dicative of the illness or wellness information–
seeking behavior and all those equal to zero as
not. An HISB measure with 4 discrete levels was
created, and respondents were classified as no
use (50.6%), illness only (14.1%), wellness only
(15.2%), and illness and wellness combined
(20.0%) for subsequent analyses.
Health Indicators
Six questions adopted from the 2006 Be-
havioral Risk Factor Surveillance Survey
(BRFSS) instrument37 assessed respondents’
perceptions of their health. These included
health status (‘‘Would you say that in general
your health is excellent [5], very good [4], good
[3], fair [2], or poor [1]?’’), diminished physical
health (‘‘Now thinking about your physical
health, which includes physical illness and injury,
for how many days during the past 30 days was
your physical health not good?’’), diminished
mental health (‘‘Now thinking about your mental
health, which includes stress, depression, and
problems with emotions, for how many days
during the past 30 days was your mental health
not good?’’), and poor quality of life (‘‘During
the past 30 days, for about how many days did
poor physical or mental health keep you from
doing your usual activities, such as self-care,
work, or recreation?’’). Respondents were asked
their height and weight, and body mass index
was calculated by a standard formula.38 The
variables for diminished physical and mental
health and poor quality of life were transformed
with a base-10 logarithm to improve normality.
Health Risk Factors
Three health risk factors were assessed.
Smoking and physical activity behaviors were
Weaver et al. | Peer Reviewed | Research and Practice | 1521
measured by the BRFSS questions37 ‘‘Do you
now smoke cigarettes every day, some days, or
not at all?’’ and ‘‘During the past month, other
than your regular job, did you participate in any
physical activities or exercises such as running,
calisthenics, golf, gardening, or walking for exer-
cise?’’ Dichotomous variables were computed
for each, with the ‘‘not at all’’ or ‘‘no’’ responses
set as 0 and all other responses as 1. Respondents
were also asked ‘‘Do you purchase prescription
medications?’’ as a proximal measure of any
ongoing medical condition requiring pharma-
ceutical therapy. Responses were coded as
‘‘yes’’ (1) or ‘‘no’’ (0).
Covariates
Building from previous research,21,39,40 we
examined 4 measures as covariates: respon-
dent’s age, household income, perceptions of
health information importance, and overall
Internet use. Respondent’s age (mean = 44.7
years; SD =13.1) was assessed with the ques-
tion, ‘‘What is the YEAR of your birth?’’
Household income (mean = $86 829.84;
SD = $58194.34) was measured by asking
respondents to ‘‘please indicate your gross
family income.’’ The perceived importance of
health information was assessed through re-
spondents’ ratings of ‘‘how important’’ they
considered ‘‘health information,’’ with re-
sponse options including ‘‘I don’t use’’ (0) and
a scale ranging from ‘‘not at all important’’
(1) to ‘‘extremely important’’ (9). All respon-
dents attributed some importance to health
information, with responses ranging from 2
to 9 (mean = 5.67; SD =1.96). Respondents
were also asked how much time they spent
during a typical week ‘‘surfing the Internet’’
outside of work or school responsibilities to
assess overall Internet use (mean = 7.39 h/wk;
SD = 8.77). The variables for household in-
come and Internet use were transformed with
a base-10 logarithm to improve normality.
Statistical Analyses
The primary predictor variable for all
analyses was HISB (no use, illness only,
wellness only, and illness and wellness com-
bined). The 5 health indicators and 3 health
risk factors were the outcome variables. Bi-
variate analyses (Table 1) revealed that only 1
demographic characteristic—respondent’s
sex—varied significantly as a function of
 RESEARCH AND PRACTICE

TABLE 1—Participant Characteristics as a Function of Online Health Information–Seeking Behavior (HISB): Seattle–Tacoma,
Washington, 2006

HISB
% of Estimated No Use Illness Wellness Combined
Seattle–Tacoma % of Estimated (n = 283), (n = 79), % or (n = 85), % or (n = 112), % or
Characteristic Population Sample % or OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) c2 (df)

Age, y 12.72 (6)

