Computers and the Internet show substantial promise for increasing participation in health promotion activities; thus, we might have more difficulty reducing health disparities if access to technology is not actively promoted [34
]. This large study of low-income public housing residents indicated that more than half owned home computers. This level of computer ownership is higher than that found for the general population in recent national surveys (~ 44%) [6
] and that found by other studies in similar low-income populations [35
Most of the attention on reducing the digital divide has been focused on improving access for racial/ethnic minorities. However, access is only one piece of the equation. To fully realize the benefits of computers and the Internet, regular computer use, which builds computer literacy and instills confidence, must be achieved. Our study showed that 42% of participants regularly used a computer, which indicates that there is a large group of low-income racial/ethnic minorities that are potentially experienced computer users. Most participants reported that they used a computer more often at home rather than at work or elsewhere. The location where an individual uses the computer often reflects the quality of their computer and/or computer access [36
]. Our finding of substantial home use is encouraging. Most people use computers at home, likely due to a combination of convenience and employment in settings without computer access. Healthy People 2010 emphasizes the importance of home computers and Internet access to increase opportunities for health communication and improve health [37
]. Therefore, making computer ownership more available and affordable is important.
This study also points out that there is still a significant group that does not have access to this technology, with 48% of participants reporting that they had never used a computer. The factors that may impact computer use in this population are not clear. Social contextual factors were not as strongly associated with ownership and use as we hypothesized. In addition to employment, we conjecture that cost is likely an issue, as is lack of interest and relevance. Age did appear to be a key factor, in that the majority of older adults (65+ years) did not own (82%) and had never used (86%) a computer. Although older adults are more likely to report greater barriers (eg, vision problems or other disability) to computer use, [38
] studies also show that they are just as likely as younger populations to be interested in using computers to look for health information [39
]. The current computer skills acquired by today’s baby boomers are likely to lessen or eliminate the differential in computer use among the elderly; however, exploring psychosocial and motivational reasons for computer ownership, particularly among elderly who do not currently possess such skills, is important if we are to increase access in this population.
As expected and consistent with the findings of other reports, [36
] we found that sociodemographic factors, employment, and income were positively associated with computer ownership and regular computer use. However, the association between perceived financial hardship and greater ownership would seem counterintuitive considering the above association. We suggest future work to explore whether (1) people now consider computers a necessity and thus find ways to include them in their budget, as noted by one report [43
], (2) the association is being confounded by having children under the age of 18 in the household (this was not included in our survey), (3) perceived financial hardship and objective measures of poverty are not measuring the same constructs, or (4) low-income families own computers through the efforts of computer donation programs.
Interestingly, being non-Hispanic was positively associated with regular computer use, but not computer ownership in multivariable models. Although rates of ownership may be similar among racial/ethnic groups, computer use varies. In our study, more Hispanics (61%) than any other racial/ethnic group never used a computer. We also found that greater education was associated with greater computer ownership and regular computer use; in bivariate analyses, there was a positive dose-response relationship between education and ownership and use. Education is a consistently strong predictor of access to and interest in information services, including the Internet and computers [3
]. Low levels of education likely explain a large part of the difference in the digital divide between Hispanics and others [45
], and more strategies are needed to increase ownership and access in this group. Moreover, computers serve as an educational tool that can help increase education for both children and adults [47
]. Consequently, the US government and other private nonprofit groups, such as the Bill and Melinda Gates Libraries Initiative, have focused on increasing computer access for low-income groups, such as through public libraries, which are key venues for increasing literacy and an educated workforce [48
Select social contextual factors were also associated with computer ownership and use. For example, feeling safe in one’s neighborhood was associated with a 76% increase in being a regular computer user. This may be particularly salient for those who access computers outside the home, such as a library or neighborhood center. In our study area, there are a number of community computer centers, and this trend of having computers at community centers is growing nationally. We also found that having multiple responsibilities was strongly correlated with computer use. This could be explained by the fact that our low-income study population was largely female (71%) and unmarried (68%) and thus likely to be responsible for childrearing, finances, and taking care of other households (eg, parents). They are also likely to be employed in order to meet these needs. This accounts for our finding that employment increases computer ownership. Moreover, one study found that employed women with caregiving responsibilities were likely to have a “management style” of executing tasks [50
]; computers would help them coordinate services and resources to maintain control. We also found an association between social network ties and frequency of computer use. Computer access has been shown to be particularly important in building social support among those dealing with chronic illness. Several studies have shown that online support groups for breast cancer survivors and parents of ill children have positive health and social impacts [51
]. Stronger social network ties may also provide better access to computers and information about beneficial health programs [54
Strengths and Limitations
Our study focused on access to computers among low-income minority groups. We did not specifically ask about Internet access and use. Information regarding Internet use, type of Internet connection, and reasons for computer use would have further contextualized the communication experience of low-income minority adults. However, government reports show that about two thirds of households with computers also have Internet access [41
]; rates of Internet access among our participants are therefore likely similar. Also, ownership does not imply use. It is possible that other people in the household (eg, children) actually use the computer. As our study was a cross-sectional design, we were unable to determine whether sociodemographic and social contextual factors causally influence computer ownership, frequency of use, and location. Because this study was conducted in urban, low-income minority public housing communities, its findings are only generalizable to similar settings. Nevertheless, this large study illustrates the level of access to computers among low-income, urban minority adults.
The racial/ethnic and socioeconomic disparities in access to communication technologies are narrowing, even among very low-income households, making communication technologies for health communication more feasible. However, as the number of technology-based prevention interventions that provide important health information increases, it will be imperative to continue to identify factors that contribute to disparities in access and to connect low-income racial/ethnic minorities to these technologies, particularly computers. In this study, computer ownership among low-income minorities was over 50%, showing noteworthy strides. This suggests that computer-based studies might be reasonable for this population provided that options for nontechnology modalities are also provided. While sociodemographic factors are commonly associated with computer access, a unique finding of our study is that it may be equally as important to consider specific social contextual factors when trying to increase access and use among low-income minorities, such as social network ties, household responsibilities, and neighborhood safety.