To our knowledge, this is the first study of nationally representative cohorts to show the independent associations of two classes of health information (interpersonal sources and mass media) with meeting recommendations for ongoing health behaviors and cancer screening. This study also addresses limitations of prior research by examining the association of cumulative sources of health information with health behaviors.
In the 2005 HINTS, participants most likely to report meeting recommendations for health behaviors were those utilizing print media and community organizations as sources of health information over the past year. In the 2007 HINTS, utilization of healthcare providers during the most recent search for health information was often associated with meeting recommendations, particularly for fruit and vegetable intake and colon cancer screening.
One previous study examined the relationship of self-reported adoption of disease prevention behaviors with types of health information sources.33
Use of friends and family, print, and Internet media were associated with increased self-reported preventive behaviors comprised in a summary score including fruit and vegetable intake, daily exercise, and smoking abstinence. However, this study did not control for concomitant use of other health information sources, and did not assess cancer screening behaviors. This HINTS study not only explored a composite measure of health behavior, but also determined if associations among classes of health information were limited to specific types of health behaviors.
Although levels of smoking and cancer screening in the data presented here were similar to those found in other large nationally representative surveys, HINTS respondents had different levels of fruit and vegetable intake and regular exercise.34,35
For example, respondents meeting current recommendations for fruit and vegetable intake represented about 11% and 44% in the 2005 and 2007 HINTS cohorts, respectively, compared to 23%–24% of adults who reported consuming five or more fruits per day in the 2005 and 2007 Behavioral Risk Factor Surveillance System Surveys (BRFSS).34
Similarly, approximately 58% and 35% of the 2005 and 2007 HINTS respondents, respectively, met recommendations for exercise, compared to almost 49% of 2005 and 2007 BRFSS respondents. Methodologic issues such as inaccuracy of subject reporting, differences between HINTS survey years and BRFSS in question wording, and the smaller sampling frame for HINTS may all contribute to these observed differences.
Although no health information sources were associated with achieving recommended levels of daily exercise in the 2005 HINTS, utilization of community organizations were associated with meeting dietary recommendations for fruit and vegetable intake and nonsmoking. A recent review noted that social support was strongly associated with adult fruit and vegetable intake.36
In HINTS, there was a very low prevalence of meeting dietary recommendations, decreasing the power to detect significant associations in the current study.
Cancer screening behaviors also showed variability in their relationships with specific health information sources. Use of TV for health information was associated with increased odds of receiving mammography whereas use of print, Internet, and social networks (i.e., community organizations and friends/family) for health information were associated with increased odds of colonoscopy. The results presented here differ from prior reports of increased colonoscopy screening following TV coverage of colon cancer screening.37
However, this report was broadcast in March 2000, so it is possible that the observed rise in colonoscopy screening dissipated without sustained attention.
Based on the composite outcome score in the 2005 HINTS cohort, print media and community organizations were the health information sources associated with increased odds of achieving recommendations for health behaviors, even after adjustment for other concurrent health information sources. Furthermore, reporting some health behaviors increased as the number of sources within either social network or mass media categories increased. Data from the 2007 HINTS show that respondents who reported using healthcare providers as an information source also had higher odds of meeting recommendations for some health behaviors. This is supported by prior data showing that health information seekers rely on healthcare providers.11,38
The study presented here has several limitations. First, HINTS are cross-sectional surveys and thus it is not possible to establish causality between information source and behaviors. Those who adopt lifestyle behaviors and cancer screening practices may be more health conscious and thus more likely to seek health information from specific types of health information sources.6,33,39
Second, survey data are susceptible to responder bias as well as misclassification bias. Third, respondents with missing responses for a particular health information source were categorized as “non-users” for that source, which could have biased the current results toward the null. Fourth, although demographic, socioeconomic, and health status covariates were added to multivariable models, there may be unmeasured confounders (e.g., health literacy) that may need to be considered in future studies.40
Last, there was no information on whether the content area of the general health information reported (e.g., nutrition and diet information) was tailored to the specific outcomes (e.g., fruit and vegetable intake).
In these nationally representative surveys, use of print media and interpersonal sources such as friends and family, community organizations, and healthcare providers were associated with reported health behaviors even after adjusting for concurrent health information sources. Additionally, these data show that increasing the number and/or classes of health information utilized often increases the odds of reporting recommended health behaviors. Hence, efforts should focus on using multiple health communication modalities, including better utilization of social networks, to disseminate health recommendations (e.g., identifying leaders of community organizations to help formulate and disseminate health information).