18–34 29 27.0 27.6 16.5 36.5 25.9
35–54 42 48.5 44.8 58.2 48.2 50.9
‡ 55 29 24.5 27.6 25.3 15.3 23.2
Educationa,b 9.94 (6)
High school or less 31 5.6 3.2 6.4 9.4 8.0
Some post–high school 34 30.7 34.8 26.9 24.7 27.7
College or more 35 63.7 62.1 66.7 65.9 64.3
Household Income,a $ 13.76 (9)
< 35 000 19 9.8 9.5 5.1 11.8 12.5
35 000–49 999 17 10.6 12.0 16.5 9.4 3.6
50 000–74 999 19 23.1 22.6 24.0 27.1 20.5
‡ 75 000 45 56.5 55.8 54.4 51.8 63.4
Marital statusc 6.82 (6)
Never married 27 26.0 26.1 20.3 29.8 26.8
Married 57 62.9 64.0 62.0 57.1 65.2
Divorced or widowed 16 11.1 9.9 17.7 13.1 8.0
Race/ethnicityd,e 11.51 (9)
White 85 82.2 80.4 86.0 76.5 88.3
African American 4 3.8 3.9 3.8 7.1 0.9
Asian American 6 9.9 11.8 5.1 12.9 6.3
Other 5 4.1 3.9 5.1 3.5 4.5
Sex 17.368* (3)
Female 50 51.9 43.5 55.7 63.5 61.6
Malef 50 48.1 56.5 44.3 36.5 38.4
Sex · HISB interaction 0.50 (0.36, 0.70) 1.19 (0.74, 1.93) 1.76 (1.09, 2.83) 1.64 (1.07, 2.50)

Note. Population estimates were compiled from the 2007 Scarborough Research Report, Release 2 Seattle–Bellevue–Everett Metropolitan Statistical Area.30
a
The population and sample distributions differed significantly across education (c22 = 128.49; P < .05) and household income (c23 = 15.57; P < .05).
b
For the ‘‘No Use’’ HISB category, n = 282. For the ‘‘Illness’’ HISB category, n = 78.
c
For the ‘‘Wellness’’ HISB category, n = 84.
d
Across race/ethnicity, small sample sizes among the African American, Asian American, and Other groups within the HISB cohorts threatened the validity of the c2 test. However, a follow-up test
with these 3 groups collapsed yielded the same statistical decision (c23 = 6.85; not statistically significant).
e
For the ‘‘No Use’’ HISB category, n = 280.
f
Referent categories of dummy-coded variables.
*P < .05, using Sidak’s adjustment.

HISB. In light of this finding and previous
research,4,11,21,39 sex was incorporated as
a moderator of HISB in subsequent analyses.
Consequently, the focal relationships between
HISB and the 8 health outcome measures were
tested with multivariate linear (for the 5 health
indicators) and logistic (for the 3 health-risk
factors) regression models parameterized in
a sex-by-HISB (2 · 4) factorial design with cova-
riate adjustment. Post hoc comparisons were
computed with the t test (linear models) or the
Wald c2 test (logistic models).
RESULTS
The sample comprised 559 adults, 49.4% of
whom reported HISB during a typical week.
More women (60.5%) than men (39.5%)
reported HISB (odds ratio [OR] =1.99; 95%
confidence interval [CI] =1.42, 2.79), with
substantial sex differences evident across the
4 HISB categories (Table 1).
Table 2 displays the test statistics resulting
from linear and logistic models examining the
sex (female, male) by HISB (no use, illness only,
wellness only, and illness and wellness com-
bined) factorial model, adjusted for the cova-
riates. The HISB main effects were significant
(P < .05) for 5 of the 8 health measures: health
status, diminished physical health, poor quality

1522 | Research and Practice | Peer Reviewed | Weaver et al. American Journal of Public Health | August 2010, Vol 100, No. 8
 RESEARCH AND PRACTICE

other groups, they had the highest health

TABLE 2—Analyses of Health Indicators and Health Risk Factors as a Function of Online status, the fewest days of diminished physical
Health Information–Seeking Behavior (HISB) and Respondent’s Sex: Seattle–Tacoma, health, and the lowest poor-quality-of-life as-
Washington, 2006 sessment (Table 3). In addition, wellness-in-
HISB (df = 3) Sex (df = 1) Interaction (df = 3) formation seekers were among the most likely
to engage in physical activities and the least
Health indicator, F (gp2) likely to use prescription medications (Table 3).
Health status 5.75** (0.03) 0.13 (< 0.01) 1.36 (0.01) Illness-information seekers, on the other hand,
Diminished physical healtha 3.52** (0.02) 0.49 (< 0.01) 0.68 (< 0.01) reported poorer health indicators than well-
Diminished mental healtha,b 1.12 (< 0.01) 1.55 (0.01) 2.45 (0.01) ness-information seekers, including lower
Poor quality of lifeb,c 2.74* (0.02) 1.92 (< 0.01) 1.73 (< 0.01) health status, more diminished physical health
Body mass indexa,b 0.34 (< 0.01) 3.69 (0.01) 1.52 (0.01) days, and a poorer quality of life (Table 3).
Health risk factor, c2 (gp2) Furthermore, illness-information seekers were
Physical activitiesa,d 7.96* (0.02) 0.78 (< 0.01) 0.99 (< 0.01) more likely to report health risks—they were
Prescription medicationsb 16.19** (0.03) 2.00 (< 0.01) 0.52 (< 0.01) less likely than wellness-information seekers to
Smoking 4.65 (0.01) 0.02 (< 0.01) 3.18 (< 0.01) engage in physical activities and were more
Note. A 2 · 4 factorial design with respondent’s sex (male, female) and HISB (no use, illness only, wellness only, and illness likely to use prescription drugs (Table 3).
and wellness combined) was parameterized for all linear and logistic regression models.
a
Income included as significant covariate in model. DISCUSSION
b
Age included as significant covariate in model.
c
Overall Internet use included as significant covariate in model.
d
Participation in ‘‘any physical activities or exercises’’ was assessed. The findings demonstrate that health infor-
*P < .05; **P < .001. mation seeking among Seattle–Tacoma Inter-
net users is a prevalent behavior. Consistent
with much previous research on HISB,11,27
of life, physical activities, and prescription Table 3 displays the resulting means and about half of the sample (49.4%) reported
medications (Table 2). The age, income, and percentages associated with the significant spending time during a typical week obtaining
overall Internet use covariates were significant HISB main effects. These results reveal that either illness (14.1%), wellness (15.2%), or both
but modest (gp2 < 0.02) contributors to some wellness-information seekers reported the most types (20.1%) of health information online. HISB
models, as indicated in Table 2. positive health indicators—compared with the was more prevalent among women (60.5%) than
men (39.5%).

TABLE 3—Differences in Respondents’ Health Indicators and Health Risk Factors as Types of Health Information Sought
This report is one of the first to explore
a Function of Online Health Information–Seeking Behavior (HISB): Seattle–Tacoma,
differences in health perceptions and behaviors
Washington, 2006
among individuals seeking different types of
HISB online health information. We discovered
No Use (n = 283) Illness (n = 79) Wellness (n = 85) Combined (n = 112) considerable variability in health indicators
and health risk factors across the 4 levels of
Health indicator, mean (SE)
HISB, with prominent differences between in-
Health status 3.81y (0.53) 3.52x (0.10) 4.05z (0.10) 3.65x,y (0.09)
dividuals exclusively seeking wellness infor-
Diminished physical health 0.22x,y (0.02) 0.31y (0.05) 0.14x (0.05) 0.31y (0.04)
mation and those in the other 3 HISB groups.
Diminished mental health 0.26 (0.03) 0.33 (0.05) 0.28 (0.05) 0.34 (0.04)
Overall, wellness-information seekers reported
Poor quality of life 0.15y (0.02) 0.24z (0.04) 0.11x (0.04) 0.20y,z (0.03)
the most positive health indicators and the
Body mass index 27.15 (0.36) 27.19 (0.65) 27.04 (0.64) 27.77 (0.57)
lowest levels of health risks. The opposite
Health risk factors, %
pattern was evident for illness-information
Physical activitiesa 78.8x 82.3x 94.1y 86.6x,y
x y x seekers, who tended to report the most nega-
Prescription medications 63.6 83.5 57.7 80.4y
tive health indicators and more health risks.
Smoking 13.8 15.2 4.7 12.5
These differences suggest that distinct motiva-
Note. For the health indicators, least square means having different superscripts (x–z) differ at P < .05 by the 2-tailed t test. tions may underlie HISBs,27,40 a phenomenon
For health risk factors, percentages having different superscripts (x–z) differ at P < .05 by the Wald c2 test. Missing data on frequently overlooked in previous research.11
body mass index excluded 16 respondents (total respondents, n = 543; no use, n = 272; illness, n = 77; wellness, n = 84;
illness and wellness combined, n = 110). One key conclusion of this study, illustrated
a
Participation in ‘‘any physical activities or exercises’’ was assessed. by these trends, is that a substantial portion of
health information seekers (30.8%) perceive

August 2010, Vol 100, No. 8 | American Journal of Public Health Weaver et al. | Peer Reviewed | Research and Practice | 1523

themselves as well and healthy and are using
online health information about wellness per-
haps, as others have suggested, ‘‘in a proactive
manner for health promotion.’’23(p187) This
suggests that, with thoughtful formative research
and effective targeting, the Internet could pro-
vide an efficient channel for primary health
promotion and disease prevention activities,
encouraging many individuals engaged in HISB
to maintain a healthy lifestyle.8
By contrast, the findings also show that
many who engage in HISB pursue content
about medical concerns (e.g., illness or disease,
medications, or treatments) and that these
illness information seekers (28.6%) report less
positive health indicators and more health
risks. This would suggest that, consistent with
the bulk of previous research, seeking health
information may be a common behavioral
response among those facing health challenges
and that online health information may effec-
tively bolster secondary and tertiary preven-
tion interventions.
At the same time, the observation that
many health information seekers sought both
illness and wellness information (40.6%;
combined HISB group) was somewhat un-
expected and needs further investigation. One
can quickly envision a number of circum-
stances in which there may be coexisting
needs for different types of health informa-
tion. Therapies for prevalent chronic diseases
(e.g., cardiovascular disease, diabetes), for in-
stance, often involve both medically super-
vised treatments and healthy-lifestyle behav-
ioral changes. Notably, however, there was
essentially no variability in health indicators,
health risk factors, perceived importance of
health information, overall Internet use, and
demographic characteristics between the
illness-only and combined groups.
Possible Motives for Health Information-
Seeking Behavior
Taken together, the direct linkages between
health assessments and the type of health
information sought online observed in this
study suggests that different health-related
motives may underlie each type of HISB. This
observation appears inconsistent with expla-
nations for Internet HISB built on concepts
such as the ‘‘cyberchondriac’’1—a word
frequently ‘‘used to describe anyone who
1524 | Research and Practice | Peer Reviewed | Weaver et al.
RESEARCH AND PRACTICE
seeks health-related information on the
Internet’’41(p209)—or ‘‘incidental health infor-
mation use’’ (e.g., inadvertent or nonpurposive
use of health information).42 Instead, the data
at hand suggest that further exploration of in-
dividual-level antecedents of HISB,27,40 particu-
larly the cognitive and affective components of
health anxiety,40,43–47 could prove a fruitful
avenue for future research.
Equally important, the fact that most
(50.6%) of this Seattle–Tacoma sample
reported no HISB raises critical questions
about the viability of the Internet as a channel
for health promotion and disease prevention
that require further consideration. The consis-
tency of this observation across numerous
studies1,5,6,9,15,24 highlights the need for research
to extend our understanding of why so many
people apparently ignore easily accessible in-
formation resources that could aid in maximizing
their health. The current results offer few in-
sights, since several potential determinants (e.g.,
poor health literacy and media literacy, demo-
graphics) seem unlikely contributors given the
characteristics of the sample (i.e., Internet users
with elevated income and education levels).
Clearly, if our goal is to convey health-promoting
content to the broadest audience, further re-
search examining the barriers and motives
influencing HISB is necessary to facilitate en-
gagement with those who are not actively seek-
ing health information.
Although this study reveals new insights re-
garding HISB, there are several limitations to
acknowledge. First, this is a cross-sectional study
and attribution of causality is not warranted. In
addition, the sample characteristics (e.g., concen-
trated in western Washington State, drawn from
an Internet-based panel) limit generalizability.
Finally, although informed by formative research
and more detailed than most previous research,11
the 6 health information–seeking domains
examined here were not comprehensive and left
considerable room for respondents’ interpreta-
tion. Future studies of HISB can substantially
advance our understanding by refining measures
to capture in greater detail the characteristics
of respondents’ choices and preferences regard-
ing health information.
In conclusion, the findings reveal distinct
patterns in the health information content
sought by adult Internet users in western
Washington State and highlight unique
American Journal of Public Health | August 2010, Vol 100, No. 8
linkages between the type of health informa-
tion sought (e.g., wellness, illness, and so on)
and several health indicators and health risk
factors. As reported in previous research,
much HISB seems to be disease or illness
oriented. Actively seeking wellness informa-
tion, on the other hand, emerges as a unique
behavior among many health-conscious in-
dividuals. These findings demonstrate ‘‘that
consumers who are active health information
seekers are not a monolithic group, and
should not be treated as one.’’27(p42) The
findings suggest that integration of a basic com-
munication-tailoring strategy, targeted toward
specific health indicators and health risks, into
Internet health communication endeavors
could substantially improve the efficacy of the
Internet as a channel for primary, secondary,
and tertiary prevention. j
About the Authors
James B. Weaver, III, Darren Mays, Stephanie Sargent
Weaver, Doğan Eroğlu, and Jay M. Bernhardt are with the
National Center for Health Marketing, Centers for Disease
Control and Prevention, Atlanta, GA. Gary L. Hopkins is
with the Center for Media Impact Research, Institute for the
Prevention of Addictions, Andrews University, Berrien
Springs, MI.
Correspondence should be sent to James B. Weaver,
III, Centers for Disease Control and Prevention, 1600
Clifton Road MS-E21, Atlanta, GA 30333 (e-mail:
jim.weaver@cdc.gov). Reprints can be ordered at
http://www.ajph.org by clicking on the ‘‘Reprints/
Eprints’’ link.
This article was accepted December 8, 2009.
Contributors
James B. Weaver, III originated the study and supervised
all aspects of the preparation of the article. Darren Mays
and Stephanie Sargent Weaver assisted with data anal-
ysis and interpretation and assumed a primary role in
writing the article. All other authors conceptualized ideas,
interpreted results, and reviewed drafts of the article.
Acknowledgments
This research was supported in part by a grant from the
Center for Media Impact Research in the Institute for
Prevention of Addictions at Andrews University and by
appointments of D. Mays and S. S. Weaver to the Re-
search Participation Program at the Centers for Disease
Control and Prevention (CDC) administered by the Oak
Ridge Institute for Science and Education through an
interagency agreement between the US Department of
Energy and the CDC.
We are indebted to Richard E. Dixon, Wendi
Kannenberg, Duane C. McBride, John V. Stevens Jr,
and the anonymous reviewers for their significant con-
tributions to this project.
Note. The findings and conclusions in this article are
those of the authors and do not necessarily represent the

views of the CDC or the US Department of Health and
Human Services.
Human Participant Protection
The institutional review boards of Andrews University,
Emory University, Loma Linda University, and Virginia
Polytechnic Institute and State University approved the
protocol for this study.
References
1. Harris Interactive Inc. Harris Poll shows number of
‘‘cyberchondriacs’’—adults who have ever gone online for
health information—increases to an estimated 160 mil-
lion nationwide. July 31, 2007. Available at: http://
www.harrisinteractive.com/vault/Harris-Interactive-Poll-
Research-Cyberchondriacs-2007-07.pdf. Accessed
August 4, 2008.
2. Online Activities: Total. Washington, DC: Pew Internet
and American Life Project; 2008. Available at: http://
www.pewinternet.org/Trend-Data/Online-Activites-Total.
aspx. Accessed October 9, 2008.
3. Anderson JG. Consumers of e-health: patterns of
use and barriers. Soc Sci Comput Rev. 2004;22(2):242–
248.
4. Elkin N. How America Searches: Health and Wellness.
Scottsdale, AZ: iCrossing; 2008. Available at: http://
www.icrossing.com/research/how-america-searches-
health-and-wellness.php. Accessed August 1, 2008.
5. Fox S. Health information online. Pew Internet and
American Life Project, 2005. Available at: http://
www.pewinternet.org/Reports/2005/Health-
Information-Online.aspx. Accessed June 11, 2008.
6. Fox S, Fallows D. Internet health resources. Pew
Internet and American Life Project, 2003. Available at:
http://www.pewinternet.org/Reports/2003/Internet-
Health-Resources.aspx. Accessed June 11, 2008.
7. Tu HT, Cohen G. Striking Jump in Consumers Seeking
Health Care Information. Washington, DC: Center for
Studying Health Systems Change; 2008. Available at:
http://hschange.org/CONTENT/1006. Accessed August
21, 2008.
8. Lintonen TP, Konu AI, Seedhouse D. Information
technology in health promotion. Health Educ Res. 2008;
23(3):560–566.
9. Ayers SL, Kronenfeld JJ. Chronic illness and health-
seeking information on the Internet. Health (London).
2007;11(3):327–347.
10. Huang GJ, Penson DF. Internet health resources and
the cancer patient. Cancer Invest. 2008;26(2):202–207.
11. Weaver JB III, Mays D, Lindner G, Eroglu D,
Fridinger F, Bernhardt JM. Profiling characteristics of
internet medical information users. J Am Med Inform
Assoc. 2009;16(5):714–722.
12. Josefsson U, Murero M, Rice RE. Online information-
seeking behavior. In: Murero M, Rice RE, eds. The Internet
and Health Care: Theory, Research, and Practice. Mahwah,
NJ: Lawrence Erlbaum Associates; 2006:127–147.
13. Morahan-Martin JM. How Internet users find, eval-
uate, and use online health information: a cross-cultural
review. Cyberpsychol Behav. 2004;7(5):497–510.
14. Schwartz KL, Roe T, Northrup J, Meza J, Seifeldin R,
Neale AV. Family medicine patients’ use of the Internet
for health information: a MetroNet study. J Am Board
Fam Med. 2006;19(1):39–45.
August 2010, Vol 100, No. 8 | American Journal of Public Health
RESEARCH AND PRACTICE
15. Baker L, Wagner TH, Singer S, Bundorf MK. Use of
the Internet and e-mail for health care information:
results from a national survey. JAMA. 2003;289(18):
2400–2406.
16. Bundorf MK, Singer S, Wagner TH, Baker L.
Consumers’ use of the Internet for health insurance. Am
J Manag Care. 2004;10(9):609–616.
17. Goldner M. Using the Internet and email for health
purposes: the impact of health status. Soc Sci Q. 2006;
87(3):690–710.
18. Goldner M. How health status impacts the types of
information consumers seek online. Inf Commun Soc.
2006;9(6):693–713.
19. Houston TK, Allison JJ. Users of Internet health
information: difference by health status. J Am Med Inform
Assoc. 2002;4:e7.
20. Renahy E, Raizot I, Chaivin P. Health information
seeking on the Internet: a double divide? Results from
a representative survey in the Paris metropolitan area,
France, 2005–2006. BMC Public Health. 2008;8:69.
21. Rice RE. Influences, usage, and outcomes of Internet
health information searching: multivariate results from
the Pew surveys. Int J Med Inform. 2006;75(1):8–28.
22. Lambert SD, Loiselle CG. Health information seek-
ing behavior. Qual Health Res. 2007;17(8):1006–1019.
23. Pandey SK, Hart JJ, Tiwary S. Women’s health and
the Internet: understanding emerging trends and impli-
cations. Soc Sci Med. 2003;56(1):179–191.
24. Dutta-Bergman MJ. Health attitudes, health cogni-
tions, and health behaviors among Internet health in-
formation seekers: population-based survey. J Med Inter-
net Res. 2004;6(2):e15.
25. Dutta-Bergman MJ. Developing a profile of con-
sumer intention to seek out additional information
beyond a doctor: the role of communicative and moti-
vation variables. Health Commun. 2005;17(1):1–16.
26. Verheijden MW, Jans MP, Hildebrandt VH, et al.
Rates and determinants of repeated participation in
a Web-based behavior change program for healthy body
weight and healthy lifestyle. J Med Internet Res. 2007;
9(1):e1.
27. Navarro FH, Wilkins ST. A new perspective on
consumer health Web use: ‘‘valuegraphic’’ profiles of
health information seekers. Manag Care Q. 2001;9(2):
35–43.
28. Fox S, Jones S. Americans’ pursuit of health takes
place within a widening network of both online and
offline sources. Pew Internet and American Life Project,
2009. Available at: http://pewinternet.org/Reports/
2009/8-The-Social-Life-of-Health-Information.aspx.
Accessed July 31, 2009.
29. Sillence E, Briggs P, Harris PR, Fishwick L. How do
patients evaluate and make use of online health infor-
mation? Soc Sci Med. 2007;64(9):1853–1862.
30. Seattle Times Company. Seattle market overview.
2007. Available at: http://www.seattletimescompany.
com/advertise/pdfs/smo_spring07.pdf. Accessed July
14, 2007.
31. e-Rewards Marketing Research. e-Rewards US
consumer panel. 2008. Available at: http://www.e-
rewardsresearch.com/downloads/US_Consumer_
Panels.pdf. Accessed September 23, 2008.
32. e-Rewards Marketing Research. e-Rewards meth-
odology: recruitment. 2009. Available at: http://www.
Weaver et al. | Peer Reviewed | Research and Practice | 1525
e-rewardsresearch.com/eri_m_methRecruit.htm.
Accessed August 25, 2009.
33. Standard Definitions: Final Dispositions of Case Codes
and Outcome Rates for Surveys. 5th ed. Lenexa, KS:
American Association for Public Opinion Research;
2008. Available at: http://www.aapor.org/uploads/
Standard_Definitions_04_08_Final.pdf. Accessed
August 10, 2009.
34. Ekman A, Litton JE. New times, new needs; e-
epidemiology. Eur J Epidemiol. 2007;22(5):285–292.
35. Gosling SD, Vazire S, Srivastava S, John OP. Should
we trust Web-based studies? A comparative analysis of
six preconceptions about Internet questionnaires. Am
Psychol. 2004;59(2):93–104.
36. Pew Internet and American Life Project. February
15–March 7, 2007 tracking survey. 2008. Available
at: http://www.pewinternet.org/;/media/Files/
Questionnaire/Old/PIAL%20Feb07%20Tracking
%20FINAL%20Topline%20Excerpt.pdf. Accessed
June 27, 2008.
37. 2006 Behavioral Risk Factor Surveillance System
Questionnaire. Atlanta, GA: Centers for Disease Control
and Prevention; 2006.
38. BMI-Body Mass Index: How Is BMI Calculated and
Interpreted? Atlanta, GA: Centers for Disease Control and
Prevention; 2008. Available at: http://www.cdc.gov/
healthyweight/assessing/bmi/adult_bmi/index.html.
Accessed June 27, 2008.
39. Drentea P, Goldner M, Cotton S, Hale T. The
association among gender, computer use, and online
health searching, and mental health. Inf Commun Soc.
2008;11(4):509–525.
40. Lemire M, Pare G, Sicotte C, Harvey C. Determinants
of Internet use as a preferred source of information
on personal health. Int J Med Inform. 2008;77(11):
723–734.
41. Smith PK, Davies P, Hamidi-Manesh L. Cyberchon-
driacs. Int J Adolesc Med Health. 2006;18(2):209–213.
42. Tian Y, Robinson JD. Incidental health information
use on the Internet. Health Commun. 2009;24(1):41–49.
43. Eastin MS, Guinsler NM. Worried and wired: effects
of health anxiety on information-seeking and health care
utilization behaviors. Cyberpsychol Behav. 2006;9(4):
494–498.
44. Hadjistavropoulos HD, Craig KD, Hadjistavropoulos
T. Cognitive and behavioral responses to illness infor-
mation: the role of health anxiety. Behav Res Ther.
1998;36(2):149–164.
45. Lee SY, Hwang H, Hawkins R, Pingree S. Interplay of
negative emotion and health self-efficacy on the use of
health information and its outcomes. Communic Res.
2008;35(3):358–381.
46. Sonnenberg FA. Health information on the Inter-
net—opportunities and pitfalls. Arch Intern Med. 1997;
157(2):151–152.
47. Turner MM, Rimal RN, Morrison D, Kim H. The role
of anxiety in seeking and retaining risk information:
testing the risk perception attitude framework in two
studies. Hum Commun Res. 2006;32(2):130–156